Pancreatic cancer

This section provides information about pancreatic cancer. This includes its causes, risk factors, symptoms, how it is diagnosed and the different types of pancreatic cancer treatments available.

About pancreatic cancer

Your pancreas is a large gland that’s part of your digestive system. It sits just behind your stomach and creates digestive enzymes to break down food. It also makes insulin to keep your blood sugar levels stable.

Normally, your body replaces the cells in your body as it needs to. If you have pancreatic cancer, the cells in your pancreas grow and multiply in an irregular way. Rather than multiplying as and when they’re needed, in cancer the process of creating new cells becomes uncontrolled.

Facts about pancreatic cancer

• In the UK, around 8,800 people are diagnosed with pancreatic cancer each year¹
• Around half of all pancreatic cancer cases are in people over 75²
• One in three pancreatic cancer cases can be linked to smoking.³

What is pancreatic cancer?

The pancreas looks a bit like a leaf – thicker at one end (the head) and narrower at the other (the tail). You can get pancreatic cancer in the head, the tail or the body (the bit in between) of the pancreas. Your symptoms will differ depending on which part of the pancreas is affected.

The majority of pancreatic cancers – around three out of four – start in the head of the pancreas.

References

¹ Cancer Research UK, Pancreatic cancer risks and causes https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer/risks-causes
² Cancer Research UK, Pancreatic cancer risks and causes https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer/risks-causes
³ Cancer Research UK, Pancreatic cancer risks and causes https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer/risks-causes

Types of pancreatic cancer

There are a few different types of pancreatic cancer, although the most common types are exocrine cancers.

Exocrine cancers
This type of cancer starts in the exocrine part of the pancreas that produces digestive juices. There are several types of exocrine pancreatic cancers, but more than eight out of ten are adenocarcinomas. Most of these are a ductal adenocarcinoma, which means the cancer starts in the lining of the pancreas ducts.

Other types of exocrine cancer are rare but include:

• cystic tumours
• cancer of the acinar cells
• endocrine tumours.

Endocrine pancreatic tumours
This type of cancer is quite rare. It starts in the endocrine part of the pancreas, which is where hormones like insulin are made and released into the blood. You may also hear this type of cancer called pancreatic neuroendocrine tumours (PNETS) or islet cell tumours.

Around one in three of endocrine pancreatic tumours produce hormones. They’re usually non-cancerous (benign) but can produce unexpected symptoms because of the hormones.

Two in three pancreatic tumours don’t produce hormones or symptoms. These are most often cancerous (malignant).

Rare types of pancreatic cancer
There are other types of pancreatic cancer, but these are rare. They’re usually treated differently to common exocrine cancers and include:

• pancreatoblastoma mainly develops in children and is sometimes linked to genetic conditions
• sarcomas of the pancreas is a very rare cancer of the connective tissue
• lymphoma is cancer of the lymphatic system. Because your lymphatic system runs through your whole body, the cancer can occur anywhere.

Causes and risk factors

The exact cause of pancreatic cancer isn’t understood, but there are a number of factors that can put you at risk including:

• smoking
• smokeless tobacco, like chewing tobacco
• age
• obesity and lack of exercise
• diet, one high in red and processed meats and low in fresh fruit and vegetables may increase your risk
• long-term heavy drinking.

Some of the following medical conditions may also increase your risk of pancreatic cancer:

• chronic inflammation of the pancreas or hereditary pancreatitis
• stomach ulcers
• helicobacter pylori infection
• diabetes
• family history of pancreatic cancer.

Pancreatic cancer symptoms and diagnosis

In the early stages pancreatic cancer rarely causes symptoms. When symptoms do occur they are often vague but can include:

• pain in your stomach or back
• jaundice – yellowing of your skin and eye whites
• weight loss.

There are other possible symptoms you might experience if you have pancreatic cancer, including:

• itching caused by jaundice
• loss of appetite
• feeling or being sick
• change in bowel habit
• fever and shivering
• indigestion
• blood clots.

It’s important to remember that other health conditions can cause symptoms similar to pancreatic cancer. But if you do notice any of these symptoms, you should get them looked into by your doctor so you can treat any problems early.

