Pancreatic cancer (cancer of the pancreas) mainly occurs in people aged over 60. If it is diagnosed at an early stage, then an operation to remove the cancer gives some chance of a cure. In general, the more advanced the cancer (the more it has grown and spread), the less chance that treatment will be curative. However, treatment can often slow the progress of the cancer.
The pancreas is in the upper abdomen and lies behind the stomach and intestines (guts). The shape of the pancreas is like a tadpole, and so the pancreas has a head, a body and a tail. The head section is nearest to the duodenum (the part of the gut just after the stomach).
The pancreas makes a fluid that contains enzymes (chemicals) that are needed to digest food. The enzymes are made in the pancreatic cells and are passed into tiny ducts (tubes). These ducts join together like branches of a tree to form the main pancreatic duct. This drains the enzyme-rich fluid into the duodenum. The enzymes are in an inactive form in the pancreas (otherwise they would digest the pancreas). They are activated in the duodenum to digest food.
Groups of special cells called islets of Langerhans are scattered throughout the pancreas. These cells make the hormones insulin and glucagon. The hormones are passed (secreted) directly into the bloodstream to control the blood sugar level.
The bile duct carries bile from the liver and gallbladder. This joins the pancreatic duct just before it opens into the duodenum. Bile also passes into the duodenum and helps to digest food.
Cancer is a disease of the cells in the body. The body is made up from millions of tiny cells. There are many different types of cell in the body, and there are many different types of cancer which arise from different types of cell. What all types of cancer have in common is that the cancer cells are abnormal and multiply out of control.
A malignant tumour is a lump or growth of tissue made up from cancer cells which continue to multiply. Malignant tumours invade nearby tissues, which can cause damage. Malignant tumours may also spread to other parts of the body. This happens if some cells break off from the first (primary) tumour and are carried in the bloodstream or lymph channels to other parts of the body. These small groups of cells may then multiply to form secondary tumours (metastases) in one or more parts of the body. These secondary tumours may then grow, invade and damage nearby tissues, and spread again.
Some cancers are more serious than others, some are more easily treated than others (particularly if diagnosed at an early stage), some have a better outlook (prognosis) than others. So, cancer is not just one condition. In each case it is important to know exactly what type of cancer has developed, how large it has become, and whether it has spread. This will enable you to get reliable information on treatment options and outlook. See separate leaflet called Cancer - what are cancer and tumours? for more details about cancer in general.
Pancreatic cancer is relatively uncommon. It develops in about 1 in 10,000 people each year in the UK. There are several types of pancreatic cancer, but more than 9 in 10 cases are ductal adenocarcinomas.
This type of cancer develops from a cell which becomes cancerous in the pancreatic duct. This multiplies and a tumour then develops in and around the duct. As the tumour enlarges:
There are some rare types of cancer which arise from other types of cells within the pancreas. For example, cells in the pancreas that make insulin or glucagon can become cancerous (insulinomas and glucagonomas). These behave differently to ductal adenocarcinoma. For example, they may produce too much insulin or glucagon, which can cause various symptoms.
The rest of this leaflet only discusses ductal adenocarcinoma of the pancreas.
A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply out of control. (See separate leaflet called What causes cancer? for more details.)
Many people develop cancer of the pancreas for no apparent reason. However, certain risk factors increase the chance that pancreatic cancer may develop. These include:
Most cases of pancreatic cancer do not run in families. However, some families have a higher incidence of pancreatic cancer than average. It is thought that about 1 in 10 pancreatic cancers are due to inheriting an abnormal gene. See your doctor if you are concerned that pancreatic cancer is common in your family. You may be offered screening tests with the aim of detecting pancreatic cancer at an early stage when the chance of a cure is high. A study group based at Liverpool University, called European Registry for Familial Pancreatic Cancer and Hereditary Pancreatitis (EUROPAC) is researching the causes of pancreatic cancer. EUROPAC co-ordinates a national study into screening for pancreatic cancer in those at high risk. See contact details at the end of the leaflet.
In about 7 in 10 cases the tumour first develops in the head of the pancreas. A small tumour often causes no symptoms at first. As the tumour grows it tends to block the bile duct. This stops the flow of bile into the duodenum which leads to:
Pain is often not a feature at first. Therefore a painless jaundice that becomes worse is often the first sign of pancreatic cancer. Nausea and vomiting are also fairly common symptoms.
