Saving lives in our lifetime: Pancreatic cancer

It is unclear what causes most pancreatic cancers, but smoking and excess weight are known to increase the risk.

How does it start?

Around 10,000 people each year are diagnosed with pancreatic cancer in the UK, which on average is around one an hour. It becomes more common with increasing age – almost half of new cases are in people aged over 75.

Who’s affected?

Pancreatic cancer is often diagnosed in the latest stage (stage 4) and progresses rapidly, making it one of the hardest-to-treat cancer types. Cancer Research UK has been helping to increase funding in this area that will be pivotal in improving our understanding of the disease, as well as underpinning the development of the most effective treatments.

What is Cancer Research UK doing about it?

A progress timeline:

Charting cancer successes within living memory

2004

Study results bring hope for cancer patients

1989

European scientists come together to investigate different treatment combinations for pancreatic cancer

2016

Scientists take steps towards more personalised treatment

Researchers find that pancreatic cancer can be divided into four distinct subtypes. This better understanding of tumours at the molecular level helps

doctors predict which treatment will work best for individual patients. It also paves the way for the development of targeted drugs in the future.

2014

A new research strategy is unveiled

As part of Cancer Research UK’s revised research strategy, investment into hard-to-treat cancers is increased, and for

pancreatic cancer is more than doubled from £6 million in 2013/14 to £15 million in 2014/15.

saves patients from undergoing unnecessary treatment. These modest but significant results spark a series of practice-changing ESPAC trials that are still going on today.

Results from the first ESPAC trial show that a full course of chemotherapy after surgery could improve the very low five-year survival. It also finds that the radiotherapy used at this time is ineffective and so

The European Study Group for Pancreatic Cancer (ESPAC) is a long-term study to look at how

different combinations of surgery, chemotherapy and radiotherapy could benefit patients.

My pancreatic cancer story

The surgery and chemotherapy that Peter had on a pancreatic cancer trial proved successful, not only saving his life, but furthering scientific knowledge about this aggressive form of cancer

Peter Breaden is one of the success stories of an ESPAC trial. He was diagnosed with pancreatic cancer at the age of 60. “We’d gone to Barcelona for a week to celebrate our 40th wedding anniversary and I found I was getting lots of indigestion, which I don’t normally get, but I put it down to eating late in the evening. A week after we got back, I had a lovely big fry-up for breakfast and became terribly itchy all over my body. Again, I didn’t think much of it, until I turned yellow with jaundice. Before I knew it, I was in hospital having investigations.” Fortunately, Peter’s tumour was found to be operable and he immediately agreed to join a pancreatic cancer trial. “I’d worked in hospital laboratories so I was aware of how important it is that people take part in research trials,” he says. Surgeons were able to remove all of the tumour and no cancer was found in the lymph nodes, apart from one that was right next to the cancer. Following the operation, Peter received combination chemotherapy for six months. “In comparison to other chemotherapy experiences I’ve heard about, it wasn’t too

‘I now have precious time with my family thanks to surviving cancer’

Pancreatic cancer: know the symptoms

With more than 200 different types of cancer, it’s not possible to learn all the possible symptoms. The key is to get to know what’s normal for you, and if you notice anything unusual or anything that sticks around for a while, visit your GP and get it checked out.

What to look for

A dull pain in your stomach and/or mid back that feels like it’s boring into you. It’s often worse when you lie down and after meals

Jaundice – a yellowing of the skin and whites of the eyes

Weight loss for no obvious reason

Reduce your risk

It’s estimated that 31 per cent of pancreatic cancer cases in the UK could be prevented. Things that can help reduce the risk include:

Maintain a healthy weight

Fat cells produce more hormones and growth factors, which can cause cells to divide more quickly, raising the risk of some cancer types, including pancreatic cancer.

Not smoking

The chemicals in cigarettes increase the risk of 15 different cancers, including pancreatic cancer. Free stop-smoking services have been shown to roughly triple the likelihood of success compared to going “cold turkey” alone. Talk to your doctor or pharmacist, or visit the NHS Smokefree website to find out what might work best for you.

Donate today to help Cancer Research UK make more incredible strides forward in diagnosis, prevention and treatment of cancer. No matter how small or large, your gift will lead to dramatic changes to cancer outcomes in your lifetime. For example:

£40 could pay for a cancer biopsy, where a tiny sample of someone’s tumour is taken for research

£250 could buy 500 plastic dishes, essential for scientists to grow and study cells in the lab

£1,000 could help fund a clinical trial of a new, more effective treatment for pancreatic cancer

Join Cancer Research UK on its mission towards the day when all cancers are cured.

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THE FUTURE:

new pancreatic cancer cases in the UK every year – that's 27 every day (2014-16)

