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Pancreatic cancer

Published by Bupa's health information team, February 2008.

This factsheet is for people who have pancreatic cancer, or who would like information about it.

Pancreatic cancer affects about 7,000 people a year in the UK and is equally common in men and women. The development of pancreatic cancer is linked to age - about two-thirds of people who get it are aged 70 or over. Rarer types can occur in younger people and children.

Animation - How cancer develops
The pancreas
About pancreatic cancer
Types of pancreatic cancer
Symptoms
Causes
Diagnosis
Treatment
Further information
Questions and answers
Related topics
Sources

How cancer develops

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The pancreas

Your pancreas is part of your digestive system. It's about 15cm long and is found in front of your spine (back bone) where the sides of your rib cage join. Your pancreas has a thick end called the head, a middle section called the body and a thinner, pointed end called the tail. The head of the pancreas lies next to the first part of your small intestine (the duodenum).

The pancreas and surrounding structures

The pancreatic duct runs through your pancreas to join the duodenum at the same place as the bile duct which runs from your gallbladder.

Your pancreas produces digestive juices which run down the pancreatic duct into the duodenum. These help to break down food during digestion - the pancreas' exocrine function. The pancreas also produces a hormone - its endocrine function. This hormone, insulin, regulates blood sugar levels.

About pancreatic cancer

A pancreatic tumour is a lump created by an abnormal and uncontrolled growth of cells. It can either be malignant (cancerous) or benign.

Cancerous tumours can grow through your pancreas and spread to other parts of your body (through the bloodstream or the lymph system) where they may grow and form secondary tumours. This spread of cancer is called a metastasis.

Types of pancreatic cancer

Pancreatic cancer can develop anywhere in the pancreas. About seven to eight out of 10 start in the head of the pancreas.

Cancers of the pancreas are either exocrine or endocrine.

Exocrine cancers

The majority of pancreatic cancers are exocrine. Most of these begin in cells lining the ducts of the pancreas. Lots of these small ducts join the main pancreatic duct.

There are other, rarer types of exocrine cancer.

Endocrine cancers

These produce hormones - they are also known as neuroendocrine tumours.

These types of pancreatic cancer are rare but they can develop at any age, even in babies and children.

Symptoms

It may take a while for you to have any symptoms. These may be vague and not specific to pancreatic cancer. They may include:

weight loss
jaundice causing the whites of your eyes and your skin to become yellow - if your bile duct is blocked, bile (which contains yellow pigments) goes into your bloodstream instead of your duodenum
dark urine and light-coloured faeces
pain around your stomach area which may spread to your back
loss of appetite (anorexia)
diabetes
itchy skin
sickness
change in bowel movements
fever

Endocrine cancers can cause unusual symptoms related to the hormone being produced. The name of the cancer relates to the hormone that it secretes.

Gastrinomas produce gastrin which can lead to stomach ulcers.
Insulinomas release insulin which can cause low blood sugar, leading to weakness and dizziness.
Somatostatinomas secrete somatostatin which can result in diarrhoea and gallstones.
VIPomas release VIP leading to diarrhoea and high blood pressure.
Glucagonomas produce glucagon which can cause mouth ulcers, diarrhoea and a skin rash.

Although not necessarily a result of pancreatic cancer, if you have these symptoms you should visit your GP.

Causes

Little is known about the exact causes of pancreatic cancer. However, there are a number of factors that may increase your risk of developing it. These include:

smoking
a diet that is high in sugar and fat and low in fruit and vegetables, or eating lots of red meat or processed food
drinking excessive amounts of alcohol
not taking enough exercise or being overweight
being exposed to high levels of some industrial chemicals

Certain medical conditions may increase your risk of pancreatic cancer, including:

chronic pancreatitis
diabetes
stomach ulcers

Pancreatic cancer isn't usually inherited although up to one in 10 people with it may have a genetic link. If you have pancreatic cancer, other members of your family are unlikely to be at an increased risk of developing it.

Diagnosis

It can be hard to make a diagnosis at first as the early symptoms of pancreatic cancer are similar to those of a number of other conditions. Your GP will ask about your symptoms and examine you, including your abdomen (tummy) and may also ask about your medical history. Your GP will also look for jaundice and may do blood tests. You will probably be asked to give a urine sample so it can be tested for bile.

Your GP may refer you to a surgeon, a gastroenterologist - a doctor specialising in conditions of the digestive system - or an oncologist - a doctor specialising in cancer. You will probably have an ultrasound or CT scan. An ultrasound scan uses sound waves to produce images of the inside of your body; a CT scan uses X-rays to make a three-dimensional picture of part of your body.

You may also have a gastroscopy. This allows your doctor to look at the inside of your oesophagus (the pipe that goes from your mouth to your stomach) and stomach. A narrow, flexible, tube-like telescope called an endoscope is passed through your mouth and down into your digestive system.

You may also have a biopsy. A biopsy is a small sample of tissue. This will be sent to a laboratory for testing.

If you are found to have cancer, you may need to have other tests to assess if it has spread.

Treatment

Pancreatic cancer can be difficult to cure because it's often not diagnosed until it's quite advanced. Treatment can offer pain relief and relieve your symptoms.

Surgery

If your cancer is found in the early stages, you may be able to have surgery to remove it. This is possible for about 15 to 20 people in every 100 who have pancreatic cancer.

There are a number of different operations - the one you have will depend on factors such as how big your cancer is and your general health and fitness. These are major operations to remove some or all of your pancreas and possibly other parts of your digestive system.

You may be offered an operation to ease symptoms even if surgery can't remove the cancer. For example, if your bile duct is blocked, you may have a tube (stent) put in to drain bile and relieve the symptoms of jaundice.

Chemotherapy

Chemotherapy is medicine that tries to kill cancer cells. If you have had surgery, you may receive chemotherapy afterwards. If the tumour can't be surgically removed, you may be given chemotherapy to try to reduce its size and relieve your symptoms.

You may be given a type of chemotherapy medicine called gemcitabine (eg Gemzar) through a drip. This medicine can cause side-effects in some people, including:

increased risk of infection
feeling and being sick
rash
fluid retention
flu symptoms

Your doctor will only recommend chemotherapy if he or she considers that the benefits will outweigh the side-effects.

Chemotherapy is sometimes used in combination with radiotherapy. This is called chemoradiation.

You may be offered a clinical trial testing new chemotherapy medicines or chemotherapy with a biological therapy.

Radiotherapy

Radiotherapy isn't often used to treat pancreatic cancer, but it's sometimes used if it isn't possible to operate on your cancer. Radiotherapy uses X-rays to destroy the cancer cells. This may shrink the tumour and control it for a while.

Further information

Cancerbackup
0808 800 1234
www.cancerbackup.org.uk
Pancreatic Cancer UK
www.pancreaticcancer.org.uk