Pancreatic cancer | Chris O'Brien Lifehouse

This information has been prepared to help you understand more about pancreatic cancer.

Many people feel understandably shocked and upset when they are told they have pancreatic cancer. This information is intended to help you understand the diagnosis and treatment of this type of cancer.

We cannot advise you about the best treatment for you. You need to discuss this with your doctors. However, we hope this information will answer some of your questions and help you think about the questions you want to ask your doctors or other health carers.

The Pancreas

The pancreas is an organ of the digestive system, which breaks down food so it can be absorbed and used by the body. It is a thin, lumpy gland about 13-15cm long that lies between your stomach and spine. The pancreas is divided into several parts: a large rounded section (the head of the pancreas), a middle part (the body), and a narrow part at the end (the tail).

A tube called the pancreatic duct connects the pancreas to the first part of the small bowel (known as the duodenum). Another tube called the common bile duct connects with the pancreatic duct. This tube carries bile – a substance that helps to digest fats – from the liver and gall bladder to the small bowel.

The pancreas contains two types of glands: the exocrine glands and the endocrine glands.

Exocrine glands – produce juices called enzymes that help break down food. These juices flow from the pancreas into your duodenum through the pancreatic duct. Most of the pancreas is made up of exocrine glands.

Endocrine glands – are scattered amongst the exocrine glands in small clusters called pancreatic islets (or islets of Langerhans). They release hormones that control the amount of sugar in the blood. The hormones glucagon and insulin are involved in increasing and decreasing blood sugar levels, respectively.

What is pancreatic cancer?

Pancreatic cancer occurs when cells in the pancreas become abnormal and grow uncontrollably. The spread of cancerous (malignant) cells can affect how the pancreas works, including the function of the exocrine and endocrine glands.

Types of pancreatic cancer

About 70% of pancreatic cancers occur in the head of the pancreas. There are two main types of pancreatic tumours:

Exocrine tumours: the most common type – making up over 90% of pancreatic tumours. The most common sub-type begins in the lining of the pancreatic duct and is called an adenocarcinoma. Other types of exocrine pancreatic tumours include: adenosquamous carcinomas and undifferentiated carcinomas.

Pancreatic neuroendocrine tumours (PNETs): a rare type of tumour that begins in the endocrine cells which produce hormones that control the growth of cells. PNETs may be malignant (cancerous) or benign (non-cancerous). When the tumour is malignant it is often called pancreatic endocrine cancer or islet cell carcinoma.

PNETs can be categorised as functioning (hormone secreting) or non-functioning (non-hormone secreting). Functioning tumours are named after the type of hormone they produce.

Types of PNETs include:

Gastrinomas – produce too much gastrin
Insulinomas – produce too much insulin
Glucagonomas – produce too much glucagon
Somatostatinomas – produce too much somatostatin
VIPomas – create a hormone-like substance called vasoactive intestinal polypeptide (VIP).

How common is it?

If you would like to read any facts or statistics about pancreatic cancer, please refer to the Cancer Institute NSW website:
http://www.cancerinstitute.org.au/cancer-in-nsw/cancer-facts/pancreatic-cancer

What is the cause?

The exact causes of pancreatic cancer are not known, however some factors will increase your risk:

  • Getting older – you are more likely to be diagnosed with pancreatic cancer if you are over 65.
  • Smoking – if you smoke you are 2-3 times more likely to develop pancreatic cancer than non-smokers.
  • New onset diabetes – about 15-20% of people with pancreatic cancer have newly diagnosed diabetes.
  • Pancreatitis – if you have pancreatitis (chronic inflammation of the pancreas) you are more likely to develop pancreatic cancer.
  • Family history – about one in 10 people who develop pancreatic cancer have an inherited faulty gene.

You are more likely to have an inherited faulty gene if you:

  1. have two or more first-degree relatives (e.g. parents or siblings) who have been diagnosed with pancreatic cancer;
  2. have family members who carry the breast cancer gene (BRCA1 and BRCA2); or
  3. have a family history of inherited syndromes including Peutz-Jeghers syndrome, familial atypical multiple mole melanoma syndrome, Lynch syndrome, or hereditary pancreatitis.

In addition, some PNETs are caused by rare inherited syndromes called multiple endocrine neoplasia type 1 (MEN-1) and neurofibromatosis.

If you are concerned about your family history you may want to talk to your doctor about genetic testing.

What are the symptoms?

Pancreatic cancer is rarely detected in its early stages. Symptoms usually start to occur once the cancer is large enough to affect nearby organs.

If you have pancreatic cancer you may notice:

  • indigestion (heartburn)
  • a loss of apetite
  • feeling sick (nausea)
  • vomiting
  • weight loss
  • pain in your upper abdomen, side or back, which may cause you to wake up at night
  • changed bowel motions – either diarrhoea, severe constipation, or stools that are pale and hard to flush away
  • jaundice – which cases your skin and eyes to look yellowish, dark urine, pale bowel motions and itchiness
  • worsening of existing diabetes or an onset of diabetes within the last two years
  • for PNETs, hyperglycaemia (too much sugar in your blood) or blurred vision.

You may have nothing to worry about if you experience these symptoms, as they can all be caused by many other non-cancerous conditions. However, if you notice one or more of these symptoms you should bring it to the attention of your doctor for further investigation.

Diagnosis

Your doctor(s) will often do a number of tests before they diagnose pancreatic cancer, including blood tests, imaging tests and tissue sampling.

Blood tests

Blood tests are often used to determine how well your liver and kidneys are working and provide a full blood count. If pancreatic cancer is suspected, your doctor will be interested in a tumour marker called CA 19-9, which is often detected in the blood of people with cancer.

If you are diagnosed with pancreatic cancer, your CA 19-9 level will be tested again throughout your treatment to see how the cancer is responding.

Imaging tests

In addition to blood tests, imaging tests will be used to diagnose pancreatic cancer. You will probably undergo one or more of the following imaging tests:

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