Pancreatic cancer

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Pancreatic Cancer

Overview - Pancreatic cancer

Pancreatic cancer is caused by the abnormal and uncontrolled growth of cells in the pancreas, a large gland that's part of the digestive system.

Around half of all new cases are diagnosed in people aged 75 or over. It's uncommon in people under 40 years of age.

This information is for the most common type of pancreatic cancer, known as pancreatic ductal adenocarcinoma. Other, rarer types of pancreatic cancer may be treated differently.

Symptoms of pancreatic cancer

In the early stages, a tumour in the pancreas does not usually cause any symptoms, which can make it difficult to diagnose.

The first noticeable symptoms of pancreatic cancer are often:

  • pain in the back or stomach area – which may come and go at first and is often worse when lying down or after eating
  • unexpected weight loss
  • yellowing of the skin and whites of the eyes (jaundice) – it also may cause dark yellow or orange pee, pale-coloured poo and itchy skin

Other possible symptoms of pancreatic cancer include:

  • feeling sick and being sick
  • changes in bowel movements (diarrhoea or constipation)
  • fever and shivering
  • indigestion
  • blood clots

It's important to remember that these symptoms can be caused by many different conditions and are not usually the result of cancer.

But you should contact a GP if you're concerned or these symptoms start suddenly.

You may also develop symptoms of diabetes if you have pancreatic cancer. This is because the tumour can stop the pancreas producing insulin as it normally would.

Causes of pancreatic cancer

It's not fully understood what causes pancreatic cancer, but a number of risk factors for developing the condition have been identified.

Risk factors for pancreatic cancer include:

  • age – it mainly affects people aged 50 to 80
  • being very overweight
  • smoking – around 1 in 3 cases are associated with using cigarettes, cigars or chewing tobacco
  • having a history of certain health conditions – such as diabetes, long-term inflammation of the pancreas (chronic pancreatitis), a stomach ulcer and Helicobacter pylori infection (a stomach infection)

In about 1 in 10 cases, pancreatic cancer is inherited. Certain genes also increase your chances of getting pancreatitis, which in turn increases your risk of developing cancer of the pancreas.

If you have 2 or more close relatives who have had pancreatic cancer or you have an inherited disease, such as Lynch or Peutz-Jeghers syndrome, your doctor may recommend regular check-ups as you may be at increased risk of pancreatic cancer.

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Diagnosing pancreatic cancer

A GP will first ask about your general health and carry out a physical examination. They may examine your tummy (abdomen) for a lump and to see whether your liver is enlarged.

They'll also check your skin and eyes for signs of jaundice and may request a sample of your pee and a blood test.

If your GP suspects pancreatic cancer, you'll usually be referred to a specialist at a hospital for further investigation.

You may have either:

Depending on the results of the scan, further tests may include:

  • endoscopic ultrasound (EUS) – a type of endoscopy that allows close-up ultrasound pictures to be taken of your pancreas
  • endoscopic retrograde cholangiopancreatography (ERCP) – a type of endoscopy used to inject a special dye into your bile and pancreatic ducts; the dye will show up on an X-ray and highlight any tumours
  • laparoscopy – a surgical procedure that allows the surgeon to see inside your body using a laparoscope (a thin, flexible microscope)
  • magnetic resonance cholangiopancreatography (MRCP) – which uses magnetic fields to allow detailed pictures of your pancreas

You may have a biopsy, where a small sample is taken from a suspected tumour.

Treating pancreatic cancer

Cancer of the pancreas is difficult to treat. It rarely causes any symptoms in the early stages, so it's often not detected until the cancer is fairly advanced.

If the tumour is large or has spread to other areas in the body, treating the cancer will be more difficult.

If you have been diagnosed with pancreatic cancer, your treatment will depend on the type and location of your cancer and how far it's advanced, also known as its stage.

Your age, general health and personal preferences will also be taken into consideration.

The 3 main treatments for pancreatic cancer are:

You may also be offered a clinical trial.

Some stages of pancreatic cancer only require 1 form of treatment, whereas others may require 2 types of treatment or a combination of all 3.

Recovering from surgery

Recovering from pancreatic cancer surgery can be a long and difficult process.

You'll probably experience some pain after your operation. The staff at your hospital will make sure you have adequate pain relief.

After any type of surgery to your digestive system, your bowel will temporarily stop working. This means you will not be able to eat or drink straight away.

You'll gradually be able to sip fluids before eventually being able to drink and eat more regularly.

You may be referred to a dietitian, who can advise you about what foods you should eat after your operation.

You may also be given pancreatic enzyme replacement therapy. These are tablets you take that contain the enzymes you need to help digest food.

After the tumour has been removed, you'll probably have a 6-month course of chemotherapy, which greatly increases your chance of being cured.

But because cancer of the pancreas is difficult to diagnose and treat, some people's cancer will come back despite this treatment.

Page last reviewed: 11 April 2018
Next review due: 11 April 2021

Treatment - Pancreatic cancer

Treatment for pancreatic cancer depends on the type, location and stage of your cancer (how far it's spread).

Your age, general health and personal preferences will also be considered when deciding on your treatment plan.

If the cancer has not spread it may be possible to remove the tumour during an operation. If this isn't possible, the focus will be on preventing the tumour growing and causing further harm.

Sometimes it's not possible to get rid of the cancer or slow it down, so treatment will aim to relieve your symptoms and make you as comfortable as possible.

Cancer of the pancreas is very difficult to treat. In its early stages, this type of cancer rarely causes symptoms, so it's often not detected until it's quite advanced. If the tumour is large or has spread, treating or curing the cancer is much harder.

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Discussing your treatment

Deciding what treatment is best for you can be a difficult process. There's a lot to take in, so it's important to talk about the possible alternatives with a family member or friend.

