Pancreatic cancer

What is pancreatic cancer?

The pancreas is a leaf-shaped gland that lies just below the stomach. It produces pancreatic juices, which help to digest food, and is linked to the gallbladder, which empties into the gut just below the stomach. Other pancreatic cells produce hormones including insulin, which helps the body to regulate the amount of sugar in the blood.

There are two types of pancreatic cancer - carcinoma of the pancreas and, far more rarely, cancer of the cells that make insulin. Like many cancers of internal organs, the tumours tend to develop silently, causing few symptoms until disease is well advanced.

Pancreatic cancer causes

Although scientists don't know why many people develop pancreatic cancer, some risk factors have been identified. These include:

• Smoking and other types of tobacco use - smokers are up to three times more likely to get the disease
• A diet high in fat, sugar and red or processed meats and low in fresh fruit or vegetables
• A history of chronic inflammation of the pancreas (pancreatitis), diabetes (a small increase in risk) or stomach ulcers
• An inherited tendency towards cancer (in 10 per cent of cases)
• Being overweight or inactive
• Exposure to certain industrial chemicals, particularly chlorinated hydrocarbon solvents
• Excess alcohol consumption

Pancreatic cancer symptoms

It's often the pressure of a large tumour pushing on other organs or parts of the body that's the first clue something is wrong. However, symptoms are often very non-specific and depend greatly on the size of the tumour and where it's located.

They include:

• Unexplained weight loss
• Abdominal pain (often described as a dull, gnawing ache that spreads to the back, which may becomes worse if the patient eats)
• Jaundice - as a result of the tumour expanding and blocking the bile duct, the skin and whites of the eyes turn yellowish and urine may become darker
• Weight loss and weakness
• Nausea and loss of appetite
• Back pain
• Itching of the skin
• Diabetes
• Fever and shivering

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 the head of the pancreas may present as painless jaundice and in the body and tail as abdominal or back pain without jaundice).

The rarer form of pancreatic cancer can cause the pancreas to make too much insulin, leading to similar symptoms to diabetes, including:

• Dizziness
• Muscle spasms
• Diarrhoea

Diagnosing pancreatic cancer

If pancreatic cancer is suspected, there are a number of tests a GP can do, including:

• Physical examination - although it can be difficult to feel a tumour owing to the position of the pancreas in the body
• Blood tests, including pancreatic amylase and liver function tests

Tests that may be used to confirm pancreatic cancer include CT and MRI scans, endoscopic retrograde cholangio-pancreatography (ERCP), or ultrasound. A special type of ultrasound, known as an endoluminal ulatrasound (EUS) and done during an endoscopy or telescopic investigation of the intestines, enables doctors to look at the pancreas from deep inside the body.

A biopsy is the only sure way to complete a diagnosis. This involves taking a tiny tissue sample from the tumour. In some cases, a probe is passed through a small cut into the abdomen to see how far the disease has spread.

Occasionally a more serious laparotomy operation is needed. This involves making a larger cut so that surgeon can look more closely at the organs.

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.

Pancreatic cancer treatments

A combination of therapies can either cure the cancer if caught early or improve quality of life and reduce pain.

Surgery may be used to remove the diseased part of the pancreas, especially if the tumour is less than 3cm in diameter, or the whole organ, although the latter is a very rare. If other organs, such as the stomach, gut, spleen and gallbladder, are involved, they can be partly or totally removed. However, this is major surgery and unsuitable for many patients.

Pancreatic cancer patients may also be given radiotherapy or chemotherapy. The National Institute for Clinical Excellence (NICE) recommends chemotherapy, especially a drug called gemcitabine, be considered as a 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 and meets several other criteria. Guidelines also 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 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.