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Pancreatic cancer


Expert reviewer, Mr Christian Macutkiewicz, Consultant General & Hepato-Pancreatico-Biliary Surgeon
Next review due February 2022

Pancreatic cancer happens when cells in your pancreas grow abnormally and out of control, forming a lump or tumour. Your pancreas is part of your digestive system that sits in the upper part of your abdomen (tummy).

Pancreatic cancer is usually a disease of older people – over half of people diagnosed with it are over the age of 75. It’s the 11th most common cancer in the UK.

Diagram of the pancreas and surrounding structures

About pancreatic cancer

Your pancreas is a gland that sits in the upper part of your abdomen (tummy), close to your stomach and liver. It has many different functions, including producing digestive juices to break down the food you eat, and producing hormones.

Pancreatic cancer can affect different parts of your pancreas. The most common type is called primary ductal adenocarcinoma. This is a type of ‘exocrine’ pancreatic cancer, which begins in the cells that line the ducts of your pancreas. About eight in 10 pancreatic cancers are this type.

Rarer types of pancreatic cancer can affect the cells in your pancreas that produce hormones (the endocrine cells). These are called neuroendocrine cancers. These cancers behave quite differently from pancreatic ductal adenocarcinoma and other exocrine cancers. They’re treated differently too. Our information focuses on primary ductal adenocarcinomas.

Symptoms of pancreatic cancer

In the early stages, pancreatic cancer doesn’t cause many symptoms. You might just have a bit of discomfort in your upper abdomen or a dull backache. These types of symptoms are common, so you may overlook them.

As the disease progresses, you may start to notice more symptoms. These can include the following.

  • Pain around your upper abdomen (tummy), which may spread to your back.
  • Jaundice. This is a blockage of a substance called bile, which helps with digestion. It causes dark urine, pale stools and itchy skin and eventually, a yellowing of your eyes and skin. See our FAQ for more information on jaundice.
  • Losing weight without any obvious reason, and losing your appetite.
  • A change in your stools (poo) – they may be large, paler, have a foul smell and be hard to flush away. You may also have diarrhoea or constipation.
  • Feeling sick and vomiting.
  • Problems with your digestion – such as getting full quickly and bloating.

These symptoms can be caused by lots of things other than pancreatic cancer. If you’ve been having symptoms like this for some time though and they don’t seem to be getting any better, contact your GP for advice. If you think you have jaundice, you should seek immediate medical attention.

Causes of pancreatic cancer

It’s not fully understood exactly why some people develop pancreatic cancer. However, there are a number of things that are thought to increase your risk.

  • Your age. The risk of pancreatic cancer increases as you get older – half of people who are diagnosed are over the age of 75.
  • Smoking. This is the most common lifestyle risk for pancreatic cancer. Your risk of pancreatic cancer is twice as great if you smoke, and it could be even greater if you’ve been a heavy smoker for a long time.
  • Your diet – eating a lot of red and processed meat can increase your risk, whereas eating plenty of fruit and vegetables can lower it.
  • Being obese – especially if you carry weight around your middle.
  • Having certain conditions, including diabetes, chronic pancreatitis (long-term inflammation of your pancreas), inflammatory bowel disease and stomach ulcers.
  • Drinking alcohol to excess over several years – this can increase your risk of chronic pancreatitis, which is linked to pancreatic cancer.
  • Having a family history of pancreatic cancer, or certain other genetic disorders that are linked to pancreatic cancer, such as hereditary pancreatitis or Peutz–Jeghers Syndrome.

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Diagnosis of pancreatic cancer

In the early stages of pancreatic cancer, the symptoms can be quite vague, which can make it difficult to diagnose. Depending on your symptoms and medical history, your GP may arrange for you to have a CT scan or ultrasound.

This can show up if there are any abnormal areas on your pancreas. Your GP may also ask you to give a urine and/or a blood sample.

You may need to have several more tests with a specialist to diagnose pancreatic cancer. You’ll also need tests to see how large it is and whether it’s spread. You may have some of the following.

  • A pancreatic protocol CT scan. This is a special type of CT scan that can give very clear and detailed images of the pancreas.
  • Blood tests. These are carried out to check how well your liver and kidneys are working, and to look for specific ‘tumour markers’. These are chemical substances produced by cancers that may be used to help diagnose pancreatic cancer.
  • A PET-CT scan. This is a type of CT scan that uses a radioactive dye to show up cancer cells. You might have this if your previous scans have been unclear.
  • An endoscopic ultrasound (EUS). This is another option if previous scans haven’t been able to confirm cancer. It involves your doctor passing an endoscope (a narrow, flexible tube), down your throat into your stomach. The endoscope contains a small ultrasound probe to produce an image of the inside of your pancreas.
  • An endoscopic retrograde cholangiopancreatography (ERCP). In an ERCP, your doctor takes X-rays of your pancreatic and bile ducts using an endoscope passed down your throat, into your stomach). Your doctor can also take a cell or tissue sample with an ERCP. You’re likely to have this procedure if you have jaundice, as it it’s normally used to insert a stent, to unblock your bile duct.
  • A magnetic resonance cholangiopancreatography (MRCP). This is a special type of MRI scan, often used with a dye to give clear pictures of your pancreatic and bile ducts. It can show up any blockages inside them.
  • A laparoscopy. This is a minor operation that involves inserting a tube-like telescopic camera through a small cut in your tummy, to look at the tissues and organs inside. This will help your doctor see if the cancer has spread. It can be used with an ultrasound probe too – this is called a laparoscopic ultrasound.

