Understanding pancreatic cancer

Pancreatic cancer is an aggressive type of cancer that, unfortunately, is commonly undiagnosed until it is in advanced stages. In this article, a consultant hepato-pancreato-biliary surgeon explains the symptoms of pancreatic cancer, diagnostic methods, and options for treatment.

What is pancreatic cancer?

The pancreas is a large gland in the upper abdomen which produces insulin to manage the blood glucose levels in the body. Pancreatic cancer develops when the cells that comprise the tissue of the pancreas begin to behave abnormally, leading to unprecedented growths (tumours).

Cancer can occur in different areas of the pancreas. The most common is pancreatic ductal adenocarcinoma, which occurs on the head of the pancreas, and represents about 90 per cent of all cases; other types include:

Ampullary cancer, where the pancreatic duct meets the bile duct before entering the intestines.
Cystic tumours, where noncancerous cysts become cancerous
Neuroendocrine tumours, which start in the endocrine cells
Acinar cell carcinomas, which develop in the cells that synthesise the pancreatic fluid

Patients most at risk of developing pancreatic cancer include those over 50 years old, smokers, and those with a family history of the disease.

What are the symptoms of pancreatic cancer?

Pancreatic cancer can be very difficult to catch in its early stages, as symptoms may not be apparent until further along. When symptoms do appear, they are often misattributed to other illnesses, and so without intentional testing and screening, the cancer may remain undiscovered for some time.

The earliest occurring symptoms are typically indigestion, abdominal pain, nausea, lack of appetite, stomach aches, and unexplained weight loss. As the disease progresses, patients can develop jaundice or diabetes.

Uncovering pancreatic cancer involves diagnostic procedures such as blood tests for specific tumour proteins (namely CA19-9), a variety of imaging scans to assess the form of the pancreas, and a biopsy to test the tissue of the pancreas for cancerous activity.

How is pancreatic cancer treated?

Treatment of pancreatic cancer depends on the stage of the cancer. As most cases are discovered in an advanced stage, surgery is often the best option for treatment, with the aim of completely removing the cancerous tissue. It can be performed with robotic or laparoscopic techniques. Some approaches that can achieve this include:

Whipple’s operation to remove the head of the pancreas and part of the bowel
Distal pancreatectomy/splenectomy to remove the tail and spleen
Total pancreatectomy to remove the entire pancreas

Chemo- and radiotherapy are also often employed to attack the cancer cells and reduce the size of tumours, either in conjunction with surgery or as an alternative for patients who cannot undergo surgery, as their physical condition and age may make it risky to undergo the procedure.