Pancreatic cancer from a different perspective
directorsblog.nih.gov
directorsblog.nih.gov
The one-year relative survival rate after diagnosis is 20%, and the five-year rate is 7%. In the US it is the 4th most common cause of death from cancer, and kills more than half a million people per year worldwide.
http://pancreatic.org/pancreatic-cancer/about-the-pancreas/p...
(... at least until we perfect the longevity treatments ;) ).
As a European working in the US medical system, my general impression is that US people fear death much more than in Europe, where people bother much more about suffering than dying in itself. I don't really understand why, but americans seem in my experience far more willing to undergo invasive procedures to live longer, even if it means bad quality life.
I can relate my only illness anxiety experience though: I had some lab tests done for autoimmune diseases, and came back negative for everything except a liver antibody test. The disease that the test is specific for has initial symptoms of fatigue and itching. You can imagine how most students have some amount of fatigue, and I must have had some contact dermatitis from something else giving me an itching sensation. There was a week long period where I thought my life was going to revolve around when I'd get a liver transplant.
EDIT: Looks like it's tied up in various patent and testing limbos, the former of which seem somewhat self-imposed. There's also some doubt about the specificity of mesothelin to pancreatic cancer.
The bigger issue though will likely be managing the false discovery rate. Nearly everyone will have precancerous growths and benign lesions which may share many genetic biomarkers with potentially malignant growths. Many genetic variants associated with cancers occur years or decades before the development of a tumor. It may be difficult to develop a test that doesn't have a difficult tradeoff between sensitivity and specificity, prior to significant tumor growth. I do think its a promising approach, however, and look forward to see the progress researchers make in the coming years.
Relatedly, circulating tumor DNA is not only useful in diagnosis, but its already proving to be useful in the treatment of cancer. Its much less invasive than surgical biopsy, and as a result, clinicians can track the evolution of the tumor, response to specific treatments, and development of resistance in way that was just never possible before.
I suspect that one decade we will consider this idea almost impossible, and by the end of the next, it will seem old hat. I just wonder which decade that will end up being.
George Church (and others) looked at Andraka's preprinted paper and wasn't exactly blown away. The cost and speed comparisons were wrong, the sensitivity and specificity were both too low to be clinically useful, and like you pointed out, mesothelin has some intractable problems when trying to diagnose tumors.
https://www.forbes.com/sites/matthewherper/2014/01/08/why-bi...
Kids with the aptitude and interest to devote themselves to biotech or engineering should absolutely be encouraged but putting them on the cover of magazines never works out.
My grandfather, a professor for chemistry, did as a student research on ion exchange resin - which later became valuable applied to water softeners. He did a lot of interesting research later when it came to analytical sciences (radio-chemistry) but that early success sort of over-shadowed everything.
Its a haunting experience, unless you dono longer externalize your value as a researcher.
We really need early detection. The list of famous people that I've heard of who died from pancrer cancer keeps growing:
Randy Pausch - Last Lecture
Steve Jobs
Patrick Swayze
Sally Ride - astronaut
Piers Sellers - astronaut
Hans Rosling
Richard Hatch
Where did I say anything about not needing early detection(1) or anything negative at all?
I'm giving actionable advice that you can follow right now at this very moment until we have other methods of prevention. That's what we got and it's easy to implement(2) and mildly effective.
(1) Though that's another can of worms considering there's cases where routine screening of asymptomatic individuals at low-to-average risk of a disease can actually do more harm than good, but that's another topic. Screening certainly can also be beneficial too, I'm not hating on it as a concept.
(2) Provided you aren't already a smoker. If you are, it can be difficult to quit, obviously.
Stop telling people that.
The current belief is that a lot of cancers are just "bad luck": https://www.scientificamerican.com/article/most-cancer-cases...
http://www.cancerresearchuk.org/about-cancer/pancreatic-canc...
> We don’t know what causes most pancreatic cancers. But there are some factors that may increase your risk of developing it.
[...]
> About 7 out of 10 cases (70%) of chronic pancreatitis are due to long term heavy drinking. Chronic pancreatitis is a known risk factor for cancer of the pancreas.
> Some research suggests there may be a link between heavy drinkers and risk of pancreatic cancer.
> The risk is higher in people who drink 3 or more alcoholic drinks a day compared to those who drink less than 1 alcoholic drink a day.
[...]
