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What is pancreatic cancer?
The pancreas is a leaf shaped gland which lies just below the stomach in the abdomen It produces pancreatic juices, which help digest food, and is linked to the gallbladder, which empties into the gut just below the stomach. Other pancreatic cells produce hormones, including insulin, which helps the body regulate the amount of sugar in the blood.
There are two types of pancreatic cancer - carcinoma of the pancreas, and, far more rarely, cancer of the cells which make insulin. Like many cancers of internal organs, the tumours tend to develop silently, causing few symptoms and signs which might provide a clue to its presence until disease is well advanced.
Pancreatic cancer is equally common in men and women, but the majority of cases occur in the over-70s. It accounts for only 3 per cent of cancers in the UK.
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Causes
Although scientists don’t know why many people develop pancreatic cancer, risk factors identified may include:
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Symptoms
It’s often the pressure of a large tumour pushing on other organs or parts of the body which is the first clue something is wrong. However, symptoms are often very non-specific and depend greatly on the size of the tumour, and where on the pancreas it’s located.
They include:
The rarer form of pancreas cancer can cause the pancreas to make too much insulin, leading the symptoms a diabetic gets if, including:
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Diagnosis
If pancreatic cancer is suspected, there are a number of tests a GP can do , including Physical examination –althought it can be very difficult to feel a pancreatic cancer due to its position in the body.
Blood tests, including pancreatic amylase and liver function tests Confirmatory tests include:CT and, MRI scans, ERCP (endoscopic retrograde cholangio –pancreatography) or the use of ultrasound. A special type of ultrasound scan, which is done during an endoscopy or telescopic investigation of the intestines, enables doctors to look at the pancreas from deep inside the body. This sort of scan is known as an endoluminal ulatrasound or EUS.
A biopsy operation is the only sure way to complete a diagnosis. This involves taking a tiny tissue sample from the tumour. In some cases, a probe is passed through a small cut into the abdomen to see how far the disease has spread. Occasionally a more serious ‘laparotomy’ operation is needed - this involves making a larger cut so that the surgeon can look more closely at the organs.
Blood tests may be done to check for general signs of disease such as anaemia, as well as chemical markers in the blood which provide clues about certain types of cancer. These tests, and a small operation to look inside the abdomen if necessary, help the doctors to work out how far it has advanced and decide whether an operation to remove the cancer might help. They also help to give an idea of prognosis or long-term outlook.
Top
Treatment
A combination of therapies can either cure the cancer if caught early, or, if not, improve quality of life and reduce pain. Surgery may be used to take out the diseased area of the pancreas, especially if the tumour is less than 3 cm in diameter, or even the whole organ, but the latter is a very rare option. If other organs, such as the stomach, gut, spleen and gallbladder, are involved, they can be partly or totally removed. However, this is major surgery and unsuitable for many patients.
Pancreatic cancer patients may also be given radiotherapy or chemotherapy. NICE (the National Institute for Clinical Excellence) recommend that chemotherapy, especially a drug called Gemcitabine, may be considered as a treatment for advanced pancreatic cancer, either on its own or with radiotherapy, as long as the patient is well enough to cope with the side-effects of treatment and meets several other criteria. Also guidelines recommend that post-operative (adjuvant) chemotherapy may be beneficial, but adjuvant radiotherapy (with or without chemotherapy) is not recommended.
Unfortunately, only about 15 per cent of people diagnosed with pancreatic cancer survive past a year, and only three per cent live for more than five years after diagnosis. Those people whose cancer is caught early have a better prognosis, as do those who are generally fitter. Some less common types of pancreatic cancer also have better survival rates.
A number of clinical trials are looking at new drugs or combinations of existing treatments, new biological agents, cancer vaccines and even gene therapy, as well as better treatments to help symptoms such as poor appetite, weight loss and pain.
The pancreas is a leaf shaped gland which lies just below the stomach in the abdomen It produces pancreatic juices, which help digest food, and is linked to the gallbladder, which empties into the gut just below the stomach. Other pancreatic cells produce hormones, including insulin, which helps the body regulate the amount of sugar in the blood.
There are two types of pancreatic cancer - carcinoma of the pancreas, and, far more rarely, cancer of the cells which make insulin. Like many cancers of internal organs, the tumours tend to develop silently, causing few symptoms and signs which might provide a clue to its presence until disease is well advanced.
Pancreatic cancer is equally common in men and women, but the majority of cases occur in the over-70s. It accounts for only 3 per cent of cancers in the UK.
