Pancreatic cancer: outlook and life expectancy

Post by Master, Doctor Mai Vien Phuong - Head of Department of Gastrointestinal Endoscopy - Department of Medical Examination & Internal Medicine - Vinmec Central Park International General Hospital

The outlook for pancreatic cancer depends heavily on the stage of the cancer at the time of diagnosis. The late stages of pancreatic cancer are often more deadly than the early stages. Many cases of pancreatic cancer are not detected until it has spread to other parts of the body. That's why it's so important to get regular check-ups.

The National Cancer Institute (NCI) estimates that nearly 58,000 people in the United States will be diagnosed with pancreatic cancer by 2020. This year, just over 47,000 deaths will occur from the disease.
Pancreatic cancer develops in the pancreas, an organ located behind the stomach in your upper abdomen. Among other functions, the pancreas is responsible for the two main tasks of the body, digestion and blood sugar regulation.
The pancreas produces fluid or “digestive juices” that are carried into the intestines and help break down and digest food. Without these digestive juices, the body may not be able to absorb nutrients or break down food properly. The pancreas also produces insulin and glucagon, which are responsible for helping you maintain optimal blood sugar levels. The pancreas secretes these hormones directly into your bloodstream.

Staging the cancer helps doctors and care teams understand how advanced the disease is. Knowing the stage is important for choosing the best treatments and therapies. This also plays a role in your prognosis for the future. The most common staging system for pancreatic cancer is the American Joint Committee on Cancer (AJCC) TNM system. It uses a scale of 0 to 4. AJCC stages and substations are defined by key information:
Tumor size (T); Metastasis of the cancer to the lymph nodes (N); Whether the cancer has spread or metastasized to distant sites (M). Cancer can also be described using one of the Surveillance, Epidemiology and End Results (SEER) classifications or stages. The SEER program collects cancer statistics from nearly 20 regions across the United States.

The stages and substations of AJCC are described below:
3.1. Stage 0 Non-invasive stage 0 pancreatic cancer. This means it has not spread beyond the top layers of the pancreatic duct or outside the pancreas. Stage 0 cancer is also known as carcinoma in situ.
3.2. Stage 1 The cancerous tumors have not spread outside the pancreas and they are no larger than 1.6 inches (4 cm).
3.3. Stage 2 In a subtype of stage 2 pancreatic cancer, the tumors are larger than 1.6 in (4 cm) across, but they have not spread outside the pancreas. You will also be diagnosed at stage 2 if all of the following apply:
You have tumors, regardless of their size The cancer has spread to 3 nearby lymph nodes The cancer has not spread beyond the gland pancreas 3.4. Stage 3 You will be diagnosed with stage 3 pancreatic cancer if all of the following apply:
You have tumors, regardless of their size; Cancer has spread to at least 4 nearby lymph nodes; The cancer has not spread beyond the pancreas. You will also be diagnosed with stage 3 if your cancer has not spread to distant sites but it has spread outside the pancreas to nearby large blood vessels.
3.5. Stage 4 Late-stage cancer, such as stages 3 and 4, has spread beyond the main tumor site to nearby tissues, blood vessels, nerves, and other organs. This process is called metastasis.
Pancreatic cancer stage 4 is the most advanced stage. Cancer has spread beyond the pancreas and to distant sites in the body, such as the liver or bones.

If you have been diagnosed and your stage has been determined, you may be curious about your prognosis. The outlook is based on pooled information from people with similar cancers.
Although they are useful, survival statistics are not certain. Make sure you discuss your personal views with your doctor so you can better understand what it means for you.
4.1 Understanding the Numbers A commonly made prognosis of 5-year survival. This number refers to the percentage of people who are still alive at least 5 years after their initial diagnosis. Most survival rates do not exceed 5 years, but it is important to understand that many people live well beyond that time.
The stats below are originally from the SEER database. The corresponding AJCC stages are also included for easy reference.
4.2 Pancreatic Cancer The survival rate for people diagnosed between 2010 and 2016 is:

4.3 Pancreatic neuroendocrine tumors (PNETs) Pancreatic neuroendocrine tumors (PNETs) that develop in the cells responsible for making insulin and glucagon PNETs are rare. They are also known as NETs or small cell tumors.
For people diagnosed with PNET between 2010 and 2015, the overall 5-year survival rate is 54%. People with this type of tumor have a better prognosis than people with the more common pancreatic cancer.

Every year there are great advances in treatment, which is good news for those who are currently undergoing treatment for pancreatic cancer. As treatments improve, so do survival rates.
In addition, other factors affect your prognosis, including:
Age; General health; Life style; Attitude towards your treatment. Your doctor can also help you make sure you're doing all you can to improve your prognosis and live a healthy life. Not only will you feel in control of the situation, but your mental health and overall prognosis will also improve.
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References:
Mayo Clinic Staff. (2020). Pancreatic cancer: Symptoms and causes. mayoclinic.org/diseases-conditions/pancreatic-cancer/symptoms-causes/syc-20355421 Pancreatic cancer stages. (2017). cancer.org/cancer/pancreatic-cancer/detection-diagnosis-staging/staging.html Summary staging. (n.d.). training.seer.cancer.gov/staging/systems/summary Survival rates for pancreatic neuroendocrine tumor. (2020). cancer.org/cancer/pancreatic-neuroendocrine-tumor/detection-diagnosis-staging/survival-rates.html