Pancreatic Cancer

Pancreatic cancer happens when cells in the pancreas grow in an uncontrolled way and form a tumour. The pancreas is a gland that sits deep in the upper abdomen, behind the stomach. It produces enzymes that help digest food and hormones, including insulin, that control blood sugar.

Most pancreatic cancers begin in the cells lining the ducts that carry digestive juices and are a type called pancreatic ductal adenocarcinoma. A smaller number start in the hormone-producing cells and behave differently.

Because the pancreas lies deep inside the body, a tumour cannot be seen or felt during a routine examination, and early cancers often cause few symptoms. This is part of why pancreatic cancer can be difficult to detect early.

Early pancreatic cancer often causes no symptoms, or only vague ones. As it develops, common symptoms include yellowing of the skin and the whites of the eyes (jaundice), which may come with itchy skin, darker urine and paler stools, pain in the upper abdomen that can spread to the back, and unexplained weight loss.

Other symptoms can include loss of appetite, feeling or being sick, indigestion, changes in bowel habit, and unusual tiredness. Some people are newly diagnosed with diabetes, or find that existing diabetes suddenly becomes harder to control, which can occasionally be an early clue.

These symptoms can all be caused by conditions that are not cancer. But jaundice, persistent abdominal or back pain, and unexplained weight loss should always be checked promptly, because finding pancreatic cancer earlier gives more treatment options.

The exact cause is often not known, but several factors increase the risk. Smoking is one of the most important and avoidable. Older age, being very overweight, long-standing type 2 diabetes, and chronic pancreatitis (long-term inflammation of the pancreas) are also linked to a higher risk.

A family history of pancreatic cancer, and certain inherited gene changes such as BRCA mutations, can raise the risk in some families. Heavy alcohol use, which can lead to pancreatitis, may also contribute.

Having one or more of these factors does not mean a person will develop pancreatic cancer, and some people who develop it have no clear risk factors. Not smoking, keeping to a healthy weight and limiting alcohol are sensible steps that may lower the risk.

Because the pancreas cannot be examined by hand, diagnosis relies on imaging. A CT scan is often the first detailed test. Other scans may include MRI, a specialised MRI of the bile and pancreatic ducts (MRCP), and an endoscopic ultrasound, which uses a camera and ultrasound probe passed into the digestive tract to view the pancreas closely.

A biopsy, in which a small sample of tissue is taken, is often used to confirm the diagnosis. This can sometimes be done during an endoscopic ultrasound. Blood tests, including a marker called CA 19-9, may be used to support diagnosis and to follow how the cancer responds to treatment, though they are not used alone to diagnose it.

These tests together show the type and stage of the cancer and whether it can be removed with surgery, which guides the treatment plan.

Treatment depends on the size and position of the cancer, whether it has spread, and a person's general health. A team of specialists works out the best plan, which may use one treatment or several together.

Surgery offers the best chance of long-term control when the cancer is found early and has not spread. The most common operation for tumours in the head of the pancreas is the Whipple procedure, which removes the head of the pancreas along with nearby structures. Other operations remove different parts of the pancreas depending on where the tumour is.

Chemotherapy is widely used, either after surgery to lower the risk of the cancer returning, before surgery to shrink the tumour, or as the main treatment when surgery is not possible. Radiotherapy may be used in some situations, and in selected cases targeted therapy is matched to specific features of the tumour.

Relieving symptoms is an important part of care at every stage. If jaundice is caused by a blocked bile duct, a small tube called a stent can be placed during an endoscopy to drain the bile and ease symptoms such as itching.

Pancreatic cancer can affect digestion and appetite, so people may be given enzyme supplements to help break down food, along with dietitian support. Pain can usually be well controlled with the right medicines and specialist input, and palliative care teams focus on comfort and quality of life alongside other treatment.

There is no certain way to prevent pancreatic cancer, but not smoking, keeping to a healthy weight, eating a balanced diet, limiting alcohol and managing diabetes can all help lower the risk.

People with a strong family history or certain inherited conditions may be offered genetic counselling and, in some cases, monitoring. It is worth discussing this with a doctor if several close relatives have had pancreatic cancer.

The outlook depends mainly on whether the cancer can be removed with surgery and on its stage when found. Because early symptoms are often vague, getting warning signs such as jaundice or unexplained weight loss checked promptly is important. The medical team is the best source of information about an individual outlook.