What is pancreatic cancer?

Pancreatic cancer is a cancer of the pancreas. The pancreas is an organ in your abdomen, near the stomach and small bowel (small intestine). It's a gland — which means it releases chemicals that help your body work.

Your pancreas sends out natural substances called enzymes into the small bowel that help digest food. It also releases hormones like insulin into the blood stream, to help store the energy from food.

Cancer happens when abnormal cells grow out of control. Most pancreatic cancers start in the cells of ducts of the pancreas (called exocrine pancreatic cancer). Cancer can also start in the hormone-producing cells of the pancreas (called pancreatic neuroendocrine tumours).

What are the symptoms of pancreatic cancer?

If you have early-stage pancreatic cancer you may not have any symptoms. Symptoms often don't appear until the cancer is already quite advanced, and has grown or spread to other parts of your body.

Possible signs and symptoms of pancreatic cancer may include:

• yellow skin and eyes (jaundice) or dark urine
• loss of appetite
• nausea and vomiting
• changed bowel motions (poo), like diarrhoea or severe constipation
• pale, greasy poo
• pain in the upper abdomen — you may feel this pain in your back or side.

Other general symptoms of cancer may include:

• fatigue
• unexplained weight loss

What causes pancreatic cancer?

The cause of pancreatic cancer isn't known, but there are some things that can increase your chances of getting it. These include:

• smoking
• obesity
• older age — most people who get pancreatic cancer are older than 60 years old
• long term type 2 diabetes
• excessive alcohol use
• a family history of pancreatic cancer, ovarian cancer or colon cancer and some genetic conditions
• being around certain chemicals a lot

Some less common medical conditions can make it more likely for you to get pancreatic cancer. These include:

• chronic (long term) inflammation of the pancreas (pancreatitis)
• certain types of cysts in the pancreas
• stomach infections caused by the bacteria Helicobacter pylori

Food and pancreatic caner

Research suggests that eating a lot of red and processed meats may increase your chance of getting pancreatic cancer. Eating more fruit and vegetables may decrease your chances.

Smoking and pancreatic cancer

Smoking or chewing tobacco makes you twice as likely to develop pancreatic cancer than non-smokers.

Learn more about quitting smoking.

When should I see my doctor?

You should see your doctor promptly if you have unexplained weight loss, severe stomach pain, jaundice, or other symptoms like those listed above that worry you.

Many medical conditions and illnesses can cause these symptoms, so having these symptoms doesn't always mean you have cancer. Your doctor can talk to you about your symptoms and your medical history and tell you if you need any special tests.

How is pancreatic cancer diagnosed?

Your doctor may use different tests to diagnose the cause of your symptoms. This can include asking you about your symptoms, examining you and sending you for blood tests.

They may suggest other tests to check if you have pancreatic cancer and if any 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 mouth on the end of a long tube, called an endoscopic ultrasound)
• cholangiopancreatography — a test that uses x-rays or MRI to look at the pancreatic ducts and bile ducts
• a PET scan which can show where a cancer has spread

Your doctor may also recommend a biopsy. This involves taking a sample of tissue from your pancreas for testing in a lab. A biopsy can help to find out if you have cancer and, depending on the type of biopsy, can check how far it's spread.

There are different ways your doctor might take a biopsy:

• They may insert a needle into the tissue through the abdomen to take a sample — this is called fine-needle aspiration or needle biopsy. This is done using a form of imaging to guide them.
• They may insert a camera-tipped tube into your mouth and down through the gut to collect images from the area near the pancreas (endoscopy).
• They may use a form of keyhole surgery known as laparoscopy, which involves making small incisions (cuts) in your abdomen to collect samples and examine the area.

If your doctor thinks pancreatic cancer is likely and that the tumour can be removed, they might suggest surgery without doing a biopsy first.

If you are diagnosed with pancreatic cancer, you will probably be told about the stage of the cancer. These stages explain how far the cancer has spread:

• stage I — the cancer is small and only in the pancreas
• stage II —a large cancer in the pancreas and there may be spread to nearby lymph nodes
• stage III — wider spread into major nearby blood vessels or nerves but no metastasis (spread to other organs)
• stage IV — spread to other organs such as the liver, lungs or lining of the abdomen

Genetic testing

Genetic testing looks for gene differences that may increase your chance of getting some types of cancers.

Sometimes, your doctor may offer extra tests on your biopsy sample, like:

• genetic tests — which look for gene changes you were born with
• molecular tests — which look for gene changes you get from the environment and may help your doctor decide which treatment to suggest

Most people with pancreatic cancer don't have a family history of it. You might want to get tested for gene differences if other family members have pancreatic cancer, if you were diagnosed at a very young age, or if you have had other types of cancer along with pancreatic cancer.

To learn more about family history and genetic testing, ask your doctor about visiting a family cancer clinic.

You can also read more about the types of genetic testing.

Medicare may cover the costs of some genetic tests, but you may have to pay for them yourself. Be sure to ask your treatment team about this. Medicare usually does not pay for molecular testing for pancreatic cancer.

How is pancreatic cancer treated?

Treatment will depend on the size of the cancer and if it has spread (its stage). It will also depend on where the cancer is, your age, your health and your personal preference.

Treatment options may include one or more of the following:

• surgery
• endoscopic treatment
• chemotherapy
• radiotherapy

Your doctor may recommend palliative care options to reduce your symptoms and improve your quality of life instead of trying to remove the tumour.

Surgery

If the cancer is in the early stages, your doctor may recommend surgery to remove part or all of your pancreas, and sometimes parts of your other abdominal organs. The specific procedure your doctor recommends will depend on the location and size of your cancer, and whether it has spread.

Radiation therapy

Radiation therapy uses high-energy beams 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 medicines to help kill cancer cells. It can be injected into a vein or taken orally (by mouth as tablets or liquids). It may sometimes be used together with radiation.

Targeted therapy

Targeted therapy uses medicines that attack specific differences within cancer cells.

Palliative care

Palliative care aims to give you the best possible quality of life. If you have palliative care, your healthcare team will try to relieve your cancer symptoms without trying to cure it.

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

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

Living with pancreatic cancer

Living with pancreatic cancer can bring many challenges. It's important to give yourself time to get used to the changes in your body and your feelings.

Cancer can make you feel both physically and emotionally tired. That's why it's important to take care of yourself by eating a healthy diet and staying active.

Talk to your family, friends, doctors, nurses and cancer support groups to help you manage your feelings and daily challenges.

What are the complications of pancreatic cancer?

Pancreatic cancer and its treatment change how your pancreas works. This can lead to complications like:

• jaundice — treatment of jaundice can include 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 medicine, radiation therapy, or an injection can be used to reduce pain signals to the brain
• bowel obstruction — treatment of bowel obstruction can include 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 can be used to help digestion, under advice from a dietitian

Can pancreatic cancer be prevented?

Pancreatic cancer can't be prevented, but you can reduce your risk by addressing any factors that increase your risk, for example, avoiding smoking.

Resources and support

• Pankind has online information to support you, your family and carers after being diagnosed with pancreatic cancer.
• Pankind also has information on genetic testing.
• Pancare Foundation can connect you to support groups and offers a PanSupport support helpline.
• General information about cancer is available online in many community languages.
• Read all about cancer for Aboriginal and/or Torres Strait Islander people.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.