Understanding pancreatic cancer: risk factors, symptoms, diagnosis and treatment

Every year in the UK around 10,500 people are diagnosed with pancreatic cancer, which as the name suggests, starts in the pancreas. To better understand pancreatic cancer and its signs and symptoms, it helps to get a clearer idea of what your pancreas does. 

The function of your pancreas

Your pancreas is a leaf-shaped gland that sits in your upper abdomen, tucked into the curve of part of your small intestine called your duodenum. It is located closer to your back than your front, which is why problems with your pancreas can often cause back pain.

Your pancreas produces digestive enzymes that help your gut digest fat but also produces the hormones insulin and glucagon to help control the levels of glucose (sugar) in your blood.

Types of pancreatic cancer

Pancreatic cancer can be divided into two major groups: pancreatic adenocarcinoma and neuroendocrine pancreatic cancer.

Pancreatic adenocarcinoma accounts for the vast majority of pancreatic cancer cases and starts in the cells that line the channels (ducts) of the pancreas.

Neuroendocrine pancreatic cancer starts in the hormone-producing cells of the pancreas.

There are also extremely rare cases of primary pancreatic lymphoma, which starts in the lymphatic channels of the pancreas.

Cancer from another part of the body can also spread to the lymph glands around and very close to the pancreas, mimicking pancreatic tumours, or to other parts of the pancreas, causing secondary or metastatic pancreatic cancer.

Who is at risk of pancreatic cancer?

The most common lifestyle risk factors for pancreatic cancer include drinking alcohol, smoking and being overweight. 

Your risk of pancreatic cancer is significantly higher if you have chronic (long-term) inflammation of the pancreas (pancreatitis). 

Your risk is also higher if you have certain genetic changes ie carry a mutation in the BRCA1 or BRCA2 genes or have the inherited condition called Lynch syndrome. 

Age increases your risk too. 

Signs and symptoms of pancreatic cancer

Signs and symptoms of pancreatic cancer include unintentional weight loss, jaundice (ie yellowing of the skin and eyes), abdominal pain, discomfort and bloating after eating, and back pain. 

You may notice that your urine is darker and your stools are pale, loose and/or floating, especially after eating a fatty meal. 

A sudden diagnosis of diabetes could also be a manifestation of pancreatic cancer. 

Getting a diagnosis

Pancreatic cancer is diagnosed through a combination of tests usually starting with a physical examination and blood tests to check the function of your liver. 

As the channel that leaves your pancreas joins up with the channel that leaves your liver (bile duct) before draining into your small intestine, problems with your pancreas can affect the flow of fluid (bile) from your liver. This is what produces abnormal liver function results. 

If cancer is suspected, blood tests can also check for tumour markers. High levels of tumour markers don’t necessarily mean you have cancer as these markers can be raised with non-cancerous tumours too. These results are, therefore, considered in the context of your other test results. 

Depending on your results, your doctor may also recommend an internal, CT scan, MRI scan and if needed an endoscopic ultrasound scan.

During an endoscopic ultrasound scan, a thin, flexible telescope-like tube (endoscope) with a light, camera and ultrasound probe at the end is passed via your mouth into your stomach and duodenum to get as close as possible to your pancreas. If an abnormality is detected, a tissue sample can be collected during this procedure, which is called an endoscopic ultrasound-guided fine needle aspiration or biopsy (EUS- FNAB).

If a lump in your pancreas pushes against the bile duct from your liver, bile can accumulate in your liver and spill out into your blood, causing jaundice. Your doctor may, therefore, recommend an endoscopic retrograde cholangiopancreatography (ERCP). 

This endoscopic procedure is used to collect cells from the squashed part of your bile duct. At the same time, a special tube (stent) can be inserted into the bile duct to open it back up, widen the narrowing and resolve the jaundice before treating the lump in your pancreas.

Pancreatic cancer treatment

Treatment for pancreatic cancer depends on the type of pancreatic cancer you have, the size of your tumour and the stage to which your cancer has progressed.

You will likely need further scans to determine how far your cancer has progressed, which is staged according to the TNM (tumour, nodes, metastasis) staging system. 

For example, if you have pancreatic adenocarcinoma, you may need to have a full body scan to check if the tumour has spread elsewhere and whether or not it is curable. 

Treatment largely includes surgery, radiotherapy and chemotherapy. 

If your pancreatic cancer is curable, you will need surgery to remove the tumour, which may be preceded and/or followed by radiotherapy and/or chemotherapy. If your pancreatic cancer is not curable, radiotherapy and chemotherapy will be used to shrink your tumour and reduce your symptoms. 

New treatments are under development including proton beam therapy, a type of radiotherapy which causes less damage to surrounding healthy tissue, targeted therapies that can be directly delivered to the tumour cells, anti-angiogenic therapies, immune therapies and cancer vaccines. 

Outcomes for pancreatic cancer

The earlier pancreatic cancer is detected the better the outcomes.

Currently, over half of people diagnosed with pancreatic cancer in the UK are already in the advanced stage (stage 4). At this point, the five-year survival rate is low at less than 10%. In contrast, those with early pancreatic cancer can hope for a cure.