The number of patients with pancreatic cancer is growing every year. In more than half of patients, the tumor has already spread at the time of diagnosis. Oncological surgeon Ignace de Hingh explains what pancreatic cancer exactly is and why the disease is still so difficult to treat.
Dorien DijkhuisDecember 25, 2023, 12:13
Last year, 2900 people in the Netherlands were diagnosed with pancreatic cancer. According to oncological surgeon Ignace de Hingh, that number is already large in itself, but what is more shocking, according to him, is the survival rate of people who receive that diagnosis. Almost everyone dies within a few years.
“Unfortunately, what does not yet apply to many other cancer types: pancreatic cancer is becoming easier to detect and treat, which means that people die from it less and less often,” says De Hingh, who works at the Catharina Hospital Eindhoven. . He specializes in complex oncological procedures such as operations on pancreatic cancer and metastases in the peritoneum.
Pancreatic cancer is the ninth most common cancer when the two types of skin cancer are counted as one. But when it comes to cancer as a cause of death, pancreatic cancer ranks third, behind lung cancer and colon cancer. “By comparison: for all cancer types combined, 65 percent of patients are still alive 5 years after diagnosis. For pancreatic cancer that is less than 5 percent.”
Doctors expect that, due to the increasing aging population and increasingly better treatment of colon cancer, pancreatic cancer in the Western world will become the second cause of death from cancer within 10 years.
No link with lifestyle
The pancreas is an organ located deep in the upper abdomen, behind the intestines and against the vertebrae. The gland has two functions: it plays a role in the sugar balance in the blood and it produces enzymes that are necessary for the digestion of our food.
We do not yet know exactly how pancreatic cancer develops, says De Hingh. With other types of cancer there is often a link with lifestyle – for example, smoking increases the risk of lung cancer – but with pancreatic cancer there appears to be no such link. “I see many patients who have always lived super healthy lives.”
Every year, approximately the same number of men and women are diagnosed with pancreatic cancer. About one in five patients is 80 years or older and about 15 percent of all patients are younger than 60 years. “Heredity plays a role in 5 to 10 percent of pancreatic cancer patients. But to most patients who ask me how they got pancreatic cancer, I tell them it’s probably just bad luck.”
Non-specific complaints
The fact that people with pancreatic cancer have such a poor chance of survival is also because the disease is usually only discovered at a late stage. In more than half of people, the tumor has already spread by the time they are diagnosed. “People have often been walking around with complaints for a long time without even thinking about pancreatic cancer. Neither by the patient nor by the GP.”
These are therefore so-called ‘non-specific complaints’: complaints that everyone has from time to time, such as abdominal pain, rumbling intestines, bloating, loose stools or fatigue. “Only when a patient comes to the consultation hour with a yellow skin color do the alarm bells go off. Jaundice is a common symptom of pancreatic cancer.”
This jaundice occurs because the tumor has grown so large that it is compressing the bile duct. Through this route, the liver normally transports a yellow-colored waste product to the intestine. If that no longer works, the waste product, as it were, overflows into the blood. This causes the whites of the eyes to turn yellow first and then the entire body. “Once someone has jaundice, the tumor is usually so large that it has spread to important tissues. These are usually located in the liver, lymph nodes, peritoneum or lungs.”
Cure-oriented treatment is not possible for people with metastases. De Hingh: “After diagnosis, the majority of patients do not receive any treatment for the tumor itself, but only supportive care. This currently applies to 60 percent of patients.”
In the early 1990s this was 86 percent, so an increasing proportion of patients are receiving a treatment option. “Some people who already have metastases can still receive chemotherapy. And for one in three people who do not have metastases and are fit enough to undergo such tough treatment, surgery may be an option.”
Small steps
There are population studies for the early detection of breast cancer and colon cancer. Shouldn’t there also be a population screening for an earlier diagnosis of pancreatic cancer? “No,” says the oncological surgeon. “It is currently very difficult to detect pancreatic cancer early. The normal and malignant tissue are very similar in the early stages. Even if we are quite sure that there must be a tumor, we do not always see it on the CT scan. There is therefore a good chance that you will miss a small tumor in the population survey. Moreover, the question is whether the prognosis can actually be improved.”
Yet progress is being made slowly but surely, says De Hingh. He is optimistic about the future. “The Netherlands is at the forefront when it comes to research into pancreatic cancer. All Dutch hospitals have united in the Dutch Pancreatic Cancer Group, in which joint research is conducted to improve both the quality of surgery and the quality of life for patients. Hopefully a drug will soon be found that is very effective against pancreatic cancer. Until then, we will do our utmost to increase the chances of survival in other ways.”
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2023-12-25 11:13:43
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