Fighting NATURE’S Silent CANCER
The odds are stacked in the fight against pancreatic cancer, but a team of scientists and medical professionals are determined to do all they can to change that
Striding out on a 12-kilometre run through the national park near his home in the Adelaide Hills in January 2019, Professor Chris Baggoley AO, former Australian Government chief medical officer, was feeling in peak physical condition. Then 66, he had overhauled his diet and exercise regime in the previous 18 months, having been told by a doctor that he was borderline diabetic, and felt fitter than ever before.
His only niggling health issue was some changes in a recent blood test, which concerned his GP enough to refer him to a haemotologist, whose tests included a scan of his abdomen.
Further testing would reveal the shocking news: he had pancreatic cancer.
Unlike the majority of Australians who know little about this relatively rare cancer, as the nation’s top medic from 2011 to 2016, Dr Baggoley was grimly aware of the gravity of his diagnosis. Pancreatic cancer is Australia’s third deadliest cancer, killing over 3300 Australians each year.
Dr Baggoley was one of the lucky ones – his chance diagnosis meant he was one of a small percentage of pancreatic cancer patients who was able to be operated on.
“It was early stage, so it was only in my pancreas, about 2.5cm in size,” he explains.
“I had what’s called a Whipples procedure, in which they cut out half the pancreas, the first part of the small intestine, the gall bladder, a bit of stomach and liver, then join it all back together in a way that nature never intended. It’s a big operation, so it laid me low for quite a while, and after that I had six months of chemotherapy.”
Follow up tests have shown Dr Baggoley currently shows no sign of cancer, for which he is ‘very grateful’, citing recent sobering data from the US National Cancer Institute.
“Only ten per cent of patients have their cancer localised to the pancreas when diagnosed,” he says. “Those people have a five-year survival rate of around 37 per cent in the US. But if it’s already spread beyond the lymph nodes to the liver or lung, the fiveyear survival rate is just three per cent. So simply by being diagnosed earlier, I have 12 times the survival rate of someone whose cancer has already spread, which is why early detection is so important.”
For these reasons, PanKind, an Australian foundation exclusively dedicated to pancreatic cancer, has launched an Early Detection Initiative, working with the research communit y to improve early diagnosis.
“Often when a patient is diagnosed, they are close to death,” says Michelle Stewart, CEO of PanKind. “This is largely because most patients are diagnosed when the cancer has already progressed too far for existing treatments to work,” she says.
“If you have inoperable pancreatic cancer, 80 per cent of patients only survive six to 12 months. We believe that early diagnosis offers the greatest hope to triple survival rates by 2030.”
A sea of challenges
The odds are stacked against the doctors and scientists fighting this deadly disease for several reasons. Firstly, there are often few signs or
OFTEN THE SYMPTOMS CAN BE MISTAKEN FOR SOMETHING ELSE
symptoms, or the symptoms are so vague they can easily be mistaken for something else. For example, Dr Baggoley had put his weight loss prior to diagnosis down to his new health regime. Looking back, he says, “There’s no doubt, given my background in medicine, if I’d seen someone my age who’d lost 15 kilograms of weight, even if they’d said it was deliberate, I would have said, ‘Yeah, but where’s your cancer?’”
Along with unexplained weight loss or loss of appetite, some of the subtle signs of pancreatic cancer include upper abdominal pain, often radiating through to the back, and reflux-type symptoms. If the tumour arises in the head of the pancreas it can compress the bile duct, which can cause jaundice – presenting as yellow eyes, yellow skin, dark coloured urine or pale-coloured stools.
“The real challenge is that pancreatic cancer occurs rarely and the signs and symptoms occur commonly, and are usually signs of something else,” says Professor Rachel Neale, head of the Cancer Aetiology and Prevention Laboratory at QIMR Berghofer Medical Research Institute, Brisbane, where one of two groundbreaking new pancreat ic
cancer early detection research projects are being undertaken. “The challenge for both patients and GPs is deciding when it’s something that needs to be investigated.”
Often, she says, it might be a case of seeing where these symptoms might be occurring in tandem. “Let’s say you have upper abdominal pain and you’ve unexpectedly lost some weight, or lost your appetite – that could signal something is amiss with the pancreas.”
Another issue is that there is no
early screening test for pancreatic cancer, nor is there likely to be.
“Unfortunately screening all Australians for pancreat ic cancer is not a viable option. Instead, we are looking to identify who is most at risk of pancreatic cancer and determine whether monitoring this group would lead to bet ter outcomes,” Professor Neale says.
Like all cancers, pancreatic cancer arises due to mutat ions in a person’s DNA, but the exact causes of the disease are largely unknown. Risk factors may include smoking, obesity, pancr eat it is, heavy drinking, ethnicity, or an inherited genetic condition.
