Pancreatic cancer

Pancreatic Cancer

Your pancreas sits behind the lower part of your stomach. It releases enzymes that assist with digestion and the hormone insulin to help your body process blood sugar.

Pancreatic cancer doesn’t normally produce any symptoms in the early stages, which means it can be difficult to diagnose until it is more advanced when there is a risk that it has spread to nearby organs. If you have a family history of pancreatic cancer or pancreatic cysts you will normally be offered screening to pick up any problems in the early stages.

Causes of pancreatic cancer

There are different types of pancreatic cancer.

Some arise from the exocrine cells such as pancreatic adenocarcinoma and others are from the endocrine cells called neuroendocrine tumours.

The exact cause of pancreatic cancer is not known however there are some risk factors which have been identified, these include:

  • Increasing age
  • Smoking
  • Being overweight
  • A background history of chronic pancreatitis
  • A family history of pancreatic cancer (and other cancers)
  • Diabetes

Other possible risks include increased alcohol consumption, diet containing processed meat. There are also genetic mutations that can be inherited.

Symptoms of pancreatic cancer

If you experience symptoms, they can be intermittent and not always easy to pinpoint. However, jaundice or pain in the upper abdomen leading around to the back should always be investigated as these can be an indicator of pancreatic cancer, particularly when accompanied by weight loss.

Pancreatic cancer shares many symptoms with other, less serious conditions such as irritable bowel syndrome, hepatitis, gallstones and pancreatitis. For this reason, it is important to see your doctor if you experience any of the symptoms listed below. Most times they won’t be caused by pancreatic cancer:

  • Pain in the abdomen and back – Often this starts as tenderness in the stomach before spreading to the back and becoming more painful. Pain levels can vary from person to person. It may be worse after eating or when lying down.
  • Unexplained weight loss – The pancreas plays a key role in digesting food and processing nutrients so losing weight for no reason can be an indicator of pancreatic problems.
  • Indigestion.
  • Jaundice (yellowing of the skin and eyes, itchy skin and dark coloured urine).
  • Loss of appetite.
  • Nausea and vomiting.
  • Pale, smelly stools that may float and can be difficult to flush away (steathorrhoea).Steathorrhoea is caused by fat in the stool because the enzymes that normally break it down are not being released by the pancreas.
  • Diarrhoea or constipation.
  • Digestive problems, including feeling full very quickly when eating, wind or bloating.
  • Difficulty swallowing which may feel like there is something stuck in your throat. This can cause coughing, choking or vomiting.
  • Recently diagnosed diabetes. When the pancreas stops working properly it may not produce enough of the hormone insulin, which helps to control the amount of sugar in the blood. This can lead to the development of diabetes.
  • Fatigue.
  • Depression.
  • Deep vein thrombosis.
  • Fever and shivering.
Consultation with a specialist, who can conduct the necessary diagnosis tests, is the first step to better understanding your symptoms.

Diagnosis of pancreatic cancer

Tests to diagnose pancreatic cancer include:

  • Blood test to check for proteins that indicate the presence of cancer cells.
  • Imaging including CT, MRI and PET scans.
  • Endoscopic ultrasound (EUS) to obtain detailed images of your pancreas from inside your abdomen. This test can also allow direct sampling of the pancreatic tissue in the form of a biopsy.

Pancreatic Cancer Treatment

The treatment you are offered will depend on the location of the cancer and what stage it is at.

You may be offered:

  • Radiation therapy, which uses radiation to destroy cancer cells.
  • Chemotherapy, which uses drugs to kill cancer cells. These can be injected or taken orally. Chemotherapy may be combined with radiation therapy.
  • Surgery including:
  • Whipple procedure, which is for cancer in the head of the pancreas. It involves removing the head of the pancreas, first part of the small intestine, gallbladder and part of the bile duct.
  • Distal pancreatectomy, which involves removing the tail of the pancreas. Your spleen may also be removed.
  • Total pancreatectomy, which is the removal of the entire pancreas. You will need insulin and enzyme replacement therapy if your pancreas has been removed.
  • Patients with pancreatic cancer can become jaundiced when the bile duct becomes blocked. In this case an ERCP can be performed and a stent placed to alleviate the jaundice and its associated symptoms.

If you have advanced pancreatic cancer, you will have involvement from the palliative care team, who focus on pain reliefand managing symptoms to help you to feel better and live well for as long as possible.

There are clinical trials underway currently to advance the treatment of pancreatic cancer including the endoscopic injection or radioactive treatment (Oncosil trial) and you may wish to consider this.

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A consultation with a specialist to discuss the necessary diagnostic tests is the first step.