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Daffodil Day: 'Pancreatic cancer crept up silently and swiftly and took my dad in two months'





By 2020 one in two of us will be diagnosed with some form of cancer but while these statistics are shocking to say the least, advances in medical research mean that most cancer patients have a relatively good chance of surviving the disease - unless it's pancreatic.

Researchers in the UK have revealed that by 2026, this strain will be the fourth deadliest as symptoms are virtually non-existent until the cancer is in its advanced stages and by that point there is very little which can be done.

According to the latest figures from the National Cancer Registry Ireland (NCRI), there are 500 new cases of pancreatic cancer in Ireland each year and close to 500 deaths. The five year survival rate is just 8pc and when compared to breast cancer survival rates at 82pc and prostate at 91pc, the prognosis for pancreatic cancer patients is extremely bleak.

I know first-hand the horrors of this cancer - my father was diagnosed with it in March 2015, and died just two months later, a week before his 69th birthday. It crept up silently and swiftly and destroyed a man who, for his entire life, was renowned for his strength and larger-than-life qualities.

He had little or no symptoms until a few months before he passed away - vague issues with back pain and stomach cramps which were thought to be the classic symptoms of IBS. During the Christmas period of 2014, he began to lose his appetite and felt nauseous after eating - again none of these complaints indicated something was drastically wrong.

But in early January 2015, he started losing weight at a rapid rate. Tests and scans were ordered to determine the cause of this weight loss, but initially proved inconclusive. Then a month later, a more detailed investigation revealed the earth shattering news - he had a tumour in his pancreas.


Arlene Harris

Arlene Harris

Treatment began in March, but at this point it was a foregone conclusion - there was no way anything could stop the horrific disease which was rampaging through his body. And despite doctors' best efforts he lost the fight on May 21st 2015.

The stealth and ferocity of the disease left us shell shocked in its aftermath - although I knew it was one of the hardest cancers to treat, the speed in which it took my father's life was devastating.

Then a year later, his sister, who was in her mid-50's, was diagnosed with the disease and in less than a month, she too, died in its cruel grip.

Like with my father before her, my aunt had little warning until the cancer was so advanced that it was virtually untreatable.

Dr Robert O'Connor is head of research at the Irish Cancer Society. He says pancreatic cancer is very difficult to detect due to the complexity of the disease and the location of the organ.

"There are several reasons why survival is low," he explains.

"Common pancreatic tumours behave differently to cancers seen in other organs and recruit lots of non-cancerous cells around them to feed their growth and they become quite solid with few blood vessels. These characteristics tend to mean that current cancer drugs have difficulty getting to target cancer cells.

"Also the pancreas can sustain quite a lot of damage before symptoms are evident. It sits under the liver in the abdomen so there is no way to see or feel tumours from the outside and they can grow for some time before they produce clear symptoms."

As initial symptoms can be quite indistinct and hard to distinguish from other ailments and conditions, people can have them for some time before it becomes clear that there is a cancer there.

The more advanced this is, usually the more difficult it is to treat. And for every 100 people diagnosed with pancreatic cancer in Ireland, 93 will die within five years.

Professor Dermot O'Toole, medical expert in pancreatic disorders (in both St James' and St Vincent's University Hospitals and Trinity College) says while some patients may be eligible for surgery, the prognosis is rarely positive in the long term.

"Pancreatic cancer remains one of the most deadly cancers worldwide and at five years, less than 10pc of patients remain alive," he says.

"The prognosis has largely remained unchanged over the past three decades as the tumours have aggressive biological patterns and spread to invade local nodes and give secondary's readily.

"So by the time a tumour becomes recognised, many will have developed to a stage where treatments are very difficult. The tumours are also notoriously resistant to chemotherapy and indeed radiotherapy.

"Surgery is the only possible cure but is possible in only less than 20pc of cases - often due to spread to liver or adjacent local structures. And even of these patients who can have surgery (followed often by chemotherapy) only 1/5 are alive at five years."

This is stark news indeed but despite the fact that treatments haven't advanced very far in the past 30 years, Dr Robert O'Connor says researchers are working to try and improve statistics.

"There are a number of research directions being explored within Irish and international pancreatic cancer research teams which include new combinations of drugs and treatments which target the support cells feeding the tumour to stop them feeding cancer cells and allow easier access of drugs," he says.

The oncology expert says while progress is slow, other possible advances include improved treatment combinations and means of accessing tumours.

"Better harvesting of pancreatic tumours will enable easier and more accurate testing of new possible drug candidates," he says. "And there are also researchers looking at better diagnostics to rapidly detect pancreatic cancer if someone presents with some of these vague symptoms.

"While survival is improving and research is making an impact, it is slow and there is much more work to do to identify better therapeutic approaches and combinations to give the best chance of survival."

Professor O'Toole agrees and says despite much research, significant improvements have yet to be realised.

"Advances have been made to improve the results of surgery (such as pre-treating with chemotherapy and radiotherapy)," he says.

"And several other innovative therapies are under development. But while many newer treatments have shown excellent promise in cancers such as lung, breast and colon, results to date in pancreatic cancer remain disappointing."

However while the likelihood of eliminating pancreatic cancer in the foreseeable future remains slim; there are ways in which people can reduce their risk of developing the disease.

"Stopping smoking is the single-most important environmental factor influencing pancreatic cancer," says Professor O'Toole. "In countries where smoking has considerably decreased, cases of pancreatic cancer have also fallen.

But an increase in obesity rates in some western countries may explain why the disease has not deceased significantly as other tobacco-associated cancers.

"Other risk factors include heavy alcohol consumption, chronic pancreatitis, diabetes and family history.

"And as with other cancers, more and more data links obesity to pancreatic cancer - and obesity is also linked to adult onset diabetes which is another risk. So avoiding obesity will thus help decrease risk and also developing diabetes."

The pancreatic expert says while it can be difficult to screen for pancreatic cancer, those with a strong family history should discuss their risk with a medical professional.

"Screening in the general population is fraught with many difficulties and this form of cancer is hard to detect using standard methods," says Professor O'Toole.

"More attention is now turning to screening high risk groups so if there is a strong family history (two or more first degree relatives), it may be worth seeking an opinion as to whether screening is worthwhile.

"Although this represents a minority of cases of pancreatic cancer and the data supporting screening at-risk families remains to be firmly validated."

÷ For more information visit cancer.ie. The Irish Cancer Society's 30th Daffodil Day takes place on Friday, March 24th. Hold an event, volunteer or buy a Daffodil and raise vital funds to support people affected by cancer. Thousands of volunteers all around the country will be selling Daffodils. You can buy a Daffodil or make a donation by visiting www.cancer.ie, calling CallSave 1850 60 60 60 or texting 'Daff' to 50300 to donate €4*.

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