Pancreatic cancer is one of the most deadly cancers in Brazil – 02/13/2023 – Health

Every two or three years, Inca (National Cancer Institute) publishes a document in which it makes projections on the numbers of cases and deaths related to the most common tumors in the Brazilian population.

“And for the first time in the historical series, Inca included pancreatic cancer as one of the most frequent in the country”, informs clinical oncologist Mariana Bruna Siqueira, from Oncologia D’Or, in Rio de Janeiro.

“The increase in the incidence of this tumor occurs in the economically more developed regions, and it already appears among the ten tumors that most affect women in the South, Southeast and Midwest regions”, adds the specialist, who is also a member of the Instituto D’Or of Research and Teaching.

Inca estimates that, in 2023, 10,980 cases of pancreatic cancer will be diagnosed in the country.

The fatality rate is also on the rise. Between 2011 and 2020, deaths per year related to this disease jumped from 7,700 to 11,800 — an increase of more than 50%.

In absolute numbers, Inca calculates that in 2020 this disease killed 5,882 men and 6,011 women. This makes this tumor the seventh deadliest for men and the fifth for women.

It is worth remembering that the pancreas is a gland responsible for producing insulin, an essential hormone in the use of glucose as a source of energy for the cells to work.

And the upward trend is not just national: in the United States, scientists point out that pancreatic cancer will become the second most lethal type, behind only lung tumors. Case numbers will also rise by more than 65% among Americans over the next two decades.

But what justifies this change of scenery? Behind this increase, there are at least four reasons: the aging of the population, lifestyle, late symptoms and the aggressiveness of the condition.

LONGEVITY AND INAPPROPRIATE HABITS

Doctor Duílio Rocha, director of the Brazilian Society of Clinical Oncology, points out that pancreatic cancer is a condition that usually appears in older individuals.

“Therefore, the very aging of the population contributes to this increase”, he reasons.

“The average age at diagnosis is 70 years. And Brazil has only surpassed a life expectancy of over seven decades since the year 2000”, adds the specialist, who is also head of the Oncology Unit at the Walter Cantídio University Hospital, in Fortaleza .

That is: if people live longer, it is natural that a greater number of them develop a tumor in the gland.

The second factor has to do with the lifestyle adopted, especially in more developed places.

“A good part of the scientific community believes that the increase in cases is directly related to changes in habits in the generations that were born after 1970, such as the greater consumption of ultra-processed foods rich in saturated fats, and the increase in the proportion of sedentary people and obese”, lists Rocha.

All these alterations are related to a general increase in non-transmissible chronic diseases, such as hypertension, diabetes and various types of cancer, such as those that affect the pancreas.

Speaking of diabetes, researchers have many doubts about the relationship between the two conditions. After all, patients with diabetes have a higher risk of pancreatic cancer? Or is it the tumor in the insulin-producing gland that causes uncontrolled blood sugar levels?

“It is still not certain whether diabetes is the cause or consequence in this scenario. Even so, we see this disease as an additional risk factor for pancreatic cancer”, replies Siqueira.

SILENT AND AGGRESSIVE

To complete, one of the major barriers when it comes to tumor in the pancreas is the late diagnosis.

“Only 15 to 20% of patients are identified when the disease is located in the gland and has not spread to other parts of the body”, calculates Siqueira.

In general terms, detecting the condition in the early stages of development is the main way to ensure less invasive treatments with greater potential for cure.

This, however, is not the reality most of the time. “The symptoms of pancreatic cancer usually only appear at an advanced stage and are very generic, that is, they can be confused with a series of other possible illnesses”, characterizes Rocha.

Among the main manifestations of this tumor, doctors highlight weight loss, pain in the abdomen or back and changes in the color of the skin and eyes, which take on a yellowish appearance.

This last sign has to do with the growth of the tumor and the tightening of surrounding structures, such as the ducts that connect the gallbladder to the liver.

There is also no routine exam that can catch the disease early, similar to mammograms for breast cancer and pap smears for cervical cancer.

The last factor behind the rise of pancreas tumors has to do with the very characteristics of this condition.

“It is a more aggressive disease. Even patients who are operated on have a shorter survival compared to other types of cancer”, says Siqueira.

“In localized bowel cancer treatable with surgery, for example, there is a chance of cure that exceeds 80%. In a pancreas tumor that has similar conditions, this rate is 30%”, completes the oncologist.

MEDICINE’S COUNTER ATTACK

But it’s not all bad news when it comes to pancreatic cancer.

“For a long time, we had the idea that this was a tumor against which we could do very little”, recalls Rocha.

“But in recent years, we have had a series of advances that have improved this scenario. Today, the chance of cure is six times greater than two decades ago, especially when we are able to use the best tools to diagnose and treat early” , complements.

When the gland tumor is detected in the early stages, surgery is usually the first alternative to deal with the problem.

Now, if the disease has already evolved or spread to other parts of the body, health professionals resort to chemotherapy or radiotherapy.

In some cases, the chemo itself manages to shrink the tumor, which opens up the possibility of having surgery to remove the lesions located in the gland.

More advanced options also start to come into play. One of these is immunotherapy, a class of drugs that stimulate the patient’s own immune system to fight cancer cells.

“For the time being, these remedies are only available for individuals with a specific genetic mutation, which corresponds to around 1% of cases”, points out Siqueira.

Another recent novelty is the use of CAR-T Cells, a method already approved as blood tumors that consists of extracting immune cells from the patient, modifying them in the laboratory and reintroducing them into the organism, so that they recognize and attack the tumor.

“This, however, is still an experimental treatment, which needs to be studied further”, ponders the clinical oncologist.

While pancreas transplantation is an option for patients with diabetes who have severe complications, it is not available as a cancer treatment. This is because this surgery requires the use of drugs that inhibit the immune system – which, in a patient with this tumor, would make the cancer cells spread more quickly to other parts of the body.

If the therapeutic perspectives against pancreatic cancer evolve, the guidelines for preventing the disease remain the same.

“Our main recommendation to avoid such a disease is to seek healthy lifestyle habits”, suggests Rocha.

“This includes maintaining an adequate weight, a diet based on plant sources and low in saturated fat, practicing physical activity and avoiding smoking”, concludes the doctor.