You should also have an in-depth discussion with your doctor, who can tell you the pros and cons of the treatments available to you.

If at any stage you don't understand the treatment options being explained to you, make sure you ask your doctor or nurse for more details.

There are three main ways that cancer of the pancreas can be treated:

Some types of pancreatic cancer only require one form of treatment, whereas others may require two or a combination of all three.

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Surgery to remove the tumour

Surgery is usually the only way pancreatic cancer can be completely cured. However, as the condition is usually advanced by the time it's diagnosed, surgery is not always suitable.

If your cancer has spread to other areas of the body, surgically removing the tumour won't cure you.

Surgery for pancreatic cancer is usually only an option for people who have a good general level of health. This is because pancreas surgery is often long and complex, and the recovery process can be slow.

Sometimes the risks of surgery can outweigh the potential benefits.

Your doctor will discuss with you whether surgery is a suitable option. There are several possible surgical procedures, which are outlined below.

Whipple procedure

The Whipple procedure is the most common operation used to treat pancreatic cancer, and involves removing the head of the pancreas.

Your surgeon must also remove the first part of your small intestine (bowel), your gallbladder (which stores bile) and part of your bile duct. Sometimes, part of the stomach also has to be removed.

The end of the bile duct and the remaining part of your pancreas is connected to your small intestine. This allows bile and the hormones and enzymes produced by the pancreas to still be released into your system.

After this type of surgery, some people need to take enzymes to help them digest food. This is known as pancreatic enzyme replacement therapy.

The Whipple procedure involves long and intensive surgery, but it's easier to recover from than a total pancreatectomy.

Distal pancreatectomy

A distal pancreatectomy involves removing the tail and body of your pancreas.

Your spleen will usually also be removed at the same time. Part of your stomach, bowel, left adrenal gland, left kidney and left diaphragm (the muscle that separates the chest cavity from the abdomen) may also be removed.

Like the Whipple procedure, a distal pancreatectomy is a long and complex operation that won't be carried out unless your doctor thinks it's necessary.

Total pancreatectomy

During a total pancreatectomy, your entire pancreas will be removed. This is sometimes necessary due to the position of the tumour.

Your surgeon will also remove your:

  • bile duct
  • gallbladder
  • spleen
  • part of your small intestine
  • part of your stomach (sometimes)
  • surrounding lymph nodes (part of the immune system)

After a total pancreatectomy, you'll need to take enzymes to help your digestive system digest food. You'll also have diabetes for the rest of your life because the pancreas produces insulin – the hormone that regulates blood sugar.

Removing your spleen can increase your risk of developing infections and may also affect your blood's ability to clot. This means you'll need to take antibiotics for the rest of your life, and you'll need regular vaccinations.

Sometimes, you may need to take tablets for a short period to stop the platelets in your blood sticking to each other. Platelets are a type of blood cell that cause your blood to clot (thicken).

Surgery to ease your symptoms

Although surgery may not be a suitable way of removing your tumour, you may be offered it to help ease your symptoms.

This type of surgery won't cure your cancer, but will mean that your condition is easier to manage, and make you more comfortable.

To help control jaundice, a stent can be placed in your bile duct using endoscopic retrograde cholangiopancreatography (ERCP). This will help keep the bile duct open and prevent bilirubin (the yellow chemical in bile) building up and causing jaundice.

If a stent isn't a suitable option for you, you may need an operation to bypass your blocked bile duct. Your surgeon will cut the bile duct just above the blockage and reconnect it to your intestine, which allows your bile to drain away.

These types of surgery are much less intensive than surgery carried out on the pancreas. The recovery time is much quicker, and people find that their jaundice improves significantly.

Chemotherapy

Chemotherapy is a type of cancer treatment that uses anti-cancer medicines to either kill the cancerous (malignant) cells in your body or stop them multiplying.

Chemotherapy treatment is often used alongside surgery and radiotherapy (see below) to help ensure that as much of the cancer is treated as possible.

Chemotherapy may be given:

  • before surgery – to try to shrink the cancer, so there's a greater chance of the surgeon being able to remove all of the cancer
  • after surgery – to help reduce the risk of the cancer coming back
  • when surgery isn't possible – to try to shrink the cancer, slow its growth and relieve your symptoms

Some chemotherapy medicines can be taken orally (by mouth), but some need to be given directly into a vein (intravenously).

Chemotherapy also attacks normal, healthy cells, which is why this type of treatment can have many side effects. The side effects can vary depending on which type of chemotherapy is used. The most common side effects include:

  • vomiting
  • nausea
  • mouth sores
  • fatigue
  • increased risk of infection

These are usually only temporary, and should improve once you've completed your treatment.

The chemotherapy medications can also be used in combination, so your doctor may suggest using one medication or a combination of two or three.

Combining chemotherapy medications can give a better chance of shrinking or controlling the cancer, but increases the chance of side effects. Sometimes, the risks of chemotherapy can outweigh the potential benefits.

Read more about chemotherapy.

Radiotherapy

Radiotherapy is a form of cancer therapy that uses high-energy beams of radiation to help shrink your tumour and relieve pain.

Side effects of radiotherapy can include:

  • fatigue
  • skin rashes
  • loss of appetite
  • diarrhoea
  • nausea or vomiting

These side effects are usually only temporary, and should improve after your treatment has been completed.

Read more about radiotherapy.

Psychological support

The hospital should provide you and any carers with tailored information and support to help manage the impact that pancreatic cancer may have on daily activities and your mental wellbeing.

Information and support should be available throughout your treatment to help with:

  • fatigue
  • pain
  • changes in appetite or diet
  • anxiety or depression

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Page last reviewed: 11 April 2018
Next review due: 11 April 2021