facing pancreatic cancer with hope for a better future in early detection and precision medicine
11 minute read
dan murphy, second from right, is not weak and housebound by his disease. while he can be foggy and forgetful, he’s able to get out and enjoy walks with his dog, social time with friends and family, pictured, and even a recent vacation out of the country.
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this article was produced by the healthing editorial team with the support of a grant from pancreatic cancer canada. while pancreatic cancer canada made the production of this article possible, they did not have any editorial influence or control over the content, including review prior to publication.
most people with pancreatic cancer don’t live long enough to tell their cancer story themselves. it’s a cancer that’s usually detected in the advanced lethal stages. but dan murphy is still here after a diagnosis of stage 4 pancreatic cancer in 2023 and determined to give others hope.
“the drug that i’m on now, which is fairly new and cutting-edge, is allowing me to live as fully as i possibly can and i’m super thankful for it,” says dan, a toronto business executive who never expected pancreatic cancer at age 53. he credits the support and advocacy of his wife kathy, and the emerging treatment options he’s been offered through genetic testing.
“the prognosis hasn’t changed. the outlook is i have stage 4 pancreatic cancer and that’s bad news. what [the treatment] did change for me is the quality of life that i’m able to experience 16 months later. i’m physically active and i’m doing quite well, so i’m a rarity.”
canadian statistics show that pancreatic cancer has the highest mortality rate of all major cancers, including breast or prostate cancer. the five-year survival rate is 10 per cent, which means that 90 per cent of people diagnosed with pancreatic cancer will die. and a significant 70 per cent of patients die within the first six months.
advocacy as a silver lining with pancreatic cancer
dan, however, is not weak and housebound by his disease. while he can be foggy and forgetful, he’s able to get out and enjoy walks with his dog, social time with friends and a recent vacation out of the country. in fact, he talks about the silver linings of pancreatic cancer and joining the movement to advocate for research funding and access to care through the national non-profit pancreatic cancer canada.
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pancreatic cancer north america
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“part of what’s fueling me is the hope that some of my legacy, frankly, is that i can leave behind the ability for other people in my circumstance to have some hope,” he says, focusing on the positives. “if i can help drive awareness around all of these things – early detection, genetic testing and precision medicine – then people will know there are paths to hope, not just in toronto, but in timmins and tofino and anywhere across the country.”
and while emerging science is improving quality of life, at the same time, younger people are dying from the disease. emerging trends show that one of the highest rates of increased incidence is among women under the age of 55. and recent research reveals that gen-xers and millennials are facing a significantly higher risk of developing 17 types of cancer than previous generations (pancreatic cancer is in the top three). in fact, pancreatic cancer is on track to become the second leading cause of cancer-related deaths by 2030. rates of diagnosis are increasing, but survival rates haven’t changed much in the last 35 years largely because it’s a fast-growing cancer that is often found late.
dan has come out in front of his cancer because of advocacy on his own part (and his wife kathy) along with advocacy by his doctors, and previous knowledge of what cancer looks like. as kathy says, “we had lived with my mother through glioblastoma cancer. we had lived through dan’s mother’s passing from breast cancer. and we’ve learned through that experience the importance of advocacy.”
dan and kathy murphy enjoying a sunny day on the dock.
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but dan’s cancer started with some symptoms that weren’t in any way alarming like a mild stomachache that didn’t go away. he stopped drinking milk thinking he might have a food allergy, but it lingered long enough that he went to his family doctor.
“i went into that appointment, not feeling there is anything grave at all. i was about to turn 53 and things get a little creaky all around as we’re aging,” he says. “i remember distinctly, she said, ‘you know, there’s something up and we’ll get to the bottom of it.’” he left the appointment with a requisition for an abdominal ultrasound and blood work to test for a broad range of indicators to identify the problem.
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this was the first of many steps toward his survival. one of the hurdles in pancreatic cancer is the lack of knowledge about the warning signs like back pain, jaundice and gastrointestinal discomfort. awareness of these could speed up diagnosis and change outcomes.
“not to take this lightly, because i think a lot of doctors would just give dan something digestive and send him on his way based on how he was explaining his symptoms,” kathy says. “so the fact that she said she’s going to get to the bottom of it and she made that ultrasound requisition is a very critical part of dan’s story, because if he had gone any longer we would probably not be where we are today.”
early detection still a missing piece of the puzzle
dr. anish kirpalani, chief of radiology at st. michael’s hospital in toronto, specializes in abdominal radiology and sees a lot of pancreatic cancer. abdominal radiologists are usually the first who identify the cancer and triage patients to surgeons, gastroenterologists and medical oncologists. “we’re involved in the multidisciplinary care of those patients and we go to what we call tumour conferences where we meet with other specialists to talk about treatment, imaging and the radiology studies that we do on those patients, specifically ct scans [cat scans] and mri scans.”
kirpalani had the misfortune of diagnosing his mom with pancreatic cancer in 2008.
“that’s a radiologist’s worst nightmare,” he says, explaining his personal experience led to his advocacy work with pancreatic cancer canada where he now serves as chief medical advisor. the death of his mother from pancreatic cancer also prompted his support of research and clinical programs in the disease detection and treatment.
there are advances in both surgical and non-surgical treatment that have been made in the last 15 years, he says. “one of the paradigm shifts that’s occurred is that we now have surgeons who can treat this for those who are eligible for surgery. you have to be detected early enough to be eligible for surgery, though, and that number is still a bit too low with only 20 to 30 per cent of people.” he also highlights the preoperative chemotherapy and drug regimens that improve the cancer situation prior to going into surgery and open up the options for treatment.
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early detection, however, has not progressed.
