Gerry Gajadharsingh writes:
“I wrote a section about pancreatic cancer in my iBook a number of years ago, partly as a close friend of mine had died of pancreatic cancer (a pescetarian) and also at the time Steve Jobs, the founder of Apple (a fruitarian) had also died of this particularly difficult to diagnose form of cancer.
https://www.thehealthequation.co.uk/ibook/
The pancreas is mostly related to carbohydrate metabolism and by 2030 is wildly predicted to become the second, most common cause of cancer, mortality in Europe.
Currently pancreatic cancer is the seventh most common type of cancer in Europe but is the fourth leading cause of cancer-related deaths, behind lung, colorectal, and breast cancers.
There are many challenges with pancreatic cancer: Lack of awareness, difficult to diagnose, no screening programs for the general population, poor survival rate, and limited treatment options.
Life expectancy at the time of diagnosis is just 4.6 months. Only 3% of people diagnosed with pancreatic cancer will survive for 5 years.
Pancreatic cancer is difficult to identify. It is often asymptomatic. Symptoms that do show themselves, like back pain, weight loss, and nausea, are nonspecific and make early diagnosis challenging. Many patients do not have obvious symptoms until presenting with late-stage cancer, which then makes treatment and prognosis challenging.
Until more accurate markers of pancreatic cancer emerge, the following blood tests may well be useful and if abnormal point to further specialist investigation such as imaging.
A complete blood count and liver function tests, patients with obstructive jaundice as a consequence of pancreatic cancer shows significant elevation in bilirubin, ALP, GGT and to a lesser extent AST and ALT.
Serum amylase and serum lipase (enzymes released by the pancreas), are included as a matter of routine in our 1 MBR blood test. Elevated levels can warrant further investigation, however, only 25 and 50% of patients with pancreatic cancer show elevation in these particular enzymes. One of the challenges is with pancreatic cancer the pancreas can stop also producing some of these enzymes and so low levels can also warrant further investigation.
With the tumour marker CA19-9 (by the way, CA means carbohydrate antigen), 75 to 85% of patients may have elevated levels and with CEA 45%.
Smoking is a known risk factor, as is alcohol, obesity, chronic pancreatitis and diabetes.
In a study in the American Journal of clinical nutrition, Feb 2023,” Plant-based diets and the risk of pancreatic cancer: a large perspective, multicentre study a large perspective, multicentre study”, their conclusions were that in the studied US population, adherence to a healthy plant-based diet confers a lower risk of pancreatic cancer, whereas adherence to a less healthy plant-based diet confers a higher risk. These findings highlight the importance of considering plant food quality in preventing pancreatic cancer.
So, if you’re going to choose a plant-based diet, it’s important to focus on vegetables and not refined carbohydrates and the ultra-processed foods that are common in many vegan preparations and don’t think having a massive fruit intake is going to be helpful given the sugar content, especially free sugar in things like fruit juices.”
Medscape
Siobhan Harris
“It’s a health emergency for society, with mortality rates at over 90%,” warned Professor Alfredo Carrato, the chairperson of Pancreatic Cancer Europe, speaking to Medscape Medical News.
Pancreatic cancer is the seventh most common type of cancer in Europe but is the fourth leading cause of cancer-related deaths, behind lung, colorectal, and breast cancers. By 2030, it is widely predicted to become the second most common cause of cancer mortality.
There are many challenges with pancreatic cancer: Lack of awareness, difficult to diagnose, no screening programs for the general population, poor survival rate, and limited treatment options.
Life expectancy at the time of diagnosis is just 4.6 months. Only 3% of people diagnosed with pancreatic cancer will survive for 5 years.
A 2024 systemic analysis in The Lancets suggested that people living in Western Europe are more likely to develop pancreatic cancer than those living anywhere else in the world.
Carrato, emeritus professor of medical oncology at the University of Alcalá, Madrid, Spain, wasn’t surprised. He told Medscape Medical News: “I think the lifestyle in Europe plays a part. We have all of the risk factors in society like obesity, our sedentary behaviour, too much red meat consumption, and excess alcohol intake.”
Other risk factors include smoking, diabetes, chronic pancreatitis, and a family history.
