The sad loss of John Hurt last week from pancreatic cancer chalks yet another one up to the bad guy. This particular cancer also killed Apple founder Steve Jobs and Alan Rickman and is the 11th most common cancer in the UK, with some 9,600 people diagnosed each year in the UK. About one in 70 of us will get pancreatic cancer at some point in our lives and, when I play the game ‘Which is the condition I would least like to be diagnosed with’, it’s up there in my top three.
One of the reasons is its appalling survival rate. While pancreatic cancer survival has been improving from decade to decade, the disease is still considered largely incurable and, according to the American Cancer Society, for all stages of pancreatic cancer combined, the one-year relative survival rate is 20 per cent, and the five-year rate is seven per cent. By the time 10 years have gone by from time of diagnosis it’s down to under one per cent.
Almost half of pancreatic cancer cases in England are diagnosed after presenting as an emergency: six in 10 via A&E with the other cases coming via an emergency GP referral, inpatient referral or outpatient referral.
Risk factors include advancing age — perhaps the biggest risk of all and most cases occur in people over the age of 60 – smoking, being overweight, diabetes, pancreatitis (inflammation of the pancreas) and a family history of pancreatic cancer. Up to one in ten cases may also be caused by a family cancer syndrome where a rare faulty gene increases the risk of it developing.
As a doctor, breaking the news to someone that they have this type of cancer is particularly difficult, not only because of the poor survival statistics but also because it is common for the disease to be diagnosed late.
The insidious nature of the condition means that symptoms can be mild or even absent in its early stages. Most tumours start growing in the head of the pancreas and it is often only when they grow to a size that blocks the flow of bile into the small bowel that symptoms develop. These include jaundice (yellowing of the skin), dark stools, pale urine and generalised itching. Later symptoms are often pain in the upper abdomen, weight loss and lethargy and occasionally the development of diabetes.
Because most cases are advanced before they are diagnosed, cure is unlikely and so treatment is aimed at slowing down the progression of the disease. Various treatments are available such as surgery, chemotherapy and radiotherapy but the treatment used in each case depends upon multiple factors, including general health, how large the cancer is and whether it has spread to other parts of the body.
Should the tumour be at an early stage then surgery is sometimes considered to remove the affected part of the pancreas, but unfortunately in many cases cancer cells have already spread into other areas although they remain undetectable at that stage by scans.
Technological advances continue to slowly push back though, and a new pancreatic cancer drug appears to significantly extend the survival time for patients who have undergone surgery, according to a report in The Lancet. The study found that 29 per cent of patients given a combination of two chemotherapy drugs (capecitabine and gemcitabine) lived for at least five years, compared with 16 per cent who received the single drug (gemcitabine) the NHS provides as standard. Taken together the two drugs increased median survival from 25 months to 28 months.
John Hurt lived for 18 months after his diagnosis, more than many would have done in his position, but a magic bullet to combat this most malign of tumours unfortunately still eludes us.