What is pancreatic cancer?

Pancreatic cancer is a disease of the pancreas. This is a gland near the stomach and small intestine that helps to digest food and releases hormones including insulin into the blood stream to help convert food into energy.

Cancer occurs when cells in the pancreas grow uncontrollably. Most pancreatic cancers begin in the ducts of the pancreas (called exocrine pancreatic cancer), but cancer can also form in the hormone-producing cells of the pancreas (called endocrine pancreatic cancer).

Pancreatic cancer is the eighth most common cancer in Australia. More than 3,000 people in Australia develop pancreatic cancer each year. Most of these people are over the age of 50.

Pancreatic cancer usually spreads rapidly and has often spread to other body organs by the time it is diagnosed. In most cases, it is impossible to remove the cancer with surgery. The survival rates for people diagnosed with pancreatic cancer are low.

What are the symptoms of pancreatic cancer?

Pancreatic cancer can be present without causing any symptoms at all. Symptoms might not appear until the cancer affects other organs.

Possible signs and symptoms of pancreatic cancer are:

• pain in the upper abdomen that radiates to the back
• loss of appetite
• nausea and vomiting
• weight loss
• changed bowel motions (diarrhoea or severe constipation)
• pale, greasy poo
• a bowel obstruction
• yellow skin and eyes and dark urine due to jaundice due to blockage of the bile duct
• depression
• blood clots
• fatigue
• severe back pain
• enlarged gallbladder
• high blood sugar — some people with pancreatic cancer develop diabetes

Some pancreatic cancers release excess hormones into the bloodstream that can cause symptoms such as changes in blood sugar, weakness, confusion and sweating, or stomach problems.

What causes pancreatic cancer?

Pancreatic cancer is a genetic disease, caused by changes in the DNA. Sometimes, these changes are inherited, but they can also be caused by age, lifestyle or the environment.

Some of the risk factors for developing pancreatic cancer are:

• smoking
• age (being older than 60)
• chronic inflammation of the pancreas (pancreatitis)
• diabetes
• certain types of surgery such as a gastrectomy (removal of part of the stomach) or cholecystectomy (removal of the gallbladder)
• overuse of alcohol
• a family member has had pancreatic cancer, ovarian cancer or colon cancer
• obesity
• overconsumption of meat and saturated fat, foods high in cholesterol, salt, smoked meats, dehydrated and fried foods or a lot of barbecued meat, and not enough fruit and vegetables
• frequent exposure to some pesticides or petroleum products

Diet and pancreatic cancer

People who eat a lot of meat (including processed meat) and fried foods, or who have a high cholesterol diet, have a higher than average risk of pancreatic cancer. People who eat a lot of fruit and vegetables have a lower than average risk.

The vitamin folate (called folic acid when it comes in a tablet or capsule supplement) may also reduce risk. Folate is found in fresh, leafy green vegetables.

If you have high cholesterol, you should reduce it.

Smoking and pancreatic cancer

Smokers are 2 to 3 times more likely to develop pancreatic cancer than non-smokers, and they do so at an earlier age. If you are a smoker, you should consider quitting. If you stop smoking, your risk of developing pancreatic cancer drops to nearly normal for your age.

When should I see my doctor?

You should see your doctor immediately if you experience weight loss you cannot explain, severe abdominal pain, jaundice, or other symptoms that worry you.

There are many medical conditions and illnesses that can cause any or all of these symptoms. Your doctor can discuss your symptoms along with your medical history and may suggest tests for cancer or other conditions.

How is pancreatic cancer diagnosed?

Your doctor may use a range of tests and techniques to diagnose the cause of symptoms, such as talking to you, examining you and taking blood tests.

They may then recommend other tests to indicate if you have pancreatic cancer and determine whether or not the cancer has spread.

These tests may include:

• a CT scan (computed tomography)
• an MRI (magnetic resonance imaging)
• an ultrasound (including an ultrasound passed through the nose or mouth on the end of a long tube, called an endoscopic ultrasound)
• cholangiopancreatography, using x-rays or MRI to look at the pancreatic ducts and bile ducts
• a PET scan (positron emission tomography) which can show how far a cancer has spread
• somatostatin receptor scintigraphy, where a radioactive substance is injected into the body
• angiography, an x-ray to look at blood vessels

Your doctor may also do a biopsy, where a small sample of tissue is removed for testing. This can identify if you have cancer and, depending on the type of biopsy, can determine how far it’s spread.

There are several ways the biopsy can be performed:

• inserting a needle into the tissue through the abdominal wall to capture a sample, called fine-needle aspiration or needle biopsy
• inserting a camera-tipped tube through the mouth down the gut to collect images from the area (endoscopy)
• a laparoscopy, which involves making small incisions in the abdomen that allow the surgeon to collect samples and examine the area

If pancreatic cancer is likely and it seems the tumour could be removed, your doctor may recommend surgery without a biopsy.

If you are diagnosed with pancreatic cancer, you will probably be given an indication of the stage of the cancer. These stages describe how far the cancer has spread:

• stage 0 — the cancer has not spread outside the top layers of cells in the pancreatic duct
• stage I — the cancer has grown but is still only in the pancreas; less than 2 cm across is stage 1A, more than 2 cm across is stage 1B
• stage II — local spread; there is growth outside the pancreas or into nearby lymph nodes
• stage III — wider spread into major blood vessels or nerves but no metastasis (spread to other organs)
• stage IV — confirmed spread to other organs

How is pancreatic cancer treated?

Treatment will depend on how far the cancer has spread. It will also depend on where the cancer is, your age, your health and your personal preference.

It may include surgery, endoscopic treatment, chemotherapy or radiotherapy, or a combination of these treatments. Your doctor may suggest palliative care options to control the tumour and symptoms, make you comfortable and improve your quality of life instead of attempting to remove the tumour.

Surgery

If the cancer is in the early stages, your doctor may recommend surgery. They may either remove part of the pancreas and the spleen (distal pancreatectomy) or all of the pancreas, part of the stomach, part of the small intestine, the common bile duct, the gallbladder, and nearby lymph nodes (total pancreatectomy).

Radiation therapy

Radiation uses high-energy beams such as to destroy cancer cells. It may be recommended before or after cancer surgery, often in combination with chemotherapy, or with other treatments if surgery is not an option.

Chemotherapy

Chemotherapy uses medication to help kill cancer cells. It can be injected into a vein or taken orally. It may be combined with radiation.

Targeted therapy

Targeted therapy uses medication that attacks specific abnormalities within cancer cells.

Treating complications of pancreatic cancer

Your doctor may suggest treatments to help with some of the complications that can arise from the cancer. These complications and treatments include:

• jaundice — placing a stent inside the bile duct to hold it open, or a bypass to create a new way for bile to flow from the liver to the intestines
• pain — pain relief medication, radiation therapy, or, in severe cases, an injection into the nerves to stop pain signals going to the brain (a 'coeliac plexus block')
• bowel obstruction — placing a stent in the small intestine to hold it open, or bypass surgery to attach the stomach to a lower part of the intestines
• weight loss — eating more food when possible, and pancreatic enzyme supplements to help digestion

Palliative care

Palliative care aims to give the best possible quality of life to someone who is seriously ill. If you have palliative care, it means the team will try to help with symptoms of the cancer without trying to cure it.

Palliative care may also involve medication, radiotherapy or chemotherapy to help with pain or other symptoms.

You can speak to your doctor, nurse or cancer specialist about whether palliative care is right for you, and what options are available.

Can pancreatic cancer be prevented?

Not smoking or quitting smoking reduces your risk of developing pancreatic cancer.