Updated 3 October 2023 | Approved By Dr. Umberto Russo
What is Pancreatic Cancer?Pancreatic cancer is a deadly disease that begins in the pancreas, a vital organ located behind the stomach. It occurs when abnormal cells in the pancreas start to grow uncontrollably, forming tumours. This type of cancer is often diagnosed at an advanced stage, making it difficult to treat effectively. Pancreatic cancer is characterised by its aggressive nature, as it can spread to nearby organs and tissues rapidly. Sadly, the prognosis for pancreatic cancer is often poor, emphasising the importance of early detection and research efforts to improve treatment options for this challenging disease.
Pancreatic Cancer SymptomsPancreatic cancer symptoms can be subtle but are crucial to recognise early for effective treatment. It's important to note that these symptoms can be caused by various conditions, and their presence does not necessarily mean a person has pancreatic cancer. Here is a list of common symptoms associated with pancreatic cancer :
- Stomach and abdominal pain: persistent, often located in the upper abdomen, may radiate to the back.
- Jaundice (yellowing of the skin and whites of the eyes due to blocked bile ducts)
- Unexplained weight loss
- Loss of appetite
- Digestive problems (e.g., nausea, vomiting, diarrhoea, or changes in stool colour)
- Fatigue and weakness
- Newly developed diabetes
- Blood clots
- Lower back pain
- Dark urine and pale stools
Pancreatic Cancer CausesThe exact causes of pancreatic cancer are not fully known, but there are several risk factors that are associated with this condition, which include :
- Age (particularly over the age of 60)
- Having a family history of pancreatic cancer or genetic mutations associated with this condition
- Chronic pancreatitis
- Being obese
- Being diagnosed with diabetes
Pancreatic Cancer Diagnosis and TestingThe diagnosis of pancreatic cancer typically starts with a visit to a general practitioner. When a patient reports pancreatic cancer symptoms, the GP conducts a physical examination and asks about the patient's medical history. Further tests may be conducted for a diagnosis .
Blood TestsGPs use blood tests as an initial step in the diagnosis of pancreatic cancer. One important blood marker they look for is called CA-19-9. Elevated levels of CA-19-9 may suggest the presence of pancreatic cancer, although this marker can also be raised in other non-cancerous conditions. It's essential to understand that CA 19-9 alone cannot confirm a pancreatic cancer diagnosis.
Imaging StudiesImaging techniques can be used to investigate possible cases of pancreatic cancer. These include CT (computed tomography) scans, MRIs (magnetic resonance imaging), and ultrasounds. These tests help create detailed images of the pancreas and surrounding areas, allowing doctors to assess the size and location of any tumors. If an abnormality is detected, further procedures, such as a biopsy, may be recommended to confirm the presence of cancer.
BiopsyWhen there is suspicion of pancreatic cancer, GPs may suggest a biopsy to confirm the diagnosis. During a biopsy, a small sample of tissue is taken from the pancreas for examination under a microscope. This helps determine if cancerous cells are present.
Endoscopic retrograde cholangiopancreatography (ERCP)GPs may recommend a procedure called endoscopic retrograde cholangiopancreatography, or ERCP, when investigating pancreatic cancer. ERCP involves using a thin, flexible tube with a camera that is passed through the mouth and into the digestive tract to reach the pancreas. This allows doctors to examine the pancreas and collect tissue samples for biopsy, aiding in the diagnosis of pancreatic cancer.
Pancreatic Cancer TreatmentTreatment for pancreatic cancer typically involves a multidisciplinary approach. GPs work closely with oncologists, surgeons, and other specialists to determine the most suitable treatment plan for each patient. Patient support and management of side effects are also integral components of the care process, focusing on improving the patient's quality of life. The following treatment options may be considered depending on the circumstances .
SurgerySurgical removal of the tumour is the preferred treatment when the cancer is localised and operable. Procedures like the Whipple procedure (pancreaticoduodenectomy) or distal pancreatectomy may be performed. In some cases, surgery can offer a chance for a cure.
ChemotherapyChemotherapy involves the use of drugs to kill cancer cells or slow their growth. It is often used before or after surgery to shrink tumours or target any remaining cancer cells.
RadiotherapyRadiotherapy uses high-energy X-rays to target and kill cancer cells. It can be used in combination with surgery or chemotherapy to treat pancreatic cancer.
ImmunotherapyImmunotherapy aims to boost the body's immune system to fight cancer cells. While it is still being researched for its use against pancreatic cancer, it shows promise as a potential treatment option.
Targeted TherapyTargeted therapy drugs are designed to target specific molecules involved in cancer cell growth. They are typically used in combination with chemotherapy.
Pancreatic Cancer ComplicationsPancreatic cancer can lead to several complications, which are challenges that arise in addition to the cancer itself. These complications can include:
- Jaundice (yellowing of the skin and eyes)
- Severe weight loss
- Digestive problems, such as difficulty eating and absorbing nutrients, and pain.
- Metastasis, or the cancer spreading to other organs
- Increased risk of blood clots (also known as deep vein thrombosis, or DVT)
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- Cancer Council Australia. (2023). Pancreatic cancer. https://www.cancercouncil.com.au/pancreatic-cancer/symptoms/
- Lowenfels, A. B., & Maisonneuve, P. (2005). Risk factors for pancreatic cancer. Journal of cellular biochemistry, 95(4), 649-656.
- Loveday, B. P., Lipton, L., & Thomson, B. N. (2019). Pancreatic cancer: An update on diagnosis and management. Australian journal of general practice, 48(12), 826-831.