> The links between diet and pancreatic cancer are unclear.
> A study showed that pancreatic cancer risk was higher in men who ate 120g red meat a day compared to those who ate no red meat.
> Some studies show an increase in risk with large amounts of saturated fat in your diet.
> A diet high in folate may reduce the risk of pancreatic cancer, but different studies have shown conflicting results. Folate is found in leafy, green vegetables.
1. Exocrine cells - 95% of pancreatic cancer are in the exocrine cells which produce the enzymes that are responsible for food digestion, and 95% of exocrine cancers are adenocarcinomas which impact the cell lining of the pancreatic duct. This is the bad one, with a survival rate below 10% 5 years after diagnosis.
2. Endocrine cells - The other 5% of pancreatic cancers impact endocrine cells which produce enzymes to regulate your blood sugar. Jobs' cancer was reportedly a Glucagonoma which was overproducing glucagon leading to very high blood sugars. These are extremely rare cancers but broadly, with early surgery the 5-year survival rate is above 85%. The 10 year survival rate is above 65%.
That's why there was so much criticism for Jobs' delayed treatment. His tumor was first diagnosed in 2003 and he basically ignored it for a year in favor of alternative treatments and healthy eating. By the time he actually had surgery, the cancer had progressed to mets in his lymphs and his liver.
And, to make it clear just how ridiculous his decision was, among the alternative treatments he used included coffee enemas. There's literally no reason at all to believe coffee enemas can cure cancer, but that's what he was doing while his cancer was spreading.
Everyone should be able to make their own treatment decisions, of course. But, my dad was killed by the distinctly not good kind of pancreatic cancer, and I feel a little entitled to be pissed off at folks who squander the incredible fortune of having a treatable case and ignoring every bit of relevant science in favor of the advice of quacks.
Pancreatic cancer doesn't generally compromise the pancreas before it metastasizes and compromises something else. That's the worst thing about that one; the first self-identifiable symptom is usually "My stomach is upset (because this thing has already grown past the borders of the pancreas and is now playing general hell with the abdominal cavity)."
From the article, it appears that the disease is active in your body a long time before it's detected. It's just at a very late stage before it's detected.
"Because it can take 20 years or more for precancerous cells to develop into full-blown pancreatic cancer"
Once the cancer has spread outside the pancreas to other organs then it becomes more easily detectable, and symptoms show. By then it's throughout your body and you can't easily remove it.
Here's some better information on the topic: https://www.cancer.org/cancer/pancreatic-cancer/detection-di...
Turned out to be Islet Cell (the same type that Jobs had), and they were able to catch it in time.
He's one of the extremely rare to actually have been cured of it - and I still don't think he ever really researched the disease and doesn't really count himself one of the "real" cancer survivors.
I had Thyroid cancer at the same time and he was more worried about me ;)
They use these biomarker together with a statistical algorithm to find very high specificity and sensitivity at the same time.
My father died less than a year from the diagnosis. The only real symptoms appeared 2-3 months before doctors even considered cancer.
The tumor was sneakily sandwiched between different organs, on the tail of pancreas.
As far as I know (from Polish oncologists) it was basically undetectable early enough to fight successfully. And it was probably developing for 15-20 years before.
I would really love to be able to easily check my pancreas for any unhealthy changes as the inherited risk is pretty high.
That sounds good, but it would be necessary to do this in a way where problems with only a low risk would not be highlighted.
For example, to avoid a brain aneurysm, you might opt to be scanned on a frequent basis. Except what happens if they find a blood vessel with a 1% annual chance of rupture but the fatality rate of an operation to reduce the risk is, say, 10%? This places most people into a very difficult situation where the difficulty of having a 1% annual risk of rupture is hard to balance against the 10% chance. This is just one reason why proactive screening is not done in otherwise healthy subjects.
A friend of mine was in a similar scenario recently. He was tempted to do an aggressive and risky surgery to treat a chronic condition, out of sheer frustration. I couldn't talk him down. It was only once the surgeon said "I can't look you in the eye and tell you that this will be worth it" that he reconsidered.
The distinction in important because neuroendocrine can be treated with good outcomes. They're making good progress in treating adenocarcinomas (Drs Von Hoff and Borazanci in Scottsdale making good progress).
Some sort of early detection mechanism for all of these cancers would be amazing for everyone involved.
Especially pancreatic cancer.