Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Ajith Siriwardena, University of Manchester, UK
- Second opponent: Professor Roald Flesland Havre, University of Bergen, Norway
- Third member and chair of the evaluation committee: Professor Marianne Grønlie Guren, University of Oslo
Chair of the Defence
Professor Knut Lundin, University of Oslo
Principal Supervisor
Professor II Knut Jørgen Labori, Oslo University Hospital
Summary
Early diagnosis of pancreatic cancer is crucial but challenging due to vague and late-onset symptoms. At time of diagnosis, only 15% of patients are upfront resectable, while 50% present with metastastic disease. Borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC) constitute 35%. These subgroups, previously deemed inoperable, are now managed with neoadjuvant chemotherapy to increase the chance of resection. Surgery is the only curative option and may improve 5- year survival from <10% to 25-30%. CT, MRI, endoscopic ultrasound and tissue biopsies are used in the diagnostic work-up. Biomarkers such as CA19-9 can support diagnosis and monitoring, although with limitations.
FOLFIRINOX or gemcitabine-based regimens are now standard chemotherapy and in selected patients with MSI-high genetic profiles, immunotherapy has shown promising results. Prior to neoadjuvant therapy, a tissue biopsy confirming malignancy and biliary decompression are necessary and found feasible and safe as a combined procedure. Combination of chemotherapy and resection in advanced pancreatic cancer demonstrates equal survival rates as to those undergoing upfront resection. In this study, we found a resection rate of 47% for BRPC and 13% for LAPC. Receiving gemcitabine monotherapy was a significant negative prognostic factor for resection and survival as well as CA19-9 baseline value >500 mmol/. In analysis of the surgical specimen, only CAP grade 3 was significantly associated with poor survival.
Quality of life is essential in the management of pancreatic cancer. While many patients experience treatment-related side effects, those who undergo successful resection may return to baseline quality of life, with improved symptoms and functional status within a few months.
A combined approach involving early diagnosis, surgery, chemotherapy, and emerging treatments, together with equitable access to healthcare, is essential to improve outcomes for patients with pancreatic cancer.
Additional information
Contact the research support staff.