£18 million

on pancreatic cancer research

31%

of pancreatic cancer cases in the UK are preventable

Precision-Panc

Precision-Panc is an ambitious research programme established in 2017 with a £10 million investment from Cancer Research UK, the largest-ever single investment into a pancreatic cancer project. It provides a new model that aims to address some of the problems associated with previous research and treatment. At the molecular level, pancreatic cancers can be very different but these differences cannot be detected using a microscope. Because pancreatic cancer can progress very quickly, patients often only have limited treatment options available to them, which might not be ideal for their particular type of cancer, and many do not have time to try a different treatment if the first does not work. In Precision-Panc, patients have their tumours genetically analysed, and are then matched to the most suitable existing treatment or placed on a trial testing a new drug, based on their tumour profile. From its base in Glasgow, the project has set up a network of 23 Precision-Panc centres embedded within the NHS throughout England and Scotland, and more are to be opened in Wales and Northern Ireland soon. At the time of writing, 192 patients had joined the programme, and a further 15 to 20 are being added each month. The programme will drive the development of new drugs that target specific genetic mutations and lead to more personalised treatments, says Professor Andrew Biankin, chief investigator of Precision-Panc. “We have more than 1,000 drugs but we don’t know which drugs are going to work in which patients, so up until now it’s been trial-and-error medicine,” he says. “The challenge was to develop a molecular test that is available for all patients and affordable for the healthcare system.” The ultimate aim is for all pancreatic cancer patients to be offered the option of a drug trial, and doctors will be able to refer to an extensive knowledge bank of which treatments work best for which genetic characteristics. The first step towards tackling pancreatic cancer is to slow it down and increase the available time that doctors have to try to treat patients successfully, says Prof Biankin. “Because the disease is so aggressive, patients usually receive just one line of treatment. If we can make the disease less aggressive, we will have more time to choose the right treatments according to the molecular make-up of their cancer,” he says. “If we can accelerate the way we develop new treatments by changing processes that hold up our progress, and by having a system in place where we’re learning from every patient, I think there’s a good chance of that happening in the next 15 to 20 years.”

The pancreatic cancer ‘dream team’

Cancer Research UK is co-funding an £8 million “dream team” of researchers from across the UK and the US alongside Stand Up To Cancer and the US Lustgarten Foundation. Established in 2015, it brings together some of the world’s top pancreatic cancer researchers. They have found networks of genes in pancreatic tumours controlled by genetic “hot spots” in the DNA called “super-enhancers”, that are known to control wound repair and tissue regeneration. Unlike the normal system of wound healing that has a shut-off mechanism, in tumours, the process is “hijacked” to drive constant growth. The team aims to develop approaches to reset malfunctioning super-enhancers in pancreatic tumours, hopefully increasing their sensitivity to treatments.

ESPAC-5

Saving lives in our lifetime: Pancreatic cancer

This long read examines how this hard-to-treat cancer has become a priority for Cancer Research UK, which is funding ground-breaking research projects and supporting international scientific partnerships to help tackle the disease and hope to improve outcomes for people with pancreatic cancer

JUMP TO

Timeline

Case Study

Symptoms

Prevention

The pancreas is a gland that sits high up in the abdomen, just behind the stomach. It produces digestive juices and hormones such as insulin, which controls blood-sugar levels. The part of the pancreas producing digestive juices is known as the exocrine pancreas, and this is where most tumours start. Cancers starting in the endocrine pancreas, the part producing hormones, are much less common.

What is it?

Produced by Telegraph Spark Words Caroline Roberts Commissioning Editor Jess Spiring Sub-Editor Loveday Cuming Designer Sandra Hiralal Digital Developer Pedro Hernandez Picture Editor Emma Copestake Web Producer Katherine Scott Project Manager Alex Brooksbank

The latest trial in the ESPAC series is investigating whether chemotherapy, or a mix of chemotherapy and radiotherapy, known as chemoradiotherapy, can help shrink pancreatic tumours so they can be completely removed through surgery. This could make surgery an option for those people who wouldn’t otherwise be able to have it.

Symptoms can be vague but see your GP if you are at all worried. They won't think you are bothering them unnecessarily. Even if you notice a change that isn’t on the list, talk to your doctor:

Could a breath test detect cancer in the future?

What does the future of cancer research look like?

Scientists say ‘thank you’ to cancer trial participants

Related content

What is chemotherapy?

Chemotherapy drugs circulate in the bloodstream and kill cancer cells when they are in the process of dividing into two. Because cancer cells divide much more often than most normal cells, chemo is more likely to kill them. Some chemo drugs kill dividing cells by interrupting the chemical processes involved in cell division, while others damage part of the cell's control centre that carries the instructions for division. However, the drugs also affect normal cells that are constantly growing and renewing, such as in the hair, skin and bone marrow. The damage to healthy tissue is usually short-lived, because normal cells can replace or repair the damage done by chemo. And most side effects disappear once treatment is over.

How Cancer Research UK plans to continue tackling lung cancer in the next 25 years

The PIONEER trial

Another trial is looking at whether a treatment called olaparib is safe and effective when used alongside a combination of chemotherapy and radiotherapy. Olaparib is a drug called a PARP inhibitor which targets an enzyme called PARP-1. This enzyme helps repair damaged DNA in cells. Chemotherapy and radiotherapy kill cancer cells by damaging their DNA, so scientists hope that olaparib will help them work better by preventing the cancer cells using PARP-1 to repair the damage.

How Cancer Research UK plans to continue tackling pancreatic cancer

The PIONEER trial

In 2018-19, Cancer Research UK spent

Pancreatic cancer represents

of all cancer diagnoses in the UK

pancreas?

where is the

2017

Trial signals huge step forward in pancreatic cancer treatment

Another Cancer Research UK-funded clinical trial as part of the ESPAC study, which focused on patients with operable cancer, finds that 29 per cent treated

with a combination of chemotherapy drugs lived for at least five years. It represents a 13 per cent improvement when compared with standard treatments.

bad. I was just very tired, and the skin on my hands and feet started to peel off.” Looking to the future, Peter is hoping to join the small proportion of pancreatic cancer patients who survive their disease beyond a decade. “I want to be one of the survivors,” he says. He’s now making the most of life by going caravanning on the continent and spending time with his nine grandchildren. “I’ve had fantastic care from the NHS, and my wife and family have been very supportive. I still go back every year for a check but I’ve been told I don’t need to – it’s just for my peace of mind. I realise I’ve been extremely lucky.”

10,000

There are around

Another Cancer Research UK-funded clinical trial as part of the ESPAC study, which focused on patients with operable cancer, finds that 29 per cent treated with a combination of chemotherapy drugs lived for at least five years. It represents a 13 per cent improvement when compared with standard treatments.

Trial signals huge step forward in pancreatic cancer treatment

2017