The incidence of pancreatic cancer increases with age, so the longer life expectancy in Western Europe could also contribute to the region’s high rates.
A Silent Killer
Pancreatic cancer is difficult to identify. It is often asymptomatic. Symptoms that do show themselves, like back pain, weight loss, and nausea, are nonspecific and make early diagnosis challenging.
Professor Mattias Löhr from the Karolinska Institutet, Stockholm, Sweden, told Medscape Medical News: “It’s a dismal disease. It’s not accessible for any easy screening or surveillance. Even early diagnosis is too late with pancreatic cancer.”
There have been few advancements in patient outcomes over the past few decades.
Only about 20% of patients are suitable candidates for surgery that could prolong their lives.
Also, cancer reoccurs in two thirds of surgical candidates, said Carrato, and oncologists don’t know how to identify them in advance. “I have patients who survive 3 months and others who survive 4 or 5 years, so there’s a need to identify these subtypes at a molecular level for personalized, clinical, and translational research and therapies.”
Löhr agreed: “All of the medical therapies are not really working well enough for pancreatic cancer in sharp contrast to other cancers.”
How Can Rates Be Reduced?
“Pancreatic Cancer Europe is working in every EU state to try to raise awareness,” said Carrato. “We should have primary prevention programs to modify lifestyle risks. We also need funds for translational and clinical research. Secondary prevention isn’t possible yet as we haven’t identified the higher-risk population who would be the target for screening.”
Screening programs are available for the 10% of people who have a family history of pancreatic cancer. But, for the vast majority, there are no tests or screenings that allow for earlier detection.
“We need blood or stool tests that have high specificity and sensitivity that are cost-effective,” said Carrato.
“It’s a type of cancer with a particular and very aggressive biology. There is a lack of pancreatic tumour tissue for research, as many patients are diagnosed by fine-needle aspiration cytology. It’s a challenge for researchers. We have no biomarkers available to direct our decisions; no precision oncology,” he added.
Still, there are some encouraging developments.
The European PANCAID project (pancreatic cancer initial detection via liquid biopsy) is trying to find biomarkers to screen at-risk groups for earlier diagnosis via a blood test.
Also, the European Union (EU)-funded PANCAIM project (pancreatic cancer artificial intelligence [AI] for genomics and personalized medicine) has developed an AI algorithm that detects small cancers in CT scans that even experienced radiologists might easily overlook.
The project’s head, Henkjan Huisman, is professor of medical imaging AI at Radboud University Medical Centre, Nijmegen, the Netherlands. He told Medscape Medical News: “It’s an extremely important step, as 20% of people with pancreas cancer have the ability to undergo surgery, which means they might live substantially longer. We believe if the tumours are found earlier, thanks to the algorithm, they are smaller and more contained, and so substantially more than 20% of patients would be suitable for surgery, which would be a breakthrough.”
Löhr added that a messenger RNA vaccine is being developed in the United States to prevent pancreatic cancer from returning after surgery and is demonstrating encouraging results in its early trials.
The Road Toward Better Care
To improve cancer care in Europe, Carrato said: “Reference centres should be a requirement in health policy programs because the outcomes are much better than in centres which only perform fewer surgeries, and Pancreatic Cancer Europe is working with the EU in this direction.”
Finland is a country that appears to have succeeded in this regard. Its 2005 Health Care Act, for example, ensures that cancer patients are able to receive care in one of its five specialized hospitals.
More research funding is also needed. According to Pancreatic Cancer Europe, only 2% of EU funding on cancer is spent on pancreatic cancer.
The American Cancer Society’s Cancer Facts & Figures 2024 makes room for some optimism, with the 5-year survival rate in the United States jumping to 13% from 6% in the society’s 2014 report, as a result of earlier diagnoses and more personalized treatment. But, even with potentially longer survival rates, said Löhr, “we are still on the trajectory of pancreatic cancer being number two for cancer deaths by 2030.”
“We need more money on research, centralized surgery, and networking between European countries,” said Carrato. “This networking would need more money for prevention, better diagnosis, and treatment. The problem is pancreatic cancer incidence is increasing and mortality is also in parallel, and we are not making real progress in this scenario.”