Pancreatic cancer remains a troubling area of cancer research for scientists, even as inroads are made in other forms of the disease, according to new data released by the Canadian Cancer Society.

Survival rates for blood-related cancers have improved more than any other type, from 16 to 19 per cent. Female breast cancer death rates have decreased by an estimated 48 per cent since they peaked in the 80s. And incidence and death rates from lung cancer—the most likely form of cancer a Canadian will be diagnosed with—have recently started to decrease in females.

Cancer survival rates overall have increased by 8 per cent since the early 90s, from 55 to 63 per cent. The improvement is largely due to research that has led to improvements in precision medicine that tailors therapy to the patient, said experts. 

But pancreatic cancer remains a “harder nut to crack,” said Dr. Jennifer Knox, an oncologist at Princess Margaret Hospital.

It is expected to shift from the fourth to the third leading cause of Canadian cancer deaths this year, surpassing breast cancer, according to the new report.

“We’re not winning on this one yet,” Knox told CTV News. “A lot of the gains that have been made in other areas… haven’t really worked in pancreas cancer. It’s different. It’s harder to treat, and it’s probably not as uniform as we thought it was.”

Researchers have been unable to identify why incidence of pancreatic cancer are on the rise. They recognize risk factors—smoking, diabetes, obesity, history of pancreatitis, certain blood types, family history—but explanations are still hazy. “It isn’t as cause-and-effect as smoking with lung cancer was at one point in time,” said Knox. 

Recent research has shown that “rare subtypes” of pancreatic cancer respond better to chemotherapy than average types. “We’re starting to slowly but surely tease out little tiny groups of pancreas cancer who now are doing much better than, say, five years ago,” she said.

It’s not just difficult to treat, but difficult to catch, as symptoms can include such vague issues as fatigue, nausea and lack of appetite. 

For Ingrid Bryan, the symptoms weren’t particularly alarming when she was diagnosed two years ago. “I just didn’t feel very good—that’s all—stomach-wise. You think of all sorts of things. Your diet. Perhaps you’re suffering from some sort of allergy. I didn’t think very much about it. But it didn’t get any better, so I finally went to the doctor about it,” said Bryan, whose father died of pancreatic cancer. 

Three-quarters of cases in Canada are diagnosed in Stage 4, when the cancer has spread to other parts of the body. That’s what happened to Radomir Stojadinovic of Tillsonburg, Ont. Doctors found his cancer last December.

“My symptoms started almost nine months before they diagnosed me,” he said. “I kept steadily losing weight and appetite.” Then doctors discovered Stage 4 pancreatic cancer that had spread to his liver. He has undergone 11 rounds of chemotherapy and is now on a medication to keep the cancer stable. He is fishing and feels well. “I feel perfect,” he said.

Still the urgency for more research has never been more apparent. For Michelle Cappobianco, executive director of the Pancreatic Cancer Canada Foundation advocacy group, the numbers reflect a reality that may worsen.

“We know that it’s on a trajectory to be the second deadliest cancer by 2030. The results, while disturbing, are not unexpected. Pancreatic cancer is the only major cancer where the incident rate is increasing,” said Capobianco. 

PC Canada is now funding five studies, some into the tailoring of treatment to the patient. Bryan is a part of that study and doing well. “I’ve had a great life the last two years and I’m still feeling well,” she said. “That’s thanks to the treatment.”

There is hope in new research, said Cappobianco, adding that Canadians should look to other research successes for some optimism amidst the dire numbers.

“If you look at breast cancer, 40 years ago it was exactly where pancreatic cancer is today,” she said. “If we can make similar investment in pancreatic research, we can turn these statistics around.”