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Pancreatic cancer

Pancreatic cancer is caused by an abnormal and uncontrolled growth of cells in your pancreas – part of your digestive system that sits in the upper part of your abdomen (tummy). Most people who get pancreatic cancer are between the age of 65 and 75.

How cancer develops
Cells begin to grow in an uncontrolled way

Details

  • Types Types of pancreatic cancer

    Your pancreas sits in the upper part of your abdomen (tummy), close to your stomach and liver. It has two main parts – exocrine and endocrine – which carry out different functions.

    The exocrine part of your pancreas produces digestive juices. When made, these juices run down a tube called the pancreatic duct into the first part of your small bowel (duodenum). Here, they help to break down the food you eat.

    The endocrine part of your pancreas is much smaller and produces hormones, which are released into your blood stream and control the actions of specific cells in your body. Pancreatic cancer can happen in the exocrine or endocrine cells of your pancreas. Most commonly, it affects the exocrine cells. These cancers usually begin in the cells that line the ducts of your pancreas and are so-called ductal adenocarcinomas. They’re usually found in the head of your pancreas.

    Pancreatic cancer that affects the endocrine cells of your pancreas (a pancreatic neuroendocrine cancer) is rare.

    Pancreatic neuroendocrine cancer can be functional or non-functional. If it’s functional, it causes too much of a specific hormone to be made and this results in you having a specific set of symptoms or syndrome. For example, gastrinoma causes an increase in the hormone gastrin, which leads to a condition called Zollinger–Ellison Syndrome. Symptoms of Zollinger–Ellison Syndrome include abdominal (tummy) pain and stomach ulcers. Non-functional pancreatic neuroendocrine cancers do not produce significant levels of hormones.

    Most pancreatic neuroendocrine cancers are functional. These include:

    • Gastrinoma
    • Insulinoma
    • Glucagonoma
    • VIPomas
    • Somatostatinomas

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  • Symptoms Symptoms of pancreatic cancer

    Pancreatic exocrine cancer

    Cancer that affects the exocrine cells of your pancreas is the most common type of pancreatic cancer. It often goes unnoticed because symptoms are initially vague and non-specific, including upper abdominal (tummy) pain or a dull back ache. In the later stages, symptoms become more apparent.

    Below are the most common symptoms.

    • Pain around your upper abdomen (tummy), which may spread to your back. This pain may go away when you bend forward or lie in the fetal position.
    • Jaundice. Most exocrine cancers are in the head of the pancreas. Here they obstruct the flow of bile (a substance that helps with digestion) to your intestines, causing obstructive jaundice. Dark urine, pale stools and itchy skin are all signs of obstructive jaundice. See our FAQ on pancreatic cancer and jaundice for more information. If you have jaundice, contact your GP as soon as possible.
    • Losing weight without trying.

    Other symptoms may include:

    • feeling sick or vomiting
    • feeling extremely tired
    • losing your appetite – anorexia
    • trouble swallowing
    • pain when you eat
    • bloating
    • changes in your bowel movements, such as constipation or diarrhoea
    • fatty stools, or stools that float or smell foul

    If you have any of these symptoms, contact your GP for advice.

    Pancreatic neuroendocrine cancer

    Symptoms will depend on which type of pancreatic neuroendocrine cancer you have.

    • Gastrinomas cause an increase in the hormone gastrin, which can lead to a syndrome called Zollinger–Ellison Syndrome. This syndrome is associated with stomach ulcers. Other symptoms include abdominal (tummy) pain and diarrhoea.
    • Insulinomas cause an increase in insulin, which can cause low blood sugar and lead to headaches, dizziness, confusion or problems with your sight. You may also feel weak and irritable.
    • Somatostatinomas cause the amount of the hormone somatostatin to increase, which can cause you to lose weight, have diarrhoea, and pale, smelly, loose stools that are difficult to flush away.
    • VIPomas cause an increase in the amount of a hormone called vasoactive intestinal peptide (VIP). This can cause you to have watery diarrhoea and as a result, feel weak, lethargic, have low blood pressure and lose weight.
    • Glucagonomas cause the amount of the hormone glucagon to increase. This can cause you to have a sore and inflamed mouth, diarrhoea and a reddish skin rash (this usually starts by your groin), discoloured and broken nails.

    Although these types of cancer are rare, if you have any of these symptoms, see your GP.

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  • Diagnosis Diagnosis of pancreatic cancer

    Your GP will ask about your symptoms and examine you. They may also ask you about your medical history.

    Your GP may ask you to give a urine and/or a blood sample.

    Initially, the symptoms of pancreatic cancer are often vague, which can make it difficult to diagnose.

    Your GP may refer you to a gastroenterologist (a doctor who specialises in identifying and treating conditions that affect the digestive system). You may need to have further tests.

