Pancreatic cancer is not very common, but its high mortality rate makes it the fourth leading cause of cancer death in the United States. Dr. Jing Li and colleagues at The Ohio State University provided a review. “In spite of the recent advances in screening, operation, chemotherapy, and radiotherapy, there has been little improvement in the survival of pancreatic cancer patients,” they noted. The overall 5-year survival rate is less than 5 percent.
Li and coauthors identified late diagnosis, rapid progression, and poor response to chemotherapy and radiation treatment as factors responsible for the high mortality rates. Pancreatic cancer does not produce early signs or symptoms that can be used for effective screening, and the tumors are unusual in their response to drugs. In lab tests, cells from pancreas, breast, and prostate cancers are about equally responsive to chemotherapy agents such as paclitaxel. However, in actual patients with pancreatic cancer, the response rate is less than 20 percent. Li explained that pancreatic tumors have the unique property of a high ratio of stromal to epithelial cells, and develop poor growth of blood vessels. Thus, it is difficult to deliver chemotherapy drugs to these tumors.
Dr. Jarret Woodmass and colleagues at the University of Manitoba, Canada, reported that surgery is an underutilized treatment option. According to Li, approximately 20 percent of pancreatic cancers are resectable; that is, the tumor can be removed completely. Woodmass and coauthors reported that only 20 to 35 percent of eligible patients actually get surgery. They speculated that physicians are too pessimistic, based on the poor survival rates today and a history of death during surgery. During the 1970's, the mortality rate was over 20 percent for pancreas operations. Many authors at that time suggested abandoning surgery for pancreatic cancer.
Today the mortality rate for surgery is 1 to 4 percent at medicals centers with a high volume of pancreatic cancer operations (at least 11 per year), and the 5-year survival rate is 15 percent or more for patients who receive surgery.