Treatment of pancreatic cancer

If you’re diagnosed with pancreatic cancer, you’ll be put under the care of a specialist multidisciplinary team. This will include a number of different types of health professionals including a specialist nurse, an oncologist (specialist cancer doctor), a gastroenterologist (a doctor specialising in conditions affecting the digestive system) and a surgeon. You’ll be given one key contact – usually the specialist nurse.

Throughout your treatment, your healthcare team will be on hand to offer you any information and support you need. This can include psychological support to help with the emotional impact of the disease.

What treatment you’re offered will depend on many things, including what type of cancer it is, where it is in your pancreas and whether it’s spread.

Surgery

If your cancer is small enough and hasn’t spread, it may be possible to remove it with surgery. Around one to two in 10 pancreatic cancers are suitable for treatment in this way. There are different types of surgery for pancreatic cancer, which are listed below. Which surgery you have will depend on the extent of your cancer and where it is.

  • Whipple’s procedure (pancreaticoduodenectomy). This is a type of surgery for cancer that’s in the head of your pancreas. As well as the head of your pancreas, your surgeon will remove various other parts of your digestive system. These include the lower end of your stomach, the first part of your small intestine, your gallbladder, part of your bile duct and surrounding lymph nodes.
  • Pylorus preserving pancreaticoduodenectomy (PPPD). This is a modified version of the Whipple’s procedure. It’s a similar procedure, but you won’t need to have any of your stomach removed, or the valve from your stomach into your intestine (the pylorus).
  • Distal pancreatectomy. This is surgery to remove cancer that’s in the body or tail of your pancreas.
  • Total pancreatectomy. This is surgery to remove your whole pancreas, usually along with other parts of your digestive system too. It’s very rare that this type of procedure is needed.

If your cancer can’t be treated with surgery, there are still some other procedures your surgeon may suggest 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. Or, if you have a blockage in the first part of your small intestine, your surgeon may suggest a stent or do a procedure to bypass the blockage.

Non-surgical treatments

You may be offered treatment with chemotherapy and radiotherapy after surgery, to help prevent your cancer from coming back. Or, if surgery isn’t possible, you may be offered these treatments to keep it under control and to help ease your symptoms. Providing relief from symptoms is known as palliative care.

  • Chemotherapy means taking drugs to kill or damage your cancer cells. You might have a single chemotherapy drug on its own, or a combination of drugs. The drugs can be given as injections or infusions into a vein, or as tablets. You have chemotherapy as cycles of treatment sessions with rest periods in between.
  • Radiotherapy. Radiotherapy is treatment with radiation to destroy cancer cells. You may be offered treatment with radiotherapy on its own, or in combination with chemotherapy.

Supportive care

If you have pancreatic cancer, you’ll be given supplements containing pancreatic (or digestive) enzymes to take. Pancreatic cancer can affect the production and secretion of digestive juices by your pancreas. Without these, your body can’t break down and absorb the food you eat. This means you won’t get all the nutrients you need to maintain a healthy weight. It can also cause diarrhoea. Taking these supplements can help.

Your doctor or dietitian may also recommend taking some vitamin and mineral supplements, and making some adjustments to your diet.

If you have advanced pancreatic cancer or if it has spread, you may need extra help with pain relief. Your doctor will give you painkillers to help you manage pain and make you as comfortable as possible.

After treatment

After treatment for pancreatic cancer, your healthcare team will continue to monitor you and provide you with ongoing care. If you’ve had surgery, this may involve regular check-ups to make sure your cancer hasn’t come back. If you’ve had chemotherapy, your doctor will want to check how you’ve responded to treatment, and whether you’ve had any side-effects.

Living with pancreatic cancer

You're likely to have a range of emotions if you've been diagnosed with pancreatic cancer. You may feel shocked, upset or scared. As well as the emotional aspects, there can be a lot of practical issues to sort out – such as telling other people and taking time off work.

It can help if you can talk to family and friends about what you’re going through and how you’re feeling. But you may also like to talk to others affected by pancreatic cancer. Specific organisations and support groups can be a great source of information and support (see those listed under Other helpful websites).

We have more detailed information on practical aspects of living with cancer, as well as staying healthy while you’re having treatment. Visit our cancer hub for more information.

Prevention of pancreatic cancer

If you smoke, giving up can help to lower your risk of pancreatic cancer. It’s estimated that nearly one in three pancreatic cancers are caused by smoking. Making sure you follow a healthy diet with plenty of fruit and vegetables, keeping active, and maintaining a healthy weight may also help to protect you.

