Pancreatic cancer Dr Trisha Macnair Every year in the UK over 7,000 people are diagnosed with cancer of the pancreas. Unfortunately, while the mortality for most cancers has fallen, this type remains very resistant to treatment, and the survival rate is still very low.

In this article

Introduction Causes

Symptoms Diagnosis

Treatment

The pancreas is a long gland which lies just below the stomach in the abdomen, which produces a number of different digestive enzymes and hormones. There are several different types of pancreatic cancer, and a tumour tends to develop silently, causing few symptoms and signs which might provide a clue to its presence until disease is well advanced.

Pancreatic cancer is equally common in men and women, but the majority of cases occur in the over-70s.

The exact cause of cancer of the pancreas is not yet known but risk factors may include:

• Smoking and other types of tobacco use
• A diet high in fat, sugar and red or processed meats, and low in fresh fruit or veg
• A history of chronic inflammation of the pancreas (known as pancreatitis), diabetes (a small increase in risk) or stomach ulcers
• In ten per cent of cases there is an inherited tendency towards cancer
• Being overweight or inactive
• Exposure to certain industrial chemicals, particularly chlorinated hydrocarbon solvents

The symptoms of cancer of the pancreas depend on the type of cancer and where it is. They are often very non-specific and include:

• Unexplained weight loss
• Abdominal pain (often described as a dull, gnawing ache that spreads to the back and is worse after meals)
• Jaundice
• Nausea and loss of appetite, back pain, itching of the skin, and diabetes
• Certain tumours can cause a wide range of odd symptoms related to the action of the hormone that the tumour cells produce
• Not all patients have all symptoms as they depend on the type of cancer and where it is (for example, a tumour in head of pancreas may present as painless jaundice and in the body and tail as abdominal or back pain without jaundice)

When problems are suspected with the pancreas, tests and investigations may include scans such as an ultrasound scan. A special type of ultrasound scan, which is done during an endoscopy or telescopic investigation of the intestines, enables doctors to look at the pancreas from deep inside the body. This sort of scan is known as an endoluminal ulatrasound or EUS. A biopsy or sample of suspicious tissue may be taken during this test. Your doctor may also recommend a CT or MRI scan, or sometimes another type of endoscopy called an ERCP (Endoscopic Retrograde Cholangio Pancreatography). ERCP may also be used for treatment because during the test a small tube may be left placed within the body to hold open the ducts and drain blockages which have caused jaundice.

Blood tests may be done to check for general signs of disease such as anaemia, as well as chemical markers in the blood which provide clues about certain types of cancer. These tests, and a small operation to look inside the abdomen if necessary, help the doctors to work out how far it has advanced and decide whether an operation to remove the cancer might help. They also help to give an idea of prognosis or long-term outlook.

NICE (the National Institute for Clinical Excellence) recommend that chemotherapy, especially a drug called Gemcitabine, should be considered as the first treatment for advanced pancreatic cancer, either on its own or with radiotherapy, as long as the patient is well enough to cope with the side-effects of treatment. Also guidelines recommend that post-operative (adjuvant) chemotherapy may be beneficial, but adjuvant radiotherapy (with or without chemotherapy) is not recommended.

Unfortunately, only about 15 per cent of people diagnosed with pancreatic cancer survive past a year, and only three per cent live for more than five years after diagnosis. Those people whose cancer is caught early have a better prognosis, as do those who are generally fitter. Some less common types of pancreatic cancer also have better survival rates.

A number of clinical trials are looking at new drugs or combinations of existing treatments, new biological agents, cancer vaccines and even gene therapy, as well as better treatments to help symptoms such as poor appetite, weight loss and pain.

This article was first published in October 2008.