Pancreatic cancer

Pancreatic cancer is a cancer that starts in the pancreas, which is part of the digestive system. The pancreas makes digestive juices called enzymes. It also makes hormones, including insulin.

About 10,500 people are diagnosed with pancreatic cancer in the UK each year.

There are several different types of pancreatic cancer. They are sorted by:

• where the cancer is in the pancreas, and 6 out of 10 pancreatic cancers start in the head of the pancreas
• the type of cell they start from

What follows is about the most common types of pancreatic cancer. These start in exocrine cells, which make pancreatic juices.

Macmillan Cancer Support has information about other cancers that sometimes start in the pancreas:

• neuroendocrine tumours
• lymphoma
• sarcomas

Pancreatic cancer may not cause any symptoms for a long time. Some people have only one symptom.

Some possible symptoms are:

• pain and discomfort in the upper part of the tummy (abdomen) that sometimes spreads out into the back
• unexplained weight loss

Signs of jaundice are another symptom of pancreatic cancer. These include:

• yellowing of the skin and the whites of the eyes
• itchy skin
• dark pee
• pale poo that's difficult to flush away (steatorrhoea)

Most people with these symptoms won't have pancreatic cancer, because they can be caused by other, more common conditions. But if you have any of them, it's important to get them checked by your doctor.

Macmillan Cancer Support have more detailed information about pancreatic cancer symptoms.

If you have symptoms, you'll usually start by seeing your doctor. If the doctor thinks cancer could be causing them, you'll be referred to hospital.

If you're aged 60 or older, you may be referred urgently, and a CT scan or ultrasound scan may be arranged within 2 weeks. If you're 40 or older and have jaundice, you should see a specialist within 2 weeks.

Some people are diagnosed with pancreatic cancer after they're admitted to hospital because a symptom is making them unwell.

At hospital you'll have tests, and you'll get specialist advice and treatment. Doctors often reach a diagnosis of pancreatic cancer by putting together the results of several tests, your symptoms and your medical history.

If the diagnosis is confirmed, you may need more tests to find out the size and position of the cancer. These tests will also show doctors whether it has spread to other parts of the body.

You may have some of the following tests.

You'll have blood tests to check your general health and to see how well your liver and kidneys are working.

Your doctor may ask for blood tests to look for tumour markers. These are chemicals that many pancreatic tumours produce.

An ultrasound scan uses sound waves to make a picture of the organs inside your body, such as the pancreas and the liver.

A CT scan takes a series of X-rays and puts them together to build a 3D picture of the inside of your body.

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

An MRCP, or magnetic resonance cholangio-pancreatography, uses magnetic and radio waves to build a detailed picture of your pancreas, bile ducts and liver. It's a type of MRI scan, but not every hospital has it. The scan shows any narrowing or blockages in the pancreatic ducts or bile ducts.

For an endoscopic ultrasound, the doctor passes a thin, flexible tube (an endoscope) down into your stomach. From there it can look at your pancreas and the other organs nearby. The test can also be used to take samples of tissue (a biopsy) or to see how far the cancer has spread.

An ERCP (endoscopic retrograde cholangio-pancreatography) is a test where a thin, flexible tube called an endoscope is passed down into the first part of the small bowel, the duodenum. Doctors can use it to look at the pancreas and to take small samples of tissue (biopsies).

A PET-CT scan gives your doctors more detailed information about the part of your body that is being scanned.

Your doctor may want to take a small piece of tissue from the affected area. This is called a biopsy. The sample is then looked at under a microscope to check for cancer cells, which is how pancreatic cancer is confirmed or ruled out. There are different ways of doing a biopsy.

Not everyone needs one, though. Your doctor will tell you whether it would help in your situation.

Once your tests are done, your doctors use the results to learn more about the size and position of the cancer, and whether it has spread. This is called staging.

The grade is decided by a doctor looking at how the cancer cells appear under the microscope. It gives an idea of how quickly the cancer may develop and grow.

Once the stage and grade of the pancreatic cancer are known, your doctors can decide the best treatment for you.

A team of specialists will meet to discuss the best possible treatment for your pancreatic cancer. 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 may include the following.

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

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells, and 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)

For many people with pancreatic cancer, the main aim of treatment is to control the symptoms. You can also have treatments that help you feel better and keep the best quality of life possible. This is called supportive care.

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

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

This is called supportive care. Making sure your quality of life is as good as it can be is an important part of your treatment and care.

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

After your treatment for pancreatic cancer, you'll have regular follow-up appointments. You'll have them too if you're having supportive care.

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

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

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, where you can talk to others affected by pancreatic cancer, ask questions and share your experience

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