If you have an inherited high risk of developing pancreatic cancer, you may be eligible for surveillance for pancreatic cancer. For more information on surveillance for pancreatic cancer, see our FAQ, Is a family history of pancreatic cancer significant?

Frequently asked questions

  • Jaundice is a condition that causes a yellowy tinge to your skin and the whites of your eyes. It’s 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.

    Your body usually gets rid of it by mixing it with bile (a substance that helps with digestion). It is then excreted from your body in faeces.

    Bile is made in your liver and normally flows from there into your small intestine. If you have pancreatic cancer, it can block the normal flow of bile into your small intestine. This is called obstructive jaundice. Bilirubin builds up in your bloodstream and body and causes symptoms such as:

    • itchy skin
    • pale stools
    • dark urine

    Around three in 10 people with pancreatic cancer may have jaundice. But jaundice can be caused by many other things too, including gallstones, infections and damage to your liver from alcohol, drugs, or supplements.

    If you think you have jaundice, contact your GP immediately.

  • There are certain reasons why you may be offered regular monitoring (surveillance) for pancreatic cancer. One may be if you have a first-degree relative (parent or sibling) who’s had pancreatic cancer, plus you carry specific genes that put you at greater risk. Or, if two or more of your first-degree relatives have had pancreatic cancer, your doctor also may suggest surveillance. Surveillance may also be recommended if you have an inherited type of pancreatitis or certain other genetic syndromes that put you at higher risk.

    If you’re worried about your risk of pancreatic cancer because of your family history, talk to your GP. They may refer you to a specialist who can advise you.

    Tests you may be offered include:

    • A magnetic resonance cholangiopancreatography (MRCP) – a special type of MRI scan that can show up your pancreatic and bile ducts and any blockages inside them.
    • An endoscopic ultrasound (EUS) – a test that uses a small ultrasound probe (an endoscope) passed down into your stomach to produce an image of the inside of your pancreas.
    • A pancreatic protocol CT scan – a special type of CT scan that can give very clear and detailed images of the pancreas. You should be offered this test if you have inherited pancreatitis.
    • Having regular surveillance means that if you do develop pancreatic cancer, it can be picked up as early as possible – before you even have symptoms. The earlier it’s diagnosed, the more successful treatment is likely to be.


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Related information

    • What is pancreatic cancer? Pancreatic Cancer UK. www.pancreaticcancer.org.uk, published January 2018
    • Pancreas. Encyclopaedia Britannica. www.britannica.com, last updated 12 November 2018
    • Pancreatic cancer statistics. Cancer Research UK. www.cancerresearchuk.org, accessed 3 December 2018
    • Pancreatic cancer. BMJ Best Practice. bestpractice.bmj.com, last reviewed October 2018
    • Pancreatic exocrine tumours. PatientPlus. patient.info/patientplus, last edited 23 October 2015
    • Pancreatic cancer. Medscape. emedicine.medscape.com, updated 11 September 2018
    • Signs and symptoms of pancreatic cancer. Pancreatic Cancer UK. www.pancreaticcancer.org.uk, updated August 2018
    • Visiting your GP. Pancreatic Cancer UK. www.pancreaticcancer.org.uk, updated August 2018
    • Suspected cancer: recognition and referral. National Institute for Health and Care Excellence (NICE), June 2015. www.nice.org.uk
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    • Your local pancreatic cancer specialist centre. Pancreatic Cancer UK. www.pancreaticcancer.org.uk, published January 2018
    • Types of surgery to remove pancreatic cancer. Pancreatic Cancer UK. www.pancreaticcancer.org.uk, published February 2017
    • Pancreatic cancer. Surgery to relieve symptoms. Cancer Research UK. www.cancerresearchuk.org, last reviewed 29 August 2017
    • Chemotherapy for pancreatic cancer. Pancreatic Cancer UK. www.pancreaticcancer.org.uk, updated May 2017
    • Radiotherapy for pancreatic cancer. Pancreatic Cancer UK. www.pancreaticcancer.org.uk, published July 2017
    • Coping with pancreatic cancer. Pancreatic Cancer UK. www.pancreaticcancer.org.uk, published January 2018
    • Assessment of jaundice. BMJ Best Practice. bestpractice.bmj.com, last reviewed November 2018
    • Jaundice. Encyclopaedia Britannica. www.britannica.com, last updated 23 November 2018
    • Bilirubin. Encyclopaedia Britannica. www.britannica.com, accessed 3 December 2018
    • Screening for pancreatic cancer. Pancreatic Cancer UK. www.pancreaticcancer.org.uk, updated January 2016
  • Reviewed by Pippa Coulter, Freelance Health Editor, February 2019
    Expert reviewer Mr Christian Macutkiewicz, Consultant General & Hepato-Pancreatico-Biliary Surgeon
    Next review due February 2022



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