Pancreatic cancer

Doctors don't fully understand what causes pancreatic cancer. But certain things, called risk factors, can raise a person's chance of developing it. Getting older is one such factor: most people diagnosed with pancreatic cancer are 65 or above.

A few other risk factors include:

• smoking or using tobacco
• drinking a lot of alcohol regularly
• having had cancer before

Macmillan Cancer Support have more information about the causes and risk factors of pancreatic cancer.

If you have symptoms, you'll usually start by seeing a general physician. If they think cancer could be behind your symptoms, they'll refer you to a hospital for further checks.

If you're 60 or older, the referral may be urgent, and a CT scan or ultrasound may be arranged within 2 weeks. If you're 40 or older and have jaundice, you should be seen by a specialist within 2 weeks.

Some people first find out they have pancreatic cancer after being admitted to hospital because a symptom has made them seriously unwell.

At the hospital, you'll have tests and receive specialist advice and treatment. To diagnose pancreatic cancer, doctors usually piece together information from several tests along with your symptoms and medical history.

If you are diagnosed with pancreatic cancer, you may need further tests to find out the size and position of the cancer, and whether it has spread to other parts of the body. You may be given some of the following tests.

Blood tests

General blood tests

These check your general health and how well your liver and kidneys are working.

Tumour markers

Blood tests may also be done to check for tumour markers, chemicals that many pancreatic tumours produce.

Other tests

Ultrasound scan

This uses sound waves to build a picture of internal organs such as the pancreas and liver.

CT scan

A CT scan takes a series of X-rays that are combined to build a 3D picture of the inside of the body.

MRI scan

An MRI scan uses magnetism to build a detailed picture of the inside of the body.

Magnetic resonance cholangio-pancreatography (MRCP)

An MRCP uses magnetic and radio waves to get a detailed picture of your pancreas, bile ducts and liver. It is a type of MRI scan, though it is not available in every hospital. The scan shows any narrowing or blockages in the pancreatic ducts or bile ducts.

Endoscopic ultrasound (EUS)

Here, a thin, flexible tube called an endoscope is passed down into your stomach to look at the pancreas and nearby organs. It can be used to take a tissue sample (biopsy) or to see how far the cancer has spread.

Endoscopic retrograde cholangio-pancreatography (ERCP)

In an ERCP, a thin, flexible tube is passed down into the first part of the small bowel (the duodenum). It can be used to look at the pancreas and take tissue samples.

PET-CT scan

A PET-CT scan gives more detailed information about the part of the body being examined.

Biopsy

Your doctor may want to remove a small piece of tissue from the affected area, known as a biopsy, and examine it under a microscope for cancer cells. There are different ways this can be done.

Not everyone needs a biopsy. Your doctor will explain whether it would be helpful in your particular case.

Surgery to look inside the tummy

If other tests don’t confirm a diagnosis, you may have a small operation to look inside the tummy at the pancreas. This is called a laparoscopy.

The surgeon will put a thin tube called a laparoscope through a small cut they make in your tummy. You’ll have this done under a general anaesthetic.

Rarely, if a laparoscopy isn’t suitable, you may have a bigger operation called a laparotomy instead. This is when the surgeon makes a larger cut in the tummy so they can see the pancreas.

Macmillan Cancer Support has more information on cancer tests and waiting for results.

Staging and grading of pancreatic cancer

The results of your tests help your doctors find out more about the size and position of the cancer and whether it has spread. This is called staging.

A doctor will decide the grade of the cancer by how the cancer cells look under the microscope. This gives an idea of how quickly the cancer may develop and grow.

Knowing the stage and grade of pancreatic cancer helps doctors decide the best treatment for you.

Treatment for pancreatic cancer

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).Your cancer doctor or specialist nurse will explain the different treatments and their side effects. They’ll also talk to you about certain things to think about when making treatment decisions.Macmillan Cancer Support have more information about treatments for pancreatic cancer.

Treatment for pancreatic cancer may include the following.

Surgery

If you have an early stage of pancreatic cancer, you may have surgery to remove all or part of the pancreas. Surgery may also be used to relieve relieve symptoms.

Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It’s one of the most common treatments for pancreatic cancer.You may have it:

• after surgery to reduce the chance of the cancer coming back (adjuvant chemotherapy)
• to control the cancer
• to relieve symptoms
• before surgery to help shrink the cancer (neo-adjuvant chemotherapy)

Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells. It’s not often used to treat pancreatic cancer.

It may be given:

• with chemotherapy (this is called chemoradiation) to shrink a cancer before surgery
• if the cancer has just started to spread but surgery isn’t possible
• to manage symptoms like pain

Research is going on to find more effective treatments for pancreatic cancer.

You may have some treatments as part of a clinical trial. Or you may be invited to take part in a trial of a new drug or treatment.

Macmillan Cancer Support has more information on cancer treatment options and getting organised before cancer treatment.

Coping with advanced cancer

For many people with pancreatic cancer, it won’t be possible to cure the cancer.

Chemotherapy and radiotherapy can sometimes help shrink the cancer for a time. This can help to control symptoms. You can also have other treatments that’ll help you feel better and have the best quality of life possible.

This is called supportive care. Making sure you have the best quality of life possible is an important part of your treatment and care.

Finding out you have advanced cancer can be difficult to cope with. You may feel shocked and find it hard to understand or accept. You may have questions about what to expect. Your doctor and specialist nurse are there to help.

Macmillan Cancer Support have more information about coping with advanced cancer.

After pancreatic cancer treatment

After your treatment, you’ll have regular follow-up appointments. You’ll also have follow-up appointments if you’re having supportive care.

You may keep going to the hospital for these appointments, or you may go to your GP. Sharing the appointments between the GP and hospital is sometimes called a shared care agreement.

You may continue to have regular scans and blood tests, including CA 19-9 tests. Tell your doctor or specialist nurse as soon as possible if you have any problems or new symptoms between appointments.

You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation like Pancreatic Cancer UK.

Macmillan Cancer Support also has further information to support you. You can:

• phone the Macmillan Support Line on 0808 808 00 00
• chat to Macmillan specialists online
• use the Macmillan pancreatic cancer forum – you can talk to others affected by pancreatic cancer, ask questions and share your experience

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