‘Pancreatic cancer is 4th leading cause of cancer-related deaths worldwide’

“Pancreatic cancer is one of the most lethal cancers, not because it spreads like wildfire, but because it does not cause symptoms until it is advanced. This cancer grows slowly, taking years and even decades to develop, killing 95 per cent or more of its victims within five years of diagnosis, but if the five-year survival is five per cent, that's not zero. So, never take away someone's hope.”

These views were highlighted by eminent Prof Ghulam Ali Mundrawala, consultant physician and ex-head of the medicine department at the Dow University of Health Sciences & Sindh Medical College, Karachi, at a seminar organised by the Neurospinal & Cancer Care Postgraduate Institute, Karachi on Saturday in connection with World Pancreatic Cancer Day and awareness month.

“Pancreatic cancer is the 4th leading cause of cancer-related deaths worldwide. It accounts for 7 per cent of all cancer deaths,” Prof Mundrawala said.

“The risk of developing pancreatic cancer increases with age. Most of the patients are older than 45 years and almost 90 per cent are older than 55 years. The mean age at diagnosis is 71 years. Men are slightly more likely than women to develop pancreatic cancer. Currently, the lifelong risk of developing it is around 1 in 63 for men and 1 in 65 for women. There’s also a known race association: African Americans are more likely to develop pancreatic cancer than whites. Doctors don’t know why, but they speculate that higher rates of men who smoke and have diabetes and women who are overweight may contribute to this association,” he explained.

Discussing the risk factors, Prof Mundrawala said that chronic pancreatitis may lead to pancreatic cancer, so any patient with chronic pancreatitis experiencing worsening pain or weight loss should consult a physician immediately. Patients may also present symptoms of jaundice, itching, light-coloured stools and dark urine, should not ignore these symptoms.

Dr Abid Jamal, consultant surgical oncologist and CEO at Cancer Foundation Hospital, Karachi, expressed his expert opinion regarding surgical management of pancreatic cancer.

“The missing puzzle piece to improve outcomes for pancreatic cancer may very well be the ability to identify tumors early. The disease typically spreads to other organs before symptoms arise. As a result, surgery is currently the most successful approach to treating pancreatic cancer and it is the only way to cure pancreatic cancer that has not spread or metastasised, and is the best way to contain tumors. Unfortunately, doctors often see later-stage disease, with tumors wrapped around arteries and veins, nerves and the bile duct, making operations more challenging or even impossible,” Dr Jamal said.

“The pancreas is an elongated organ that lies deep in the abdomen and is an essential part of both the digestive and endocrine systems. It secretes hormones to help regulate the body and digestive enzymes to break down food. Our goal in surgery is to leave enough of the pancreas to produce digestive juices and insulin, reattaching the remaining organ so that it functions like it did before.”

“The management of pancreatic cancer is multi-disciplinary with the involvement of gastroenterologists, surgical oncologist, medical oncologists and radiation oncologist,” said Dr Lubna Saleem, consultant medical oncologist at the Cancer Foundation Hospital.

The standard approach to pancreatic chemotherapy is to give the drugs after surgery to kill off any remaining cancer cells, or as a treatment for inoperable tumors with or without radiation therapy. “We believe the answers lie in more tailored, personalised therapies. We are using and studying new chemotherapy combinations, as well as using existing drugs with newer, targeted therapies,” Dr Lubna said.

“Targeted therapy represents a new front in attacking cancer. The idea is to target a tumor’s unique characteristics, including genes, proteins, supporting blood vessels, or host tissue, while limiting damage to healthy cells. Targeted therapies may replace current treatments, or complement them, and we are studying a number of new targets and approaches,” she elaborated.

Dr Lubna advised healthy tips for public, i.e. if you smoke, quit, maintain a healthy weight, limit your consumption of red meat, and processed meat-such as lunch meat, sausage etc. Avoid cooking meat at high temperatures, as doing so can help reduce your exposure to harmful chemicals that are formed in high temperature cooking and include at least five servings of fruits and vegetables in your daily diet.

Adeel Ahmed, manager marketing at the NCCI, thanked the experts and participants. “Pancreatic cancer is a silent disease, with more awareness among the general population and medical fraternity. We can identify this disease in time and give these patients a chance of good survival,” he said as he concluded the session.