Pancreatic cancer: an expert's insight

Pancreatic cancer remains one of the most challenging cancers to diagnose and treat effectively. This malignancy's deep-seated location in the body significantly hampers early detection and diagnostic procedures. Unfortunately, by the time symptoms such as pain, weight loss, or jaundice manifest, the disease is often at an advanced stage. This delay in symptom onset is a major reason why pancreatic cancer has such a poor prognosis. In his latest online article, Dr Shivan Sivakumar gives us his insights.

The diagnostic challenge

The pancreas is located deep within the abdomen, making it difficult to access for diagnostic tests such as biopsies. This anatomical challenge means that by the time typical symptoms appear, the cancer has usually progressed to a more advanced stage. The rarity of early symptoms compounds this problem, making early detection incredibly difficult. For a small subset of patients, jaundice can serve as an early indicator if a tumour blocks a bile duct. However, for the majority, the disease is only discovered after it has spread significantly.

Current treatment approaches

Surgery is only an option for about 15% of pancreatic cancer patients, typically those whose disease is detected at a very early stage. Another 35% of patients have localised but inoperable tumours. For these patients, as well as for those with metastatic disease, systemic therapies like chemotherapy are the primary treatments. Chemotherapy is essential for providing the best possible outcome, whether it is used before surgery to shrink tumours or after surgery to eliminate residual disease.

Despite advances in treatment, survival rates for pancreatic cancer have not significantly improved over the past five decades. In the UK, the five-year survival rate remains around 7%. Even patients who undergo surgery often face high relapse rates, with typical survival spanning two to three years. However, recent advances in multi-modality therapy—combining chemotherapy with radiotherapy, ablations, and occasionally additional surgeries—are offering hope for better outcomes in a select group of patients.

Future directions in pancreatic cancer

Early detection remains a critical area of focus. Research is exploring ways to identify pancreatic cancer sooner, such as through the monitoring of patients who develop diabetes later in life—a known risk factor. Additionally, non-invasive testing methods, such as circulating tumour DNA analysis, are showing promise.

On the treatment front, new drugs and therapies are urgently needed. Immunotherapy, which has revolutionised treatment for several other cancers, has been largely ineffective in pancreatic cancer due to its unique biological characteristics. However, ongoing research is identifying new immunotherapy targets and developing novel compounds to combat this stubborn disease. Clinical trials underway in specialised units are exploring these promising new treatments, and while it is early days, there is cautious optimism in the medical community.

Dr Shivan Sivakumar is an esteemed medical oncologist. You can schedule an appointment with Dr Sivakumar on his Top Doctors profile.