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pancreatic cancer life expectancy


WEDNESDAY, DECEMBER 8, 2010 4:19 PM POSTED BY DR HEALTH

One of the most difficult questions a

physician can be asked by a patient with

pancreatic cancer is, “what is my life

expectancy?” This question is particularly

difficult to answer because no two patients

are alike, yet it is only natural for patients to

assume that their outcome will be that of the

average or typical patient. Statistics tell us

what is likely to happen to a group of

patients, not an individual. Nonetheless, this

is an important question as patients need to

make appropriate life plans. The below information on survival of patients with pancreatic cancer is therefore

presented with the adage “plan for the worst and hope for the best” in mind. Simply put, we firmly believe that there

is ALWAYS hope. These statistics should be used to make realistic plans. They SHOULD NOT discourage nor should

they be taken as an indication of what will actually happen to a particular patient. We have all seen or read about

patients whose life expectancy was a few months, but who lived many happy years.

Life expectancy for patients with pancreatic cancer depends on stage and treatment. In general, patients with

higher stage (more advanced disease) do worse than do patients with lower stage (disease which is small and which

has not spread to the lymph nodes or other organs). For more information on staging see

http://pathology.jhu.edu/pancreas/DiagStaging.php In general, patients who have their tumors removed surgically

do better than do patients whose cancers cannot be removed surgically.


The web site of the government’s Surveillance Epidemiology and End Results (SEER) program

(http://seer.cancer.gov/statfacts/html/pancreas.html#survival) provides the below overall statistics for survival

loosely based on stage. This is for “all comers” and does not factor in treatment.

The survival for patients who have their tumor surgically resected is somewhat better. We reported the experience

here at Johns Hopkins with 1423 patients who had their pancreatic cancers surgically resected (Journal of

Gastrointestinal Surgery 2006; 10:1199-210). The median survival was 18 months, the one-year survival was 65%,

the two-year survival 37%, the five-year survival 18%, and the ten-year survival was 11%. The size of the tumor,

the status of the resection margin (did the surgeon have to cut across the cancer and leave some behind), the

lymph node status (had the cancer spread to the lymph nodes), and the histologic grade of the tumor (how much

the cancer look like normal cells under the microscope) all impacted on survival. Patients with small, margin negative

cancers that had not spread to lymph nodes and which were low-grade (well-differentiated) did better than patients

with large, margin positive cancers which had spread to lymph nodes and which were histologically high-grade

(poorly differentiated). For example, for cancers 3 cm or smaller the median survival was 21 months; the one-year

survival was 73%, the two-year survival 45%, and the five-year survival was 23%. Similarly, for cancers with no

positive lymph nodes, the median survival was 23 months; and the 1-, 2-, and 5-year survivals were 73%, 50%,

and 27% respectively.

We would like to stress that these statistics are more of a reflection on where pancreatic cancer has been, and not

where it is going. New chemotherapies and combinations of new therapies are constantly being tested in clinical

trials, new “personalized” therapy regimens are being evaluated, multi-disciplinary approaches for the care of

patients have been initiated (http://pathology.jhu.edu/pancreas/ChooseMDT.php), vaccines are being developed to

target pancreatic cancer immunologically, and scientists have advanced our understanding of the fundamental

biology of the pancreatic cancer cell by leaps and bounds. We sincerely believe in a bright future.

Again, we would like to emphasize that in presenting these statistics in such a frank manner we do not wish to

discourage anyone. Instead, our goal is to educate, and in so doing empower patients as they work together with

their physicians to chose the therapies that are best for them.

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