Diagnosing pancreatic cancer
If you are worried about any symptoms you may have your first port of call would be your GP. Your doctor may want to examine you, and ask questions about your health and symptoms. Your doctor will also check the whites of your eyes and your look at your skin to check if there are signs of jaundice. A urine test and blood tests may also be requested. If your doctor thinks you need further tests, you will be referred to a specialist consultant.

At Circle Health, our consultants may want to run the following tests:

• blood tests to check your general health
• an ultrasound scan lets your consultant look at your pancreas and liver for cysts or other abnormalities
• an endoscopic ultrasound is an ultrasound scan from inside your body. Your consultant will use a flexible tube called an endoscope to look at areas that might be cancerous. A biopsy may also be taken
• a CT scan gives a detailed picture of inside your body and can help to show where your cancer is and if it has spread
• an MRI scan uses magnetic waves to build up a detailed picture of inside your body
• ERCP test (endoscopic retrograde cholangiopancreatography) This test uses an endoscope to take an X-ray of your pancreas and gallbladder. The doctor may also use this test to take a biopsy. An endoscopic ultrasound is now used more often to diagnose pancreatic cancer and an ERCP may be used to drain bile or place stents if jaundice is a problem
• laparoscopy is similar to an endoscopy. It lets your specialist look at your pancreas using a thin, flexible tube with a camera on the end called a laparoscope.

Stages of pancreatic cancer
After your tests, your doctor or pancreatic consultant will tell you what stage your pancreas cancer is at by looking at a sample of your cancer cells under a microscope. This describes how big your tumour is and how far it’s spread. This will influence the type of treatment you’re offered.

• Stage 1: The cancer is contained to the pancreas and hasn’t started to spread
• Stage 2: The cancer has started to grow into the tissue around the pancreas. It might also be in duodenum or bile duct
• Stage 3: The cancer is no longer contained to the pancreas – it may also be in the nearby large blood vessels or lymph nodes
• Stage 4: The cancer has spread to other areas of your body, like your liver or lungs.

For more information about each stage, please read Cancer Research UK’s article about the stages of pancreatic cancer.

Pancreatic cancer treatment

The type of treatment you’re offered depends on the type and stage of your pancreatic cancer, plus your overall health.

However, treatment for the different types of exocrine pancreatic cancer is generally the same, and surgery is most often the main treatment.

Surgery to remove pancreatic cancer
This is a common treatment for stage 1 and stage 2 pancreatic cancer. Your surgeon will only do this if you’re fit enough and they think it will be possible to remove all the cancer.

Surgery to relieve your symptoms
Pancreatic cancer is often diagnosed too late for surgery to be an effective option to remove the cancer. But surgery can help to relieve symptoms like jaundice or sickness.

Relieving symptoms with stents
A stent is a small tube used to relieve blockages. Your consultant will guide the stent into a blocked bile duct to help it stay open. This will enable bile to drain and help to improve any symptoms of jaundice.

Sometimes pancreatic cancer can block the top of your small bowel. If this happens, food can’t pass along the bowel and so it builds up in the stomach. This build up makes you sick – but bypass surgery can help to alleviate these symptoms.

Chemotherapy
If you have had surgery to remove your cancer you might need chemotherapy to lower the risk of the cancer coming back. Or if your cancer is advanced, you might need chemotherapy to shrink the cancer and relieve your symptoms.

Radiotherapy
It’s quite uncommon to use radiotherapy to treat pancreatic cancer, but it may be offered in certain situations to help shrink the tumour or relieve symptoms instead of surgery.

After treatment
You’ll have regular check-ups following your treatment. How often and for how long depends on the kind of pancreatic cancer treatment that you had.

At follow-up appointments, your doctor will ask how you’re feeling and examine you and you may need a combination of tests which can include blood tests, a CT scan or ultrasound scan.

If you’re worried or spot any new symptoms between appointments, you should tell your doctor or liver consultant as soon as you can.

Paying for your treatment 
You have two options to pay for your treatment – your costs may be covered by your private medical insurance, or you can pay for yourself.

Check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy.

If you are paying for your own treatment the cost of the procedure will be explained and confirmed in writing when you book the operation.

Ask the hospital for a quote beforehand, and ensure that this includes the consultants’ fees and the hospital charge for your procedure.

Want to know more?
If you’d like to read more about pancreatic cancer, treatment or living with pancreatic cancer, please visit cancerresearchuk.org.uk.