As the cancer grows in the pancreas, further symptoms that may develop include:
If the cancer spreads to other parts of the body, various other symptoms can develop.
There are many causes of jaundice and of the other symptoms listed above. For example, a blocked gallstone or hepatitis (liver inflammation). Therefore, some initial tests are usually arranged if you develop jaundice or the other symptoms listed above. Typically, these include an ultrasound scan of the abdomen and various blood tests. These initial tests can usually give a good idea if the cause of jaundice is a blockage from the head of the pancreas.
If you are confirmed to have pancreatic cancer, or it is strongly suspected from the initial tests, then further tests may be done to assess if it has spread. For example:
See separate leaflets which describe each of these tests in more detail.
This assessment is called staging of the cancer. The aim of staging is to find out:
By finding out the stage of the cancer, it helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis). See separate leaflet called Staging and grading cancer for details.
A biopsy is when a small sample of tissue is removed from a part of the body. The sample is then examined under the microscope to look for abnormal cells. If a biopsy is thought to be needed then one way to get a sample from the pancreas is to take the biopsy sample when you have an endoscopy. This is done by passing a thin grabbing instrument down a side channel of the endoscope (gastroscope). Alternatively, sometimes a biopsy is done at the same time as having a scan. It can take two weeks for the result of a biopsy.
Treatment options that may be considered include surgery, chemotherapy and radiotherapy. The treatment advised for each case depends on various factors such as the stage of the cancer (how large the cancer is and whether it has spread), and your general health.
You should have a full discussion with a specialist who knows your case. He or she will be able to give the pros and cons, likely success rate, possible side-effects, and other details about the various possible treatment options for your type of cancer.
You should also discuss with your specialist the aims of treatment. For example:
If the cancer is at an early stage, then there is a modest chance that surgery can be curative. (An early stage means a small tumour which is confined within the pancreas and has not spread to the lymph nodes or other areas of the body).
The reason why the chance of cure is only modest is because in a number of cases thought to be in an early stage, some cells have already spread to other parts of the body but are not yet detectable by scans or other staging tests. In time they grow into secondary tumours.
If the cancer is at a later stage then surgery is not an option to cure the disease. Some surgical techniques may still have a place to ease symptoms. For example, it may be possible to ease jaundice caused by a blocked bile duct. A bypass procedure may be used, or a stent may be inserted into the bile duct. (A stent is a small rigid tube made of plastic or metal which aims to keep a duct or channel open. It is usually inserted by instruments attached to an endoscope.)
Chemotherapy is a treatment of cancer by using anti-cancer medicines which kill cancer cells or stops them from multiplying. See separate leaflet called Chemotherapy with cytotoxic medicines for more details. When chemotherapy is used in addition to surgery it is known as adjuvant chemotherapy. For example, following surgery you may be given a course of chemotherapy. This aims to kill any cancer cells which may have spread away from the primary tumour.
Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. See separate leaflet called Radiotherapy for more details. Radiotherapy is not commonly used to treat pancreatic cancer.
If a pancreatic cancer is diagnosed and treated at an early stage then there is a modest chance of a cure with surgery. As a rule, the smaller the tumour, and the earlier the tumour is diagnosed, the better the outlook. Some tumours which develop in the head of the pancreas are diagnosed very early, as they block the bile duct and cause jaundice fairly early on. This obvious symptom is then investigated and surgery to remove a small tumour may be curative.
However, most pancreatic cancers are advanced before they cause symptoms and are diagnosed. A cure is unlikely in most cases. However, treatment may slow down the progression of the cancer.
The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer is likely to respond to treatment.
2nd Floor, Camelford House, 89 Albert Embankment, London, SE1 7TW
Tel 0203 535 7099 Web: www.pancreaticcancer.org.uk
Provides information and support to pancreatic cancer patients.
The co-ordinating centre for secondary screening for pancreatic cancer in the UK.
Tel (Helpline): 0808 808 0000 Web: www.macmillan.org.uk
Provides information and support to anyone affected by cancer.
Web: http://cancerhelp.cancerresearchuk.org/ provides facts about cancer, including treatment choices.
See www.patient.co.uk/selfhelp.asp for a list of self help and support groups for cancer.