Pancreatic cancer: why is it so feared?

businessman invested in the world of media, who relaunched the legendary “Lui” with the writer Frederic Beigbeder, died at the age of 59, on March 31. The ex-husband of director and actress Maïwenn died of pancreatic cancer. This cancer is among the most feared today.

Growth of 2% per year

In France, almost 16,000 new cases were recorded in 2023, with the incidence increasing by approximately 2% each year. Nine out of ten pancreatic cancers diagnosed are “ductal adenocarcinomas”. This means that they develop from cells that produce pancreatic juice. These cells secrete necessary digestive enzymes. The remaining 10% are rare pancreatic tumors.

Between 1990 and 2018, pancreatic cancer rates increased by an average of 2.7% per year in men and a more sustained 3.8% in women.

The causes, still in the hypothesis stage

The reasons for the increasing incidence of pancreatic cancer are not fully understood. This could be due to better detection due to advances in imaging techniques, better case registration, and possibly an increase in well-established risk factors such as obesity, diabetes and smoking. If chronic pancreatitis (inflammation of the pancreas) and genetic susceptibility factors are involved, these factors alone cannot explain the increased incidence.

This is why researchers are investigating other pathways, especially the radical lifestyle changes of the 1980s, such as the industrialization of food (additives, excess fat and carbohydrates, etc.). Specific molecules such as nanoparticles (titanium dioxide) could also play a role, as could the increased use of pesticides and heavy metals (cadmium) in food and water.

The pesticide footprint is becoming clearer

Exposure to pesticides would be associated with an increased risk of pancreatic adenocarcinoma, according to two French studies presented at the March 2024 Congress of the French National Society of Hepato-Gastroenterology (JFHOD). especially with regard to three specific substances: mancozeb, glyphosate and sulfur spray. For every 2.5 kg per hectare increase in pesticide use over an 11-year period, the risk of pancreatic adenocarcinoma increases by 0.9 to 1.4 percent.

Pesticide use is massive in France, where around 300 substances are permitted and nearly 65,000 tons are used each year, making France the top consumer country in Europe. In addition, the second study looked at four other substances associated with an increased risk of pancreatic cancer. Although their use has been banned since the 1990s, they are still found in the soil and in the air!

The challenge: to intervene at a localized stage thanks to surgery

The increase in the number of pancreatic cancers is particularly alarming due to the absence of truly effective treatment in the metastatic stage (50% of cases at diagnosis) or in the locally advanced stage (30% of cases). Surgery and chemotherapy (sometimes combined with radiotherapy) are the main treatments for pancreatic cancer. This intervention involves the removal of the part of the pancreas where the tumor has developed (head, tail, etc.) and possibly adjacent organs or parts of the affected organs. However, it is only beneficial when the tumor is located only in the pancreas.

Unfortunately, at the time of diagnosis, a minority of pancreatic cancers are operable (10% to 20%), which is a situation mainly associated with the silent and insidious development of the disease. In general, pancreatic cancer develops without symptoms. Even with the first symptoms (loss of appetite and gradual fat , jaundice, etc.), the tumor is often already very advanced.

In all stages combined, the 5-year survival is around 7%.

Pancreatic cancer strikes fear for many reasons. Here’s a deep dive into why it’s such a concerning disease:

1. Silent Killer: Difficulty in Early Detection

  • Lack of Obvious Symptoms: Pancreatic cancer often goes undetected in its early stages because it doesn’t cause noticeable symptoms until the tumor is already advanced. By the time symptoms like abdominal pain, jaundice (yellowing of skin and eyes), and unexplained weight loss appear, the cancer may be more difficult to treat.

2. Aggressive and Fast-Growing

  • Rapid Progression: Pancreatic cancer is a highly aggressive cancer with a rapid growth rate. This makes early detection even more crucial, as the window for effective treatment gets smaller as the cancer progresses.

3. Limited Treatment Options with Varying Success Rates

  • Surgery: While surgery offers the best chance of a cure for early-stage pancreatic cancer, only a small percentage of patients are diagnosed at this stage when surgery is a viable option.
  • Chemotherapy and Radiation: These are often used in combination with surgery or for advanced-stage cancer, but their effectiveness can be limited.
  • Newer Therapies: Promising advancements in immunotherapy and targeted therapies are ongoing, but they are still evolving and may not be suitable for everyone.

4. Poor Overall Prognosis

  • Low Survival Rates: The five-year survival rate for pancreatic cancer remains low, with a significant disparity between early and late-stage diagnoses.

5. Difficulty in Treating Due to Location

  • Delicate Surroundings: The pancreas sits in a close proximity to vital organs like the liver, intestines, and major blood vessels. This makes surgical removal of tumors challenging and increases the risk of complications.

Hope on the Horizon

Despite the challenges, research into pancreatic cancer is ongoing. Scientists are exploring ways for earlier detection, developing more effective treatment options, and improving overall survival rates.

What You Can Do

  • Be Aware of Risk Factors: Age, smoking, obesity, and family history can increase your risk.
  • Maintain a Healthy Lifestyle: A healthy diet, regular exercise, and maintaining a healthy weight can help reduce your risk.
  • Discuss Risk with Your Doctor: If you have any concerns about pancreatic cancer, talk to your doctor about your individual risk factors and screening options.

Early detection remains the key to effectively combating pancreatic cancer. By being aware of the symptoms and risk factors, and by having open communication with your doctor, you can take steps to empower yourself in the face of this challenging disease.

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