One of the most difficult questions a physician can be asked by a patient with pancreatic cancer is, “what is my life expectancy?” This question is particularly difficult to answer because no two patients are alike, yet it is only natural for patients to assume that their outcome will be that of the average or typical patient. Statistics tell us what is likely to happen to a group of patients, not an individual. Nonetheless, this is an important question as patients need to make appropriate life plans. The below information on survival of patients with pancreatic cancer is therefore presented with the adage “plan for the worst and hope for the best” in mind. Simply put, we firmly believe that there is ALWAYS hope. These statistics should be used to make realistic plans. They SHOULD NOT discourage nor should they be taken as an indication of what will actually happen to a particular patient. We have all seen or read about patients whose life expectancy was a few months, but who lived many happy years.
Life expectancy for patients with pancreatic cancer depends on stage and treatment. In general, patients with higher stage (more advanced disease) do worse than do patients with lower stage (disease which is small and which has not spread to the lymph nodes or other organs). For more information on staging see http://pathology.jhu.edu/pancreas/DiagStaging.php In general, patients who have their tumors removed surgically do better than do patients whose cancers cannot be removed surgically.
The web site of the government’s Surveillance Epidemiology and End Results (SEER) program (http://seer.cancer.gov/statfacts/html/pancreas.html#survival) provides the below overall statistics for survival loosely based on stage. This is for “all comers” and does not factor in treatment.
|Stage at Diagnosis||5-year
Relative Survival (%)
|Localized (confined to primary site) Stage I or IIa||22.5|
|Regional (spread to regional lymphnodes) Stage IIB or III||8.8|
|Distant (cancer has metastasized) Stage IV||1.9|
The survival for patients who have their tumor surgically resected is somewhat better. We reported the experience here at Johns Hopkins with 1423 patients who had their pancreatic cancers surgically resected (Journal of Gastrointestinal Surgery 2006; 10:1199-210). The median survival was 18 months, the one-year survival was 65%, the two-year survival 37%, the five-year survival 18%, and the ten-year survival was 11%. The size of the tumor, the status of the resection margin (did the surgeon have to cut across the cancer and leave some behind), the lymph node status (had the cancer spread to the lymph nodes), and the histologic grade of the tumor (how much the cancer look like normal cells under the microscope) all impacted on survival. Patients with small, margin negative cancers that had not spread to lymph nodes and which were low-grade (well-differentiated) did better than patients with large, margin positive cancers which had spread to lymph nodes and which were histologically high-grade (poorly differentiated). For example, for cancers 3 cm or smaller the median survival was 21 months; the one-year survival was 73%, the two-year survival 45%, and the five-year survival was 23%. Similarly, for cancers with no positive lymph nodes, the median survival was 23 months; and the 1-, 2-, and 5-year survivals were 73%, 50%, and 27% respectively.
We would like to stress that these statistics are more of a reflection on where pancreatic cancer has been, and not where it is going. New chemotherapies and combinations of new therapies are constantly being tested in clinical trials, new “personalized” therapy regimens are being evaluated, multi-disciplinary approaches for the care of patients have been initiated (http://pathology.jhu.edu/pancreas/ChooseMDT.php), vaccines are being developed to target pancreatic cancer immunologically, and scientists have advanced our understanding of the fundamental biology of the pancreatic cancer cell by leaps and bounds. We sincerely believe in a bright future.
Again, we would like to emphasize that in presenting these statistics in such a frank manner we do not wish to discourage anyone. Instead, our goal is to educate, and in so doing empower patients as they work together with their physicians to chose the therapies that are best for them.