Information about pancreatic cancer.
What is pancreatic cancer?
The pancreas is an organ that lies behind the stomach. It makes enzymes that help break down food so it can be digested. It also releases hormones, particularly insulin which is important for regulating the amount of sugar in your blood stream.
Several tumours can occur in the pancreas, and these can be either cancerous or non-cancerous. The most common cancer starts in the cells lining the ducts of the pancreas that carry digestive enzymes out of the pancreas into the duodenum (first part of the small intestine). This is called pancreatic ductal adenocarcinoma.
Who can be affected by pancreatic cancer?
Anyone can be affected by this cancer. It is commonly found in people over the age of 45 years. Pancreatic cancer is slightly more common in Māori and Pacific peoples.
Anything that can increase your risk is called a risk factor. Having one or more of these risk factors does not mean that you will develop pancreatic cancer. Even if you have no risk factors you can still develop pancreatic cancer.
- Heavy drinking
- Having a family cancer syndrome also linked to breast, bowel, prostate and ovarian cancer (BRACA 2 mutation or Lynch syndrome)
- Chronic inflammation of the pancreas (pancreatitis)
- Family history of pancreatic cancer
Signs and symptoms
Pancreatic cancer does not cause many signs or symptoms in its early stages when it is most curable. This is because it does not generally cause symptoms until it has spread or the tumour is large enough to block the bile duct and cause jaundice. The symptoms that occur with pancreatic cancer can also occur with lots of other conditions.
Symptoms may include:
- Abdominal pain, commonly radiating to your back
- Loss of appetite
- Unintended weight loss
- Yellowing of your skin and the whites of your eyes (jaundice)
- Light-coloured stools
- Dark-coloured urine
- Itchy skin
- New diagnosis of diabetes or existing diabetes that's becoming more difficult to control
- Blood clots
There is no examination that is specific for the diagnosis of pancreatic cancer. Most patients will need to have several tests and scans to confirm a diagnosis of pancreatic cancer:
- Blood tests - including one to measure CA19-9, a protein that can be elevated in pancreatic cancer (but also other non-cancerous conditions such as cirrhosis of the liver)
- Ultrasound - usually the first imaging investigation requested
- CT scan - if the ultrasound shows something abnormal
- Possibly a MRI or PET scan - depending what is seen in the CT scan
In order to confirm the diagnosis, a sample of the tumour may be removed. This is done by an endoscopic ultrasound and biopsy. An endoscope is a flexible tube that is passed through your mouth and down to your stomach. It has an ultrasound attached in order to obtain pictures of your pancreas and this can also be used to get a tissue sample.
If you are suspected to have pancreatic cancer, you will be referred to a specialist called a hepatobiliary surgeon. A team of health professionals with expertise and experience with pancreatic cancer will look after your care.
The treatment for pancreatic cancer depends on stage (how far it has spread), the severity of your symptoms and your preferences.
If you are jaundiced you may need a small stent put in to relieve the blockage that is causing the jaundice.
Many surgeons perform a laparoscopy (keyhole surgery) to confirm that the cancer has not spread. If the cancer hasn’t spread then they can operate to remove the tumour.
Other treatment may include chemotherapy (medicines to destroy cancer cells) which can be given before or after surgery. There are many different types of drugs and you may be on a single drug or a combination of more drugs.
Some people may need radiotherapy (radiation treatment). This can also be before or after surgery. Occasionally it is given if people are not suitable for surgery to help minimise symptoms.
Unfortunately, pancreatic cancer has poor long-term survival as it is usually diagnosed once it has spread. If diagnosed early it can be cured. Prompt investigation of symptoms is important to ensure pancreatic cancer is diagnosed and treated as early as possible.