Prognosis and survival for pancreatic cancer

A prognosis is the doctor's best estimate of how cancer will affect you and how it will respond to treatment. Survival is the percentage of people with a disease who are alive at some point in time after their diagnosis. Prognosis and survival depend on many factors.

The doctor will look at certain aspects of the cancer as well as characteristics of the person (such as their age and if they have any other illnesses). These are called prognostic factors. The doctor will also look at predictive factors, which influence how a cancer will respond to a certain treatment and how likely it is that the cancer will come back after treatment.

Prognostic and predictive factors are often discussed together. They both play a part in deciding on a prognosis and a treatment plan just for you. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments you have and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis and chances of survival.

The following are prognostic and predictive factors for pancreatic cancer.

Resectability is whether a tumour can be removed with surgery. It is the most important prognostic factor for pancreatic cancer.

Surgery is the most effective treatment for pancreatic cancer, so tumours that can be removed with surgery (are resectable) have a much more favourable prognosis than tumours that cannot be removed with surgery (are unresectable). Early-stage cancer, smaller tumours and tumours that have not spread to other tissues or blood vessels are most likely to be resectable.

People with early-stage pancreatic cancer have a better prognosis than those with advanced pancreatic cancer.

The extent of resection is whether there is cancer left in the margin of tissue removed along with the tumour during surgery, and if so, how much.

Resectable tumours that have cancer cells left in the margin after surgery to remove the tumour (called positive surgical margins) have a poorer prognosis than those that don't (called negative surgical margins).

People with low-grade neuroendocrine tumours of the pancreas (cancer that started in the endocrine cells) have a better prognosis than people with other kinds of pancreatic cancers, such as pancreatic adenocarcinoma.

Performance status measures how well a person can do ordinary tasks and daily activities. It is based on the Eastern Cooperative Oncology Group (ECOG) score. Generally, the more active someone is and the more able they are to continue their normal activities of daily living, the better their performance status.

Because people with a good or fair performance status (ECOG score 0 or 1 – those who can function fairly normally) can usually tolerate treatments for pancreatic cancer better, they usually have a better prognosis than those with a poor performance status (ECOG score 2 or higher – those who need help with daily activities or need to spend a lot of time in bed).

Tumours that started in the head of the pancreas usually have a better prognosis than those that started in the body or tail. Tumours in the head of the pancreas often cause symptoms sooner and are more likely to be found at an earlier stage.

Studies suggest that when pancreatic cancer spreads to the lymph nodes (both regional and distant lymph nodes), the prognosis is poorer.

Pancreatic tumours that are more differentiated and slow growing (low grade) have a better prognosis than tumours that are fast growing (high grade).

Studies suggest that people with a very high carbohydrate antigen 19-9 (CA19-9) level at diagnosis have a poorer prognosis than those with a lower CA19-9 level.

Not all people with pancreatic cancer will produce CA19-9.