Prognosis in case of non-operated pancreatic cancer
If the affected persons are very old or have many concomitant diseases, a palliative procedure is chosen in the case of advanced pancreatic cancer, which has already affected large parts of the surrounding organs and has also settled distant metastases, as well as the lymphatic vessel system. Palliative treatment is not a curative, i.e. curative procedure, but a procedure that relieves symptoms and, if possible, prolongs life. Once a decision has been made in favour of such a procedure, no further operations are performed.
As a rule, chemotherapy is also no longer started. The focus of this treatment strategy is pain management and symptom relief. For example, by inserting a small tube, the pancreatic duct can be kept open, thus creating a free passage for the accumulated bile acids.
The 5-year survival rate of palliatively treated patients is 0%. This means that no patient who is treated only symptomatically and not by chemotherapy or surgery is still alive after 5 years. In this case one speaks of a fist-favorable prognosis.
On average, patients who have received palliative therapy live another 6 months. These figures also do not take into account the quality of life of the patients. If the tumour is regionally limited, a corresponding treatment, which is in principle considered curative, is applied.
This includes both surgery and chemotherapy, which can be carried out either before or after surgery. There are also tumour stages in which only chemotherapy is carried out and surgery is not required. Depending on which procedure is chosen, the prognosis and 5-year survival rates also differ.
Survival rates after surgery
The surgical measures available are the so-called Whipple operation, in which the pancreas and duodenum are removed and the adjacent and upstream organs are surgically connected. Nowadays, the preferred surgical procedure is the removal of the duodenum and pancreas, but the stomach is left standing completely (the Whipple procedure also involves the removal of parts of the stomach entrance). Since the results of both operations are almost identical, the second operation is usually chosen because it is more gentle.
If there is a limited tumour infestation in parts of the pancreas, while surrounding organs as well as the lymphatic system are tumour-free and the appropriate surgical method is used, the 5-year survival rate is 40%. This means that 40% of patients who undergo this treatment are still alive after 5 years. The statistics do not tell us anything about how many patients are still alive after 7-10 years.
Survival rate after combined surgical interventions with chemotherapeutic agents
Sometimes it may be necessary to start treatment with a chemotherapeutic agent before an operation, which should achieve that the tumour in the pancreas is already somewhat reduced in size. If the tumour is reduced in size, not only is the patient’s burden relieved, as, for example, congested bile ducts are decompressed, but the reduction in size of the tumour also makes the subsequent operation easier to perform, as not quite as much pancreatic tissue has to be removed. In general, the surgical procedure is therefore gentler, even if treatment with chemotherapeutic agents is described as more stressful for the patient.
The combination of chemotherapy and surgery is mainly performed when the tumour has already spread beyond the pancreas. If no chemotherapy is given prior to surgery, the entire tumour could never be removed, even if the pancreas has been removed. Chemotherapy can also be carried out after an operation.
Here the consideration is that, if necessary, the main tumour in the pancreas has been removed, but small tumour cells have already spread to the surrounding tissue without necessarily affecting other organs. Here, the treatment with chemotherapy after an operation is used to kill any escaped malignant cells afterwards. After chemotherapy after surgery, the average 5-year survival rate is 30%.
If only surgery is performed without chemotherapy, statistically 15% of patients are still alive after 5 years. However, these are carcinomas that have already spread or have metastasized by remote control, but for various reasons have decided against preceding or subsequent chemotherapy. In addition to the 5-year survival rates, which refer to certain treatment strategies, there is also an average 5-year survival rate for some oncological diseases, i.e. the absolute average survival rate.
As all types of treatment are included in this average, the result is extremely imprecise, as individual measures (such as time of tumour diagnosis, affected areas, distant metastasis and applied treatment) should also be taken into account for each patient. The average 5-year survival rate, which includes all types of treatment and all stages of disease, should therefore be used exclusively for comparison with other oncological diseases and should not be applied to the individual patient. In the case of pancreatic cancer, the average 5-year survival rate including all treatment methods and all stages of the disease is 5%.
This means that on average 5% of patients are still alive after 5 years. If one takes this value and compares it with the values of other oncological diseases, it becomes clear that pancreatic cancer is one of the most malignant cancers with one of the worst prognoses.
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