People with pancreatic cancer may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a person's medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognosis is the doctor's best estimate of how cancer will affect a person, and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together and they both play a part in deciding on a treatment plan and a prognosis.
Pancreatic cancer is difficult to detect and diagnose because of the location of the pancreas in the body. Pancreatic cancer does not cause signs and symptoms in its early stages. Vague signs and symptoms occur late. Because of this, most pancreatic cancers have metastasized at the time of diagnosis.
The following are prognostic and predictive factors for pancreatic cancer.
Stage
The most important prognostic factor for pancreatic cancer is the extent of the disease. As a general rule, the prognosis is more favourable if the cancer is found early. The best estimate of the extent of disease is given by the stages defined by the TNM system. Overall, the lower the stage, the greater the likelihood of cure following surgical removal of the tumour.
Surgical removal
If a tumour can be completely removed by surgery, the prognosis is more favourable than when a tumour cannot be removed. The factors that are involved in deciding whether or not a person can undergo potentially curative surgery are complicated. The most important medical factors are the stage of the tumour and the person's general health.
Surgical margins
Clear surgical margins (borders) indicate a better prognosis.
Performance status
People with a high performance status (Karnofsky performance score higher than 70) before surgery have a better prognosis than those with a lower performance status.
Location of tumour
Tumours located in the head of the pancreas have a more favourable prognosis than those in the body or tail.
Grade
A low-grade (well-differentiated) tumour has a more favourable prognosis than a high-grade (poorly differentiated) tumour.
Tumour marker levels
High blood levels of the tumour marker CA19-9 have been linked with a less favourable prognosis.