MOTIVATION

Pancreatic cancer is the fifth most common cause of cancer death in Europe and USA, and the 7000 cases which present each year in the UK have a median survival of four to six months and a five year survival of less than 3% (less than 1% for the most common type ie adenocarcinoma) . On average, less than 10% of patients have their disease caught early enough for it to be removed surgically which offers a much better chance of surviving 5 years or more. Sadly, the majority of people present with advanced disease which has spread beyond the pancreas and can't be operated on. Chemotherapy is offered to these patients with a view to improving quality and quantity of life.

Many people have never heard of pancreatic cancer. Pancreatic Cancer UK aims to raise awareness of pancreatic cancer to aid earlier diagnosis and stimulate and enable more research to develop more effective treatment.

There have been some improvements in survival in recent years due to the introduction of a new chemotherapy drug, gemcitabine. Use on its own or in combination with other drugs can improve quality of life for patients for whom surgery is not possible. In addition, it may help to prolong life to some extent, although not all patients will respond to treatment. There is clearly a need for research to develop new drugs and novel techniques to fight pancreatic cancer, such as gene therapy and immunotherapy.

In the meantime there is a need for more and better palliative care for pancreatic cancer patients and support and information for the patients and their caregivers.

In recent years government and cancer specialists have been working to improve outcomes for cancer patients in the UK eg through the introduction of the National Cancer Plan and "Improving Outcomes Guidance for Upper Gastrointestinal Cancer". It is hoped that improvements in standards, diagnosis, surgical techniques, concentration of surgery in high volume expert regional centres, more use of chemotherapy following surgery and greater availability of specialist nurses will improve care so that more patients will have a chance to survive to 5 years.

However these improvements can only be achieved by an increase in financial resources. Pancreatic Cancer UK is lobbying for pancreatic cancer to have a higher priority in allocation of resources.

It is very difficult to diagnose pancreatic cancer as the pancreas is so deep within the body and symptoms vary depending on the exact location of the tumour in the pancreas. It is principally a disease affecting middle-aged and older patients but this is not always the case and the diagnosis can be missed in younger patients. Although the commonest form of pancreatic cancer - pancreatic ductal adenocarcinoma - is so deadly, there are other much rarer forms - eg. endocrine tumours - which can affect younger patients and have a much better outlook with surgery and chemotherapy or immunotherapy.

The symptoms of pancreatic cancer can be quite vague. Early symptoms can include:

• General discomfort or pain around the stomach area
• Sickness
• Bowel disturbances
• Diabetes
• Jaundice
• Skin itching

Later stages of the disease are characterised by:

• Loss of appetite
• Unexplained weight loss
• Back pain
• Low mood and depression

Not everyone has every symptom, it depends very much on the location of the tumour in the pancreas. For example jaundice can be an early sign of a tumour in the head of the pancreas affecting the bile duct and back pain is a late sign of a tumour in the body or tail of the pancreas possibly affecting the nerves and spine.

New methods of diagnosing pancreatic cancer are required, such as markers in the blood, pancreatic juices or stool samples to identify people at risk of developing pancreatic cancer or to distinguish these symptoms which may be due to many others causes from those due to pancreatic cancer.

The cause of pancreatic cancer is not fully understood. However, we do know that the biggest risk factor for developing pancreatic cancer is a history of smoking. A diet high in meat and fat may increase the risk of pancreatic cancer, whilst eating a lot of fruit and vegetables may reduce this risk. Diabetes and recurrent pancreatitis are conditions associated with pancreatic cancer, although it is not clear whether they are cause or effect. One of the main causes of chronic pancreatitis is drinking large amounts of alcohol over long periods of time. We need to raise awareness to enable people to adjust their lifestyle to reduce their risk of cancer.

However the above is based on statistics and never apply to a single patient. The husband of one of the founding directors of Pancreatic Cancer UK was John Ballard who, after being fit all his life, never smoking and rarely drinking, died at age 50 from inoperable adenocarcinoma in the body of the pancreas. This was 27months after diagnosis so there is always hope of better outcomes. Diagnosis by ultrasound followed symptoms of general abdominal discomfort/pain and intense back pain, and he was treated with gemcitabine with cisplatin followed by some radiotherapy.

Pancreatic cancer causes 5% of deaths from cancer but only receives 1% of cancer research funding (NCRI Strategic Analysis 2002). This needs to increase to ensure better outcomes for patients.

Pancreatic Cancer UK is raising funds for peer reviewed research projects and other projects furthering the aims of Pancreatic Cancer UK under the guidance of its Medical and Scientific Advisory Board. We are also lobbying for an increased share for pancreatic cancer from the other funders of cancer research.