Top
Causes
Although scientists don’t know why many people develop pancreatic cancer, risk factors identified may include:
- Smoking and other types of tobacco use - smokers are up to three times more likely to get the disease.
- A diet high in fat, sugar and red or processed meats, and low in fresh fruit or vegetables. A history of chronic inflammation of the pancreas (known as pancreatitis), diabetes (a small increase in risk) or stomach ulcers.
- In ten per cent of cases there is an inherited tendency towards cancer.
- Being overweight or inactive.
- Exposure to certain industrial chemicals, particularly chlorinated hydrocarbon solvents.
- Diabetes, although a rare risk factor.
- Excess alcohol.
- Environmental factors such as working with petrol and some chemicals have also been linked with this cancer, although such exposure would have to be on a long-term basis.
Top
Symptoms
It’s often the pressure of a large tumour pushing on other organs or parts of the body which is the first clue something is wrong. However, symptoms are often very non-specific and depend greatly on the size of the tumour, and where on the pancreas it’s located.
They include:
- Unexplained weight loss.
- Abdominal pain (often described as a dull, gnawing ache that spreads to the back - it may become worse if the patient eats).
- Jaundice, which is the result of the tumour expanding and blocking the bile duct, another tube carrying digestive juices into the gut, then jaundice can be the result. The skin and whites of the eyes turn yellowish, and urine may become darker.
- Weight loss and weakness.
- Nausea and loss of appetite, back pain, itching of the skin, and diabetes.
- Certain tumours can cause a wide range of odd symptoms related to the action of the hormone that the tumour cells produce.
- Not all patients have all symptoms as they depend on the type of cancer and where it is (for example, a tumour in head of pancreas may present as painless jaundice and in the body and tail as abdominal or back pain without jaundice).
- Fever and shivering
The rarer form of pancreas cancer can cause the pancreas to make too much insulin, leading the symptoms a diabetic gets if, including:
- Dizziness.
- Muscle spasms.
- Diarrhoea.
Top
Diagnosis
If pancreatic cancer is suspected, there are a number of tests a GP can do , including Physical examination –althought it can be very difficult to feel a pancreatic cancer due to its position in the body.
Blood tests, including pancreatic amylase and liver function tests Confirmatory tests include:CT and, MRI scans, ERCP (endoscopic retrograde cholangio –pancreatography) or the use of ultrasound. A special type of ultrasound scan, which is done during an endoscopy or telescopic investigation of the intestines, enables doctors to look at the pancreas from deep inside the body. This sort of scan is known as an endoluminal ulatrasound or EUS.
A biopsy operation is the only sure way to complete a diagnosis. This involves taking a tiny tissue sample from the tumour. In some cases, a probe is passed through a small cut into the abdomen to see how far the disease has spread. Occasionally a more serious ‘laparotomy’ operation is needed - this involves making a larger cut so that the surgeon can look more closely at the organs.
Blood tests may be done to check for general signs of disease such as anaemia, as well as chemical markers in the blood which provide clues about certain types of cancer. These tests, and a small operation to look inside the abdomen if necessary, help the doctors to work out how far it has advanced and decide whether an operation to remove the cancer might help. They also help to give an idea of prognosis or long-term outlook.
Top
Treatment
A combination of therapies can either cure the cancer if caught early, or, if not, improve quality of life and reduce pain. Surgery may be used to take out the diseased area of the pancreas, especially if the tumour is less than 3 cm in diameter, or even the whole organ, but the latter is a very rare option. If other organs, such as the stomach, gut, spleen and gallbladder, are involved, they can be partly or totally removed. However, this is major surgery and unsuitable for many patients.
Pancreatic cancer patients may also be given radiotherapy or chemotherapy. NICE (the National Institute for Clinical Excellence) recommend that chemotherapy, especially a drug called Gemcitabine, may be considered as a treatment for advanced pancreatic cancer, either on its own or with radiotherapy, as long as the patient is well enough to cope with the side-effects of treatment and meets several other criteria. Also guidelines recommend that post-operative (adjuvant) chemotherapy may be beneficial, but adjuvant radiotherapy (with or without chemotherapy) is not recommended.
Unfortunately, only about 15 per cent of people diagnosed with pancreatic cancer survive past a year, and only three per cent live for more than five years after diagnosis. Those people whose cancer is caught early have a better prognosis, as do those who are generally fitter. Some less common types of pancreatic cancer also have better survival rates.
A number of clinical trials are looking at new drugs or combinations of existing treatments, new biological agents, cancer vaccines and even gene therapy, as well as better treatments to help symptoms such as poor appetite, weight loss and pain.