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Dr Gavin Johnson, Consultant Gastroenterologist at The Physicians’ Clinic, comments on pancreatic cancer and symptoms on Pancreatic Cancer Day

November 28, 2018

Pancreatic cancer is a killer. It is the toughest cancer to diagnose, treat and survive. The prognosis after diagnosis is grim, and the 5 year survival has not changed much in 4 decades in contrast with almost all other common cancers. This is despite advances in imaging, surgery and cancer therapies. After diagnosis, 1 in 4 will not survive the month, and 3 in 4 will not survive the year, and fewer than 1 in 10 will be alive after 5 years.

The problem with pancreatic cancer is related to the fact that symptoms of pancreatic cancer usually present late, by which time the tumour may have spread to the liver or involve the large blood vessels around the pancreas that makes surgical resection an impossibility. The biology of the cancer is also complex, such that it is resistant to many types of cancer drugs, although progress is starting to be made.

The answer is that there needs to be much more research, and the 5 year survival rate will only really improve when we are able to determine who is at high risk, so that they can be screened with blood or urine tests to detect the cancer at the very earliest stage. There is promising research in this area, but no laboratory screening test has yet made it into practice. Those with a strong family history or a genetic tendency to pancreatic cancer (e.g. BRCA2 mutation) can be offered annual endoscopic ultrasound to try and find early tumours, but this is still only an ongoing clinical trial and the benefit is still unproven.

The features to look out for are persistent abdominal pain with weight loss; new onset type 2 diabetes in those who do not have a family history or are overweight; and new onset jaundice. However, even these presentations of the disease may mean the tumour is in an advanced stage.


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