Why it's so hard to stop the cancer that's known as the 'Silent Killer'
Pancreatic cancer is in the spotlight after a harrowing 'Coronation St' storyline, but it remains hard to detect, writes Celine Naughton
Published 25/01/2014 | 02:30
The suicide of Coronation Street's Hayley Cropper has been hailed as one of soap's most poignant scenes and won the actress Julie Hesmondhaigh Best Serial Drama Performance at this week's British Television Awards.
The emotional episode saw Julie's character Hayley take her own life to avoid going through the final stages of terminal pancreatic cancer.
With a peak audience of over 10 million tuning in to watch her final moments, the storyline has done much to raise awareness of pancreatic cancer, a disease that is so notoriously difficult to detect in its early stages that it has earned the grim moniker, the 'Silent Killer.'
Dr Brian Bird, an oncologist at the Bon Secours Hospital Cork, describes it as an 'orphan cancer,' because so few people are aware of it. There are no definitive causes of the disease, although there are risk factors including obesity, which Dr Bird has warned will be likely to double the number of cancer cases in this country by 2020.
"The link between smoking and lung cancer is well established, but smoking also increases the risk of pancreatic cancer," he says. "Smoking, excess alcohol consumption and obesity are some of the reasons we are going to be looking at a doubling of pancreatic cancer cases in Ireland by 2020, and I would primarily put that down to obesity."
Pancreatic cancer is a particularly dangerous disease because by the time it is diagnosed it has often metastasized (spread) to other organs and most sufferers face a poor chance of survival.
As Professor Nick Lemoine of Barts Cancer Institute in the UK says, "One significant problem with the pancreas is that it is deep within the body. You can't see it, you can't feel it and by the time symptoms or signs of the disease develop, surgery is no longer an option."
Compared with a five-year survival rate of just above 80pc for breast cancer, the rate for pancreatic cancer is less than 5pc. Given the statistics, it is hardly surprising that some people seek private treatment at places such as Heidelberg University Hospital in Germany, a centre of excellence renowned for offering advanced surgery. A spokesman confirmed that in 2013, seven people from Ireland and the UK were treated there.
But life-saving surgery in Heidelberg does not come cheap: one woman on a discussion board says her husband's surgery there cost €52,000. "Then you have to add in flights, accommodation and transfers," says Amanda, whose husband David was only 34 when he underwent surgery in the UK in 2012.
When doctors there said there was nothing more they could do and gave him a year to live, the couple went to Heidelberg where he underwent an operation to remove his tumour. The surgery was a success.
In Ireland, around 380 people are diagnosed each year with pancreatic cancer.
Surgery is the main treatment although radiation therapy and chemotherapy are also used, but a cure is possible only if the cancer is detected at an early stage. The deadly combination of late detection and the speed of the cancer's progression mean that many patients are not diagnosed early enough to benefit from treatment.
The prognosis for pancreatic cancer compares dismally with the significant strides that have been made against breast cancer.
James Geraghty, consultant breast surgeon and senior lecturer in general surgery at St Vincent's University in Dublin, says: "The key to the increase in survival rates for breast cancer is that Irish women are becoming more breast aware, are detecting changes to their breasts, seeking advice and treatment at a much earlier stage and availing of breast screening through the BreastCheck programme."
Conversely, a study into pancreatic cancer data between 1994 and 2010 by the National Cancer Registry Ireland showed that "there has been relatively little change in mortality rates for pancreatic cancer over time.
"There are as many pancreatic cancer deaths reported as there are new cases diagnosed, an indication of the poor survival from this cancer."
So why are survival rates for this type of cancer as poor today as they were 20 years ago? According to the Irish Cancer Society: "There is no national screening programme for pancreatic cancer as it is not a common cancer and there is no single test to diagnose it. If you are worried about your risk of pancreatic cancer, talk to your family doctor."
British MP Eric Ollerenshaw remembers his late partner Michael Donoghue attending his GP in 2009 when he began suffering stomach upsets at the age of 61.
"From being the sort of man who never troubled the GP, he was suddenly there a lot, asking for help," he says. By the time he was diagnosed, it was too late. "Pancreatic cancer took him in six weeks," says Eric. "It's just no time at all."
Some patients with pancreatic cancer see their GP four or five times before being referred to a hospital for investigation. Symptoms can be vague and include weight loss, stomach pain, indigestion and loss of appetite, all signs of other, more common conditions such as dyspepsia or ulcers.
Until the patient presents with the more severe indication of jaundice, a GP may not have considered the possibility of pancreatic cancer.
And when it comes to awareness of the disease, the truth is that pancreatic cancer doesn't feature on the public radar compared with the 'Big Five' of skin, prostate, breast, bowel and lung cancer.
Meanwhile, cancers of the pancreas, head and neck, stomach, kidney, bladder and bones are less prominent in public consciousness until the death of somebody famous – or a storyline in a soap opera – puts the disease in the spotlight for a time.
Experts say that until awareness is heightened and effective, non-invasive screening is found, the prognosis remains poor.
However, there is hope on the horizon. According to a report published in this month's Journal of the American Medical Association, Danish scientists are working on developing a new blood test which could one day help detect pancreatic cancer in its early stages.
Comparing the blood of more than 400 pancreatic cancer patients with that of healthy individuals, researchers at Copenhagen University Hospital looked for telling patterns in genetic material known as microRNA.
They also checked the levels of a compound known as CA19-9, which is elevated in about 80pc of people with pancreatic cancer. In the end, they found two microRNA tests which could potentially be used to diagnose pancreatic cancer, although they point out that the results are preliminary and a lot more research is needed to establish whether these microRNAs will pave the way for a screening test for early detection of pancreatic cancer.
Another exciting breakthrough was made by a 15-year-old American high-school student who set about developing the first test for the disease after it claimed the life of his uncle.
Jack Andraka wrote to 200 professors from his home in Maryland, seeking help to develop his idea for a screening test that would be as cheap and simple to use as a home-pregnancy or diabetes test.
When specialists gave him laboratory time, he came up with a dipstick paper sensor that detects a protein in the urine or blood which is a marker for pancreatic cancer.
The discovery won him the $75,000 Grand Jury prize at the Intel International Science and Engineering Fair in 2012.
While it will take years of trials and further testing before it will be known whether Jack's technology, the Danish research, or other scientific advances will lead to a widely available screening test, other scientists in medical centres worldwide are focusing on finding better treatments for pancreatic cancer.
Finding better ways to detect and treat such an aggressive disease is a long and winding road, but there is every reason to believe it will lead to real hope for the future.
Symptoms of pancreatic cancer
Located deep in the abdomen, the pancreas is a large gland that makes digestive juices that help break down food, and hormones that help control blood sugar.
The Irish Cancer Society recommends you visit your doctor if you experience any of the following symptoms:
* Stomach and back pain, especially after eating
* Unexplained weight loss
* Loss of appetite
* Feeling full very quickly
* Nausea (feeling sick)
* Diabetes, especially if diagnosed within previous two years
* Unexplained depression
To talk to a specialist cancer nurse, call the Freephone National Cancer Helpline on 1800 200 700 Monday-Thursday from 9am to 7pm and Friday from 9am to 5pm.