Pancreatic cancer

Index:

 

  1. What is pancreatic cancer?
  2. What are the symptoms of pancreatic cancer?
  3. What causes pancreatic cancer?
  4. How is pancreatic cancer diagnosed?
  5. What is the treatment for pancreatic cancer?
  6. What's involved in pancreatic cancer surgery?
  7. What are the stages of pancreatic cancer?
  8. What are the survival rates for pancreatic cancer?
  9. Which specialist treats pancreatic cancer?

What is pancreatic cancer?

The pancreas is a large gland in the abdomen, which produces enzymes that aid in digestion. Pancreatic cancer is when abnormal cells develop in the pancreas and multiply out of control. As these cells do not function normally, as they multiply they hinder bodily functions, eventually leading to death if not treated.

 

Lady with cancer

 

Cancer can develop in different parts of the pancreas:

  • Ductal adenocarcinoma develops in the lining of the pancreatic ducts (which carry the enzymes produced to the digestive system). Around 95% of pancreatic cancer cases are ductal adenocarcinomas.
  • Ampullary cancer develops at the ampulla of Vater. This is where the pancreatic duct meets the bile duct before entering the intestines.
  • Cystic tumours – although the pancreas can develop benign cysts (fluid-filled sacs), occasionally it grows cancerous ones.
  • Neuroendocrine tumours start in the endocrine cells, which produce hormones like insulin.
  • Acinar cell carcinomas develop in the cells that synthesise the pancreatic juice (the mixture of digestive enzymes).
  • Lymphoma – cancer of the lymphatic tissue, which threads through the entire body, including the pancreas.

 

What are the symptoms of pancreatic cancer?

In the early stages, pancreatic cancer may not show any symptoms, making it hard to diagnose. Symptoms such as abdominal pain, indigestion and weight loss can manifest as the cancer develops and grows. Unfortunately, these symptoms are common and can indicate a number of other conditions. Other possible symptoms include:

  • Jaundice (yellow skin and eyes, itching)
  • Change in bowel habits, e.g. constipation, diarrhoea
  • Nausea/vomiting
  • Difficulty swallowing
  • Diabetes (especially if only recently developed or diagnosed)

 

What causes pancreatic cancer?

The causes are not fully understood, but certain risk factors have been identified, such as age (patients are generally 50-80 years old), smoking, and a history of certain conditions (e.g. diabetes, chronic pancreatitis, stomach ulcer and H. pylori infection). There is thought to be a genetic factor in some cases, as in about 1 in 10 cases the patient’s parent or parents also had pancreatic cancer. 

 

Pancreatic cancer cells

 

How is pancreatic cancer diagnosed?

There are various tests available in order to diagnose pancreatic cancer. They include: 

  • Blood tests
    • Blood is tested for specific proteins, or tumour markers, that are shed by pancreatic cancer cells. One type of test for pancreatic cancer is called CA19-9, which can assist is understanding how cancer responds to treatment.

 

  • Biopsy
    • A small sample of tissue is removed from the pancreas for examination under microscope, in a biopsy for pancreatic cancer. An endoscopic ultrasound (EUS) is collected by passing tools through the endoscope in order to collect the tissue. Sometimes, a sample of tissue is collected via fine-needle aspiration by inserting a needle through your skin and into your pancreas. 

 

  • Ultrasound scan and other imaging tests
    • An endoscopic ultrasound (EUS) makes images of your pancreas from inside your abdomen via an ultrasound device. This device is passed through a thin, flexible tube called an endoscope, down your oesophagus and into your stomach.   

Other imaging tests include:

What is the treatment for pancreatic cancer?

Pancreatic cancer is difficult to treat, as it is rarely detected until the tumour has become quite large. Treatment depends on the type, location and size of the tumour, as well as the age and general health of the patient. If it is possible to remove the tumour completely, this is the preferred option, but in cases where this is not possible, different treatment will be recommended to contain the cancer, prevent further growth and minimise the damage it does to the body.

The three main treatments, which may be used individually or in combination are:

  • Surgery
  • Chemotherapy
  • Radiotherapy

Recovering from surgery on the pancreas can be long and painful, and the bowel will stop working for a while, meaning that the patient cannot eat or drink immediately afterwards, and may be referred to a dietician for the duration of the recovery process.

What's involved in pancreatic cancer surgery?

The most effective treatment for pancreatic cancer is surgery. It's the best for removing the cancer and can assist in you living longer, while symptoms can improve as well. However, possible complications, recovery time and side effects such as digestion problems and diabetes, are some of the disadvantages of pancreatic cancer surgery

There are two main types of pancreatic cancer surgery, open or keyhole surgery.

In open surgery for pancreatic cancer, one large incision is made in the stomach, while in keyhole surgery, several small cuts about one to two centimetres are made in the same area. An endoscope with a camera attached to it, is used to guide the surgeon. Robotic surgery is similar, but used to control instruments through a computer.

Keyhole surgery may not be suitable for everyone, and if a surgeon finds that it's more complicated than they expected they will switch to open surgery. Keyhole surgery may be offered to patients having a distal pancreatomy or those having a Whipple's procedure.   

Pancreatic desmoplasia

What are the stages of pancreatic cancer?

There are five stages of pancreatic cancer; Tis, T1, T2, T3 and T4, and one of the main ways of staging cancers is the TNM system (Tumour, Node and Metastasis). 

  • Tis

​This is early stage pancreatic cancer that hasn't down into the deeper layers of tissue within the pancreas, and it's uncommon for pancreatic cancer to be diagnosed very early. 

  • T1

It means the cancer is inside the pancreas and is 2 centimetres or less in any direction. It is split into three stages, T1a, T1b and T1c.

  •  T2

This stage is where cancer is between 2 and 4 centimetres in any direction. 

  • T3

At the T3 stage, the cancer is bigger than 4cm but is still within the pancreas.

  • T4​

The cancer has grown outside of the pancreas into the nearby large blood vessels at the T4 stage. 

Node (N), describes whether the cancer has spread to the lymph nodes. If cancer has spread to the nearby lymph nodes, it means there is a higher risk that cancer cells may have spread further than the pancreas. N0 means there are no cancer cells in the nearby lymph nodes, N1 signifies that there are 1 to 3 lymph notes which have cancer cells in them, N2 means there is cancer in 4 or more lymph nodes. 

Metastasis (M) signifies if the cancer has spread to a different part of the body

What are survival rates for pancreatic cancer? 

It's been found by Cancer Research UK that pancreatic cancer survival is between one and five years for women, higher than males. It is also more likely for people who are under 50 years old.

Which specialist treats pancreatic cancer?

There are various specialists that may play a part in treating pancreatic cancer. These are:

  • Gastroenterologists. These doctors specialise in diagnosis and treatment of digestive system conditions, and can help to control symptoms. 
  • Medical oncologists. A medical oncologist specialises in treating pancreatic cancer with chemotherapy, immunotherapy and targeted therapy.
  • Surgical oncologists, who will be able to surgically operate on pancreatic cancer.
  • Radiation oncologists can treat pancreatic cancer with radiation therapy.  
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