“this is an extremely difficult cancer to find early, and this is where i want to emphasize the point that people talk about cancer as a disease. it’s really quite heterogeneous. thyroid cancer does not resemble pancreatic cancer in the least. it’s almost a misnomer to think of these kinds of things as cancer collectively,” kirpalani says.
pancreatic cancer is not as easy to find early compared to forms of uterine cancer or colorectal cancer, for example, where patients have early bleeding to signal there might be something wrong and worth investigating. he notes in pancreatic cancer, there may be vague back pain or 5lbs of weight loss. “now this primary care physician is tasked with finding out what’s wrong with this patient among the hundred things that could be wrong with them. that leads to delays and diagnosis because sometimes the wrong test is ordered and the wrong work-up is done. the wrong pathway is taken.”
connecting the dots with genetic testing and precision medicine
dan knows he’s been lucky. about two weeks after his ultrasound, he got a call from his family doctor who told him there was a spot showing on the imaging. she asked him to come into her office to pick up a new requisition for the bloodwork that added a test for tumour activity. he took it in stride, knowing that spots can be a lot of things, especially for people who live in cities where pollution impacts health. but the revelation led him and his wife to reach out to other experts to dig into what could be happening.
he told his doctor that his mom had died from breast cancer and could there be a genetic link. she quickly decided to investigate genetic testing and get a cat scan booked. cat scans typically have long wait times and dan was in contact with every hospital in toronto to make himself available for a cancellation. at the same time, his doctor referred him to a pancreatic surgeon, as well as a program at toronto general hospital that does genetic testing for people who might have pancreatic cancer. she also connected him with the city’s renowned princess margaret cancer centre.
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“so before we even knew conclusively, we got things going,” kathy says, stressing the need for speed in pancreatic cancer where survival is “a race against the clock.”
thanks to their tenacity, the cat scan happened within 10 days of the initial news from his family doctor, and within weeks the couple met with the surgeon who told them he could operate to remove the cancer. the surgeon referred him to an oncologist to confirm the diagnosis, who felt optimistic because the scans showed the cancer was possibly stage 2 or 3, less lethal than stage 4.
but the meeting was followed by another twist. dan got a call from the geneticist who explained that he did have brca2 gene mutation for breast cancer, so his pancreatic cancer was genetically linked back to his mom. about five to 10 per cent of people with the harmful brca2 mutation will develop pancreatic cancer during their lifetime. the good news, thanks to cancer research, was that a type of chemotherapy for the gene mutation could be effective before proceeding with surgery. the couple had 24 hours to make a decision because the surgery booking would be given to someone else.
“we really had no knowledge about any of this and there is no science yet to tell you what the right thing to do is,” kathy says, adding that the geneticist put them in touch with a princess margaret expert in pancreatic cancer oncology and treating people with genetic mutations like brca2. her name, the couple is grateful to share, is dr. erica tsang.
dan and kathy murphy taking a boat ride.
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“she said, ‘i can’t tell you conclusively that it’s going to be better, but the research is certainly showing that if you do this first, it will make for better surgery, which will give you a better end result,’” kathy recalls. they decided to hedge their bets on the genetic results and targeted chemotherapy – the path for precision medicine that is evolving in medical treatment in most areas. the cancer might have spread, as the surgeon had told them, meaning he wouldn’t be able to remove it in surgery and dan would have to be “sewn back up” only to wait several months to recover before other treatment could go forward.
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“just in the nick of time, the results from that genetic testing came in, so it’s hugely key if everybody that has pancreatic cancer could be as fortunate as i am to have gotten that more people with pancreatic cancer would still be here,” says dan.
the cat scans repeated at princess margaret revealed that his cancer had metastasized to his liver and he was diagnosed with stage 4 pancreatic cancer.
“hearing that in the doctor’s office at princess margaret on that monday in early june was absolutely devastating. i’m up now 16 months later telling the story that our future, the way we thought it would play out, was now changed forever,” he says with a calm acceptance that you have to admire. he hasn’t worked at his job since june 2023, moving to long-term disability and appreciating each day as it comes.
for dan, chemotherapy over the next six months was tough but effective, shrinking the tumour and stopping the growth of lesions on his liver. about two months into chemo, he got his results from the genomic testing. because of his specific gene mutations, he is part of the two or three per cent of pancreatic cancer patients that have responded well to a new therapy in development. he’s on it now, with success, to stop his cancer from growing.
“had i not gotten the genetic results which allowed the experts and us to make a decision in that little tiny window of time, i would have had the surgery. the surgery would have been unsuccessful because they would have discovered the metastasis when they opened me,” dan admits. “it would have been a much different story for me when it comes to quality of life. these things are emerging, they’re new. and one of the challenges with pancreatic cancer trials is there aren’t enough people that survive pancreatic cancer to create scale to be able to run these clinical trials. so many people pass away so quickly.”
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hope for pancreatic cancer patients in the future
if more people with pancreatic cancer have genetic testing, the knowledge and pool of data will grow so that researchers can develop more precision treatments, he says.
“this is why there is hope, even in the worst cancers, because if they can make a connection between your genetics and proven treatments, they can start treating you based on your genetic mutations and not just where the cancer is in your body.”
this summer, dan and kathy toured the oncology labs at toronto’s mars discovery district, an urban innovation hub and a registered charity that is moving science forward.
“there are people there developing plasma tests to detect early-stage pancreatic cancer, they’re looking at vaccines, they’re looking at tests that used to take a year, they can do it in a day,” dan says of the hope he holds onto and wants to share.
“all of that science is happening and it’s amazing. someday, cancers like pancreatic cancer will become more like living with a chronic disease. we’re not there today, but maybe that’s what happens.”
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