    • Blood tests to check for specific chemical markers that could mean you have pancreatic cancer.
    • An ultrasound scan, which uses sound waves to produce an image of the inside of your abdomen.
    • A computerised tomography (CT) scan, which uses X-rays to make images of your pancreas. A narrow beam of X-rays is aimed at and then rotated around your body. This generates signals that are collected by the CT scanner and built up into two-dimensional images or ‘slices’ of your pancreas. These two-dimensional images may then be layered to create a three-dimensional image. If your doctor thinks you could have pancreatic cancer after your ultrasound scan, they’ll arrange for you to have this test. If you have pancreatic cancer, this test can help to see how advanced your cancer is (ie stage the cancer).
    • An magnetic resonance imaging (MRI) scan. This scan can be used alongside a CT scan. It uses magnets and radio waves to produce images of the inside of your abdomen.
    • An endoscopic retrograde cholangiopancreatography (ERCP) test. Your doctor will arrange for you to have this test if they’re uncertain about the results from your CT scan. During an ERCP your doctor passes an endoscope (a narrow, flexible tube-like telescopic camera) down through your mouth into the first part of your stomach (duodenum). Your doctor then takes X-ray images of your pancreatic duct and bile duct. They may also take a biopsy (a small sample of tissue) during this test to send to a laboratory for testing.
    • An endoscopic ultrasound (EUS). This test allows your doctor to look inside your pancreas. Your doctor passes an endoscope down your throat into your stomach. The endoscope contains a small ultrasound probe to produce an image of the inside of your pancreas.
    • A laparoscopy. Your doctor will make small cuts in your abdomen and insert a tube-like telescopic camera to look directly at your pancreas and surrounding tissues. This will help your doctor see if the cancer has spread. It can be used with an ultrasound probe – called a laparoscopic ultrasound.
  • Treatment Treatment of pancreatic cancer

    Surgery

    Although most pancreatic cancer isn’t picked up in the early stages – if it is, it may be possible to cure the cancer by removing it during surgery. Which surgery you have will depend on the extent of your cancer and where it is. Below are the different types of surgery you may have.

    • Pylorus preserving pancreaticoduodenectomy (PPPD). You may have this type of surgery if the cancer is in the head of your pancreas. During the procedure, your surgeon removes the head of your pancreas, the first part of your small intestine (duodenum), gallbladder and part of your bile duct. Your surgeon will keep your pylorus (the opening between the last part of your stomach and duodenum) intact and reconnect the remaining parts.
    • A Whipple operation (pancreaticoduodenectomy). This type of surgery is also used for cancer that is in the head of your pancreas. In this operation, your surgeon will remove the same parts as in PPPD, but also part of your stomach and sometimes surrounding lymph nodes.
    • Distal pancreatectomy. You may have this type of surgery if the cancer is in the body or tail of your pancreas. During this procedure, your surgeon removes the segment of your pancreas where the cancer is.
    • Total pancreatectomy. This procedure isn’t very common, but you may have it if the cancer is in the neck (the part between the head and body) of your pancreas, or if there are lots of cancers in your pancreas (ie it is multifocal). During this procedure, your surgeon removes your entire pancreas.

    If surgery can't remove or treat the cancer, your surgeon may suggest a procedure to ease your symptoms. For example, if your bile duct is blocked, you may have a tube (stent) put in to drain bile and relieve the symptoms of jaundice.

    Non-surgical treatments

    Non-surgical treatments include the following.

    • Chemotherapy. Your surgeon may refer you to an oncologist to discuss chemotherapy after you’ve had surgery to help prevent the cancer from coming back. If your cancer is advanced and can't be removed with surgery, you may have chemotherapy to keep it under control and to help ease your symptoms. Providing relief from symptoms is known as palliative care. Specialist cancer doctors and nurses can help provide this support.
    • Radiotherapy. You may also be offered radiotherapy combined with chemotherapy to help improve your symptoms if the cancer is advanced and can’t be removed with surgery.

    You may be able to take part in a clinical trial if and when new treatments are ready to be assessed. Ask your doctor for information about clinical trials you can join.

    After treatment for pancreatic cancer, you’ll have regular check-ups with your doctor to make sure it hasn’t come back.

    Medicines

    If you have pancreatic cancer, you’ll be given pancreatic (or digestive) enzymes. Pancreatic cancer most commonly occurs in the exocrine cells of your pancreas where it can affect the production and secretion of digestive juices (exocrine function). Without these, your body cannot break down and absorb the food you eat. This means you won’t get all the nutrients you need to maintain a healthy weight. In addition, your stools will be soft or you might have diarrhoea. Taking these supplements can help.

    You may also need to take vitamin and mineral supplements. For more information, speak to your doctor.

    If you have advanced pancreatic cancer or if it has spread, your doctor will give you painkillers to help you manage pain and make you as comfortable as possible.

