PANCREATIC CANCER PROGNOSIS & SURVIVAL

Each year more than 50,000 people in the United States (and double this number in Europe) are now diagnosed with pancreatic cancer (adenocarcinoma). The prognosis is such that most of these people will have passed by the end of the first year. In the U.S., pancreatic cancer is 9th or 10th most commonly diagnosed cancer (depending on gender), but the fourth leading cause of cancer death in men and women.

The prognosis of pancreatic cancer (adenocarcinoma of the pancreas) is a very tough, though the survival rates have been incrementally improving particularly over the past ten to fifteen years. It is important to realize that each person is individual; each cancer is different. Statistics can only indicate what tends to happen in the aggregate, and not in the case of an individual person.

The median survival duration from the time of diagnosis until demise is arguably the worst of any of the cancers – certainly of the major cancers. The median survival for untreated advanced pancreatic cancer is about 3 1/2 months; with good treatment this increases to about eight months, though many will live much longer. We have encountered nine and eleven and twelve  year survivors.

Perhaps it is a good place to discuss what the term median means. Simply put, the median is the time point that separates half of patients who live longer from the half who will live less. Thus, there are many patients who will live much longer than the median.

The American Cancer Society prognosis figures show that the stage at which pancreatic cancer is diagnosed is strongly correlated to survival; earlier obviously being better. But, the statistics are still pretty tough. The five year survival rate with good treatment is now considered to be about 8%.  Again, it is imperative to understand that each person’s situation individual; each cancer is different. Statistics can only indicate what tends to happen in the aggregate, and not in the case of an individual person. Many people do better than average.

The prognosis for those who are able to have surgery is improved over those who are not able. Unfortunately, only about 15% of those individuals with pancreatic cancer will be found to be eligible for surgery – for most, the cancer will have been found to be too advanced. For example, patients with pancreatic cancer who received the Whipple surgical procedure in one study (from a very experienced Johns Hopkins team) were reported as having a 21% five-year survival rate, with a median survival of 15.5 months. In more recent studies this five-year median survival duration after surgery has been reported as high as twenty months.

The prognosis is also better for those whose pancreatic cancer is diagnosed at an earlier stage. The median survival duration from diagnosis with chemotherapy medical treatment in locally advanced cancer of the pancreas has been reported as 6 to 12 months.

Patients with neuroendocrine tumors tend to have a much more favorable prognosis than, for example, those with adenocarcinoma of the pancreas. The natural history of neuroendocrine tumors, islet cell tumors, and carcinoid tumors tends to be very different than that of pancreatic adenocarcinoma. For example, the median survival duration from the time of diagnosis for patients with non-functioning metastatic islet cell tumors approaches five years.