Pancreatic cancer

Published by Bupa's Health Information Team, April 2010.

This factsheet is for people who have pancreatic cancer, or who would like information about it.

Pancreatic cancer is a lump created by an abnormal and uncontrolled growth of cells in the pancreas.

How cancer develops

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The pancreas

Your pancreas is part of your digestive system. It's about 15cm long and is found in front of your spine (back bone).

Your pancreas produces digestive juices that run down the pancreatic duct into the first section of your small bowel (duodenum). These juices help to break down food during digestion - the exocrine function of your pancreas. Your pancreas also produces a hormone - its endocrine function. This hormone, insulin, controls your blood sugar levels.

Your pancreatic duct runs through your pancreas to join the first section of your small bowel (duodenum) at the same place as the bile duct, which runs from your gallbladder.

About pancreatic cancer

Pancreatic cancer affects about 7,700 people a year in the UK. The likelihood of you developing pancreatic cancer increases as you get older - about eight out of 10 people who get it are over 60.

Cancerous tumours in your pancreas can spread to other parts of your body (through your bloodstream or your lymphatic system) where they may grow and form secondary tumours. Your lymphatic system is the tissues and organs, including your bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. This spread of cancer is called metastasis.

Types of pancreatic cancer

Pancreatic cancer can develop anywhere in your pancreas. Cancers of the pancreas are either exocrine or endocrine.

Exocrine cancers
Most pancreatic cancers are exocrine. This means that they start in your exocrine pancreas - the part that produces digestive juices. Most exocrine cancers begin in cells lining the ducts of your pancreas. Lots of these small ducts join the main pancreatic duct.

Endocrine cancers
Endocrine cancers produce hormones - they are also known as neuroendocrine tumours. This type of pancreatic cancer is rare.

Symptoms of pancreatic cancer

It may take a while for you to have any symptoms and they may be vague. The most common symptom is pain around your stomach area, which may spread to your back. Jaundice, which causes the whites of your eyes and your skin to become yellow, is also a common symptom. Other symptoms include:

• weight loss
• indigestion
• loss of appetite
• diabetes
• itchy skin
• vomiting
• dark urine and light-coloured faeces
• change in bowel movements
• fever (high temperature)

Endocrine pancreatic cancers can cause unusual symptoms, which are related to the hormone that is produced. The name of the cancer relates to the hormone that it secretes.

• Gastrinomas produce the hormone gastrin, which can lead to stomach ulcers.
  
• Insulinomas release insulin, which can cause low blood sugar, leading to weakness and dizziness.
  
• Somatostatinomas secrete somatostatin, which can result in diarrhoea.
  
• VIPomas release VIP, leading to diarrhoea and high blood pressure.
  
• Glucagonomas produce glucagon, which can cause mouth ulcers, diarrhoea and skin rashes.

These symptoms aren't always caused by pancreatic cancer but if you have them, contact your GP.

Causes of pancreatic cancer

Little is known about the exact causes of pancreatic cancer. However, there are a number of factors that may increase your risk of developing it. These include:

• age - most people develop it between the ages of 60 and 80
• smoking - up to one in five pancreatic cancers may be linked to smoking
• eating a diet that is high in sugar and fat and low in fruit and vegetables, or a diet that includes lots of red meat or processed food
• drinking excessive amounts of alcohol
• not doing enough physical activity, or being overweight
• exposure to very high levels of certain chemicals found in some paints, glue and dry cleaning preparations

Certain medical conditions may increase your risk of getting pancreatic cancer, including:

• chronic pancreatitis (inflammation of your pancreas)
• diabetes
• stomach ulcers

Pancreatic cancer isn't usually inherited. If you have pancreatic cancer, other members of your family are unlikely to be at an increased risk of developing it.

Diagnosis of pancreatic cancer

Your GP will ask about your symptoms and examine you. He or she may ask about your medical history. Your GP will also look for jaundice. You will probably be asked to give a urine sample.

Your GP may refer you to a surgeon, a gastroenterologist (a doctor specialising in conditions of the digestive system) or an oncologist (a doctor specialising in cancer) for further tests.

Tests may include the following.

• Blood tests, which may include testing for cancer markers - chemical substances that show up if you have cancer.
• An ultrasound scan, which uses sound waves to produce images of your pancreas.
• Endoscopic retrograde cholangio-pancreatography (ERCP), which uses a thin flexible tube called an endoscope to take X-ray images of your pancreas and gall bladder. The endoscope is fed down your throat and can also be used to take a small sample of tissue - a biopsy - to send to a laboratory for testing.
• A laparoscopy, where your doctor uses a thin tube with a camera on the end to look inside your body in more detail. It can be used with an ultrasound probe called a laparoscopic ultrasound. It's inserted through small cuts in your abdomen under general anaesthesia.

If you have cancer, you may need other tests to see if it has spread, including a CT scan or an MRI scan.

Treatment of pancreatic cancer

Pancreatic cancer can be difficult to cure because it's often not diagnosed until it's advanced.

Surgery

If your cancer is found in the early stages, you may be able to have surgery to remove it. This is a major operation to remove some or all of your pancreas and possibly other parts of your digestive system. Surgery is possible for about 15 to 20 people in every 100 who have pancreatic cancer.

Several different operations are used to remove a tumour from your pancreas. The most common are:

• PPPD (pylorus preserving pancreaticoduodenectomy), which removes the head of your pancreas, duodenum, gall bladder and part of your bile duct
• Kausch-Whipple operation, which removes the same parts as PPPD as well as part of your stomach

Which operation you have will depend on a number of things, including the size of your cancer and your general health.

If your tumour is large, your surgeon may consider removing your entire pancreas. However, this operation isn't done very often as it can lead to other serious health problems, such as diabetes.

Your surgeon may suggest an operation to ease your symptoms even if surgery can't remove the cancer. 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

You may have chemotherapy or radiotherapy.

Chemotherapy is a treatment to destroy cancer cells with medicines. If you have had surgery, you may have chemotherapy afterwards.

If your tumour can't be removed using surgery, and you have advanced pancreatic cancer you will be given chemotherapy to try to reduce the size of your tumour and relieve your symptoms.

You may be offered to take part in a clinical trial testing new chemotherapy medicines or chemotherapy with a biological therapy (a medicine that uses substances occurring naturally in our bodies to kill cancer).

You may have radiotherapy if it isn't possible for you to have surgery. Radiotherapy uses X-rays to destroy cancer cells. This may shrink the tumour and control it for a while. Radiotherapy is often given alongside chemotherapy. This is called chemoradiation.

Prevention of pancreatic cancer

Getting enough vitamin D may reduce your risk of developing a number of cancers, including pancreatic cancer – although more research needs to be done to be certain. Vitamin D is also well known to be important for bone health.

Vitamin D is produced naturally by your body when your skin is exposed to sunlight and can also be obtained from some foods, such as oily fish. You may get enough vitamin D during summer by spending frequent short spells in the sun without wearing sunscreen (the exact time you need is different for everyone, but is typically only a few minutes in the middle of the day). However, do not let your skin redden. If you don't get much sun exposure and particularly during winter months, taking up to 25 micrograms of vitamin D a day (two high-strength 12.5 microgram capsules) can help to make sure you get enough.

Always read the patient information leaflet that comes with your supplements and if you are pregnant or breastfeeding, ask your pharmacist or GP for advice first. Talk to your GP before taking vitamin D supplements if you are taking diuretics for high blood pressure or have a history of kidney stones or kidney failure.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.