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  • Causes Causes of pancreatic cancer

    The exact reasons why you may develop pancreatic cancer aren’t fully understood. However, you’re more likely to develop it if you:

    • are older – most people who get it are between 65 and 75
    • smoke
    • have a family history of pancreatic cancer
    • have a family history of certain genetic disorders that are linked to pancreatic cancer; for example, hereditary pancreatitis or Peutz–Jeghers Syndrome
    • drink more than the recommended alcohol levels
    • eat a lot of red and processed meat
    • don’t eat enough fruit and vegetables
    • are obese

    Certain health conditions may also increase your risk of getting pancreatic cancer. These include:

    • chronic pancreatitis, which is inflammation of your pancreas that has lasted for a long time
    • diabetes (type I and II)
    • stomach ulcers
  • FAQ: pancreatic cancer and jaundice Why is jaundice common in people who have pancreatic cancer?

    Jaundice is a condition that causes a yellowy tinge to your skin and the whites of your eyes. It is caused by a build-up of a chemical called bilirubin in your blood. Bilirubin is made when red blood cells are broken down in your body. Usually, your body gets rid of bilirubin by taking it up in your liver, mixing it with bile (a substance that helps with digestion) and passing it through your bile duct into the first part of your small intestine (duodenum). Here, it goes on to be excreted from your body in faeces.

    If you have pancreatic cancer, it can cause obstructive jaundice. This is when the cancer blocks the flow of bile through your bile duct into your duodenum. Rather than being excreted from our body, billirubin builds up in your blood stream and body causing symptoms such as:

    • itchy skin
    • pale stools
    • dark urine

    Obstructive jaundice can also be caused by non-cancerous conditions such as gallstones.

    If you think you have jaundice or any other symptoms of pancreatic cancer, contact your GP immediately. It's always best to diagnose cancers as soon as possible to improve the chance of a better outcome.

  • FAQ: pancreatic cancer and survival I have pancreatic cancer, what are my chances of survival?

    If you have pancreatic cancer, your chances of surviving will depend on what type you have and how far advanced it is when you’re diagnosed.

    Sadly, the majority of pancreatic cancers are picked up when they are advanced and have potentially spread to other parts of your body. This is because symptoms are often vague and non-specific, so are easily missed or confused with other, less serious conditions.

    Surgery is the only treatment that can cure pancreatic cancer. But even if the cancer is picked up early (and can be surgically removed), most people live an average of 15 to 19 months from when they were first diagnosed. Two in every 10 people with ‘curable’ pancreatic cancer survive for five years after being diagnosed. However, with modern surgery and other treatments, things are hopefully improving.

    It's important to remember that everyone’s experience of cancer is very different and it’s not possible to predict exactly what will happen to you. If you have any questions or concerns about pancreatic cancer, talk to your doctor – they’ll be better placed to advise you on your individual situation.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Pancreas anatomy. Medscape. www.emedicine.medscape.com, last updated September 2015
    • Basics of pancreatic cancer. Johns Hopkins Medicine. pathology.jhu.edu, accessed July 2016
    • Upper gastrointestinal cancer. Oxford handbook of oncology (online). Oxford Medicine Online. oxfordmedicine.com, published August 2015
    • Pancreatic cancer. MSD Manual. www.msdmanuals.com, last full review/revision July 2014
    • Pancreatic endocrine tumours. PatientPlus. patient.info/patientplus, last checked October 2015
    • Zollinger–Ellison Syndrome. PatientPlus. patient.info/patientplus, last checked March 2014
    • Pancreatic exocrine tumours. PatientPlus. patient.info/patientplus, last checked October 2015
    • Map of Medicine. Pancreatic cancer. International View. London: Map of Medicine; 2015 (Issue 4).
    • Pancreatic cancer. BMJ Best Practice. bestpractice.bmj.com, Last updated December 2015
    • Muniraj T, Barve P. Laparoscopic staging and surgical treatment of pancreatic cancer. N Am J Med Sci 2013; 5(1):1–9. doi: 10.4103/1947-2714.106183
    • Endoscopic retrograde Cholagiopancreatography. PatientPlus. patient.info/patienplus, last checked June 2016
    • Pancreatic cancer treatment and management. Medscape. emedicine.medscape.com, updated January 2016
    • WHO definition of palliative care. World Health Organisation. www.who.int, accessed July 2016
    • Jaundice. PatientPlus. patient.info/patientplus, last checked December 2015
    • Jaundice. Merck Manual. www.merkmanuals.com, last full review/revision May 2016
    • Neoplasm of the endocrine pancreas. Medscape. emedicine.medscape.com, updated April 2015
    • Gallstones (cholelithiasis). Medscape. emedicine.medscape.com, updated April 2014
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