Such was the case for Fern Lecuna, 58, from Sydney. His father, Oscar Lecuna, had consulted his GP several times complaining of stomach pains and feeling unwell, for which he was prescribed various pi l ls. Eventually, Oscar consulted a new doctor who recommended aCT scan, which revealed he had stage 4 pancreatic cancer. Diagnosed in September 2020, just after his 81st birthday, the loving husband and father and devoted Reader’s Digest fan passed away in April this year.
Following his father’s diagnosis, Fern devoted his time to learning more about the disease. With the knowledge that his paternal grandmother had also battled pancreatic cancer, Fern could see there was a potential hereditary link. In consultation with the experts at Pan kind, Fern had aCT scan himself – only to learn that he had a tumour in his pancreas, as well as a 4.5cm spot in his liver.
He was in total shock – like Dr Baggoley, he had had no symptoms and was also very fit – running, cycling and attending the gym regularly.
“They wanted to operate that September, but because I had so much work to arrange, I waited until November 20,” recalls Fern. “The surgeon said if I had waited another three months my survival rate would have gone from 60 per cent to three per cent.”
During a mammoth nine-and-ahalf hour operation, Fern lost “half my stomach, 40 per cent of my pancreas, my gall bladder and my duodenum”. He is now being monitored for symptoms.
Researchers are now looking at how they can monitor families of pancreatic cancer patients to assess their risk and potentially increase early detect ions. And yet, genetically linked pancreat ic cancer only accounts for about ten per cent of cancer, so it’s only a small part of the puzzle.
The diabetes indicator
One primary area of interest for Professor Neale is the relatively strong link between diabetes and pancreatic cancer, particularly new onset diabetes, as was the case with Dr Baggoley, who went on to develop diabetes, which is being managed with pills, diet and exercise.
Says Professor Neale: “What we want to do, among all the people with late-onset diabetes, is predict the group who would be at the very high-end risk, who we could put into a structured surveillance screening programme for the next few years after their diabetes diagnosis, so if they do have pancreatic cancer, we’re able to pick it up earlier.”
The researchers are also interested in people whose long-term diabetes has recently become unstable and hard to manage, as that might also be an indicator of pancreatic cancer.
“Interestingly, diabetes is probably both a cause and a consequence of pancreatic cancer,” explains Professor Neale. “People with diabetes, over the long term, have an increased risk of getting pancreatic cancer, but people who have new-onset diabetes, that might have actual ly been caused by undetected pancreatic cancer.” A second research project, led by Associate Professor Andrew Metz at the Jreissati Family Pancreatic Centre at Epworth, Melbourne, is also exploring the diabetes link. Funded in partnership with PanKind and Tour De Cure, it unites the disciplines of gastroenterology and endocrinology to explore their different perspectives of pancreatic disease.
Why such a strong focus in this area? Of the patients with pancreatic cancer, about 50 per cent have a diagnosis of diabetes. And about a
THERE IS A LINK BETWEEN DIABETES AND PANCREATIC CANCER
quarter have had a diagnosis of diabetes within the previous three years.
“This really gives us an exciting opportunity to try and work out which one of these patients, who has been diagnosed with diabetes or has underlying pancreatic disease, would be suitable for ongoing testing to see whether pancreatic cancer can be detected,” says Associate Professor
Andrew Metz. To assist them, the researchers will be linking the national data of thousands of patients who have pancreatic cancer over the past 15 years, using sophisticated, non-personal-identifying machine-learning methods to predict people’s risk of pancreatic cancer.
“By making the most of existing data we can hopefully understand
more about the disease faster,” says Professor Neale, admitting that all of this research is still in the early stages.
“There’s a long road ahead, but we just need to chew it off bit by bit,” she says.
But just as important as all the research work being done globally, she says, is that patients advocate for their own health.
“I think it’s well worth people being aware that if they’ve got diabetes, a history of smoking, they’re overweight and then they get tummy pain, they shouldn’t just ignore it,” says Professor Neale. “It’s encouraging people to listen to their own bodies and be aware of their risk factors, and present to their GP when they feel they have something of concern.”
“If someone’s got the symptoms they should persist,” concurs Dr Baggoley. “They shouldn’t just put up with it for months and say, ‘Oh well, I was told it wasn’t anything important.’ Everyone has to think about it.”
It’s undeniably a challenging road ahead, but for pancreatic cancer patients and the loved ones left bereft by the rapidity and devastation wrought by this disease, it’s essential that the fight continues on every level.
“This needs a combined attack,” concludes Dr Baggoley. “There’s a lot to be done and I can help in that, and as I say to people, ‘while I can, I will’.”