The silent cancer

Pancreatic cancer will this year become the third biggest cancer killer in the EU, yet awareness of the disease remains worryingly low. Professor Matthias Löhr tells Portal what needs to be done

Pancreatic cancer is only the eighth most common cancer in Europe, but this year it is expected to overtake breast cancer as the third biggest cancer killer in the EU behind lung and colorectal. New research presented at United European Gastroenterology (UEG) Week (15-19 October) shows that mortality rates are increasing at various levels across the whole of Europe, with 91,500 people expected to die from the disease in 2017 and 111,500 in 2025 – figures that in 2010 equalled just 76,000.

This discrepancy between incidence and mortality can be explained in part by a worrying lack of progress in improving median five-year survival rates, which are today at just 5% across Europe. Added to that is a significant lack of understanding of the disease amongst Europeans themselves. Indeed, a recent survey by the charity Pancreatic Cancer UK revealed that close to three quarters (74%) of people in the UK cannot name a single symptom of pancreatic cancer – an alarming statistic which can translate into an all-too-late diagnosis.

In light of this, Portal spoke to UEG pancreatic cancer specialist Professor Matthias Löhr to find out more about efforts to improve early diagnosis and raise much-needed awareness.

What do citizens most need to be aware of when it comes to looking out for pancreatic cancer?

Pancreatic cancer is known as the ‘silent cancer’ because it presents vague and unrecognised early stage symptoms and is therefore usually difficult to recognise and subsequently diagnose. However, there are a number of signs and symptoms the general public should look out for. Pancreatic cancer could cause symptoms such as: pale and smelly stools, jaundice, low mood or depression, mid-back pain, upper abdominal pain, unexplained weight loss, diabetes and fatigue.

Misdiagnosis is common. Therefore, it is crucial that individuals displaying one or more of these symptoms contact a GP immediately and ask to be screened for the disease.

Pancreatic cancer is set to overtake breast cancer as the third biggest cancer killer in the EU. What would you say is behind this?

Pancreatic cancer is a major global issue. This recent statistic highlights the immense threat posed by mortality by pancreatic cancer: 95% of people with pancreatic cancer die from it, which is primarily due to the fact that during the early stages of the disease (Phase 1 pancreatic cancer being the most treatable stage) the disease is usually asymptomatic. Therefore, the tumour remains undetected and is allowed to metastasise and spread to various other organs/parts. High mortality due to the disease displaying vague and unrecognisable symptoms signifies the necessity for considerable investment into research regarding the pathogenesis of the disease, diagnoses, awareness of symptoms and improved treatments, i.e. improving the efficacy of chemotherapies; for example, using one antibody to block a particular protein called PD-1 which is presented on the surface of the pancreatic tumour.

Unlike many other cancers, the poor outlook for patients diagnosed with pancreatic cancer has not changed in the last 40 years. What has held back development here?   

Pancreatic cancer has been abandoned over the past 40 years; the disease is usually asymptomatic until its late stages, and misdiagnosis is common due to symptoms mimicking other illnesses. There are very few treatment options currently available for patients who have later stages of the disease; high quality research and trials have not received enough funding to create cures/effective treatment options. The lack of progress in effective treatments in the past 20 years has meant that patients with late stages of the disease have had high mortality.

Another reason why there has been no development in improving patient prognosis is that the majority of EU countries don’t collect outcome data on the efficacy of treatment for pancreatic cancer patients. Inadequate data collection therefore inhibits clinicians’, researchers’ and physicians’ understanding of the disease.

What measures now need to be in place to ensure that early diagnoses of the disease are a more widespread reality?

There are a number of fundamental measures that need to be taken to guarantee early diagnosis and prevention of pancreatic cancer-induced mortality. First, disease awareness needs to improve significantly: awareness of symptoms (knowing that misdiagnosis is common and symptoms may mimic other illnesses/disease), understanding of prevalence in both men and women, and an urgency to act if patients display one or more of the main pancreatic cancer symptoms. Secondly, healthcare professionals don’t necessarily test for the worst possible scenario first, i.e. pancreatic cancer. The disease should always be tested for immediately if a patient displays several of the main disease symptoms.

What urgent action is needed from European governments to effectively reduce pancreatic cancer mortality rates?

European governments should invest in a number of main strategy platforms to reduce mortality induced by pancreatic cancer, including early diagnosis of the disease as an essential step to improving prognosis and reducing mortality, and funding campaigns that promote awareness of the disease, symptoms linked with pancreatic cancer and prevalence of disease. Healthcare professionals as well as the general public should be strongly informed that misdiagnosis is extremely common in patients with pancreatic cancer, and extra precautionary measures should be taken by all healthcare professionals within the EU to test for pancreatic cancer if a patient presents one or more of the symptoms associated with the disease.

European governments should moreover encourage collaboration between specialist clinicians and researchers to share knowledge of the illness as shared expertise may inspire innovative research to battle it, and they should support research associated with improving the efficacy of certain treatments and improving our understanding of the biology of pancreatic cancer.

Likewise, EU institutions and member states should drastically improve data collection and maintenance, and disease registries should be set up and preserved to help increase knowledge of the disease as well as inform treatment decisions.

Professor Matthias Löhr

Pancreatic Cancer Specialist

UEG

www.ueg.eu

This article first appeared in issue 13 of Horizon 2020 Projects: Portal, which is now available here.