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Pancreatic Cancer

To download the Pancreatic Cancer Patient Handbook, click here.

The pancreas is a gland of the digestive system. It is joined to the small bowel by a duct. Pancreatic cancer starts in the cells lining this duct. It then spreads into the body of the pancreas, before invading nearby nerves and blood vessels.

If left untreated, it will spread to all the organs in the abdomen. Pancreatic cancer may also enter the lymphatic system and spread to other parts of the body.

The pancreas has two major roles in the digestive system:

  • It produces enzymes to help break down food.
  • It makes hormones that enter the body and flow around the bloodstream. The most important of these is insulin, which helps to regulate the amount of sugar in the blood.

There are different types of Pancreatic cancer which include:

  • Adenocarcinoma is the most common cancer of the pancreas, accounting for 95% of cases.
  • Neurendocrine/ Islet cell carcinoma involves cells that secrete a variety of hormones. Tumors can be functional and produce high amounts of hormones, or non-functional and not produce any hormones. Most islet cell tumors are malignant, but some such as insulin-producing islet cell tumors generally tend to be benign.
  • Isolated sarcomas, lymphoma and metastases to the pancreas (particularly melanoma, renal cell cancer and colorectal cancer) can involve the pancreas, but these are exceedingly rare.
  • Pseudopapillary neoplasms occur mostly in young women in their teens and twenties and can be malignant

Read more:

 


Statistics

In 2010, there were 2,663 new cases of pancreatic cancer in Australia (1,408 in men, 1,254 in women).
In 2014, it is estimated 2,890 Australians (1,450 men and 1,440 women) will be diagnosed with pancreatic cancer.
The risk of developing pancreatic cancer increases with age.
Pancreatic cancer has the highest mortality of all major cancers with less than 5% of patients reaching the 5-year survival mark. Two thirds of pancreatic cancer patients die within the first year of diagnosis.
Survival rates for pancreatic cancer have not changed in nearly 40 years.

Due to the lack of research into pancreatic cancer, many treatments and surgeries for the disease are still being trialed. Pancare encourages patients to do their research and seek opinions from a number of different medical professionals, to ensure the highest chance of survival and recovery.


Causes

Some risk factors associated with pancreatic cancer include:

Smoking: the risk of pancreatic cancer is higher among smokers.
Family history: pancreatic cancer can be hereditary. The exact genes responsible have not been fully identified. People with two or more relatives who have had pancreatic cancer have increased risk.
Chronic pancreatitis: This long-term inflammation of the pancreas is linked with a slightly higher risk of pancreas cancer. Chronic pancreatitis may be difficult to diagnose with pain being the most common symptom.
Obesity: Increase cancer risk has been associated with obesity, in particular a body mass index (BMI) of over 30.
Age: in most cases pancreatic cancer will occur in people over the age of 65.
Sudden onset diabetes: Diabetes has been implicated as a risk factor in some studies and an early symptom of pancreatic cancer.

Symptoms

Pancreatic cancer is known as the ‘silent killer’ with most patients not showing symptoms until the cancer is big enough to touch the other organs around the pancreases. Symptoms are often vague and easily confused with other diseases.

Symptoms of pancreatic cancer may include:

Jaundice (yellow skin, eyes and dark urine).
Pain in the upper abdomen. This may be a dull ache, a sensation of bloating or fullness or a burning type discomfort.
Lack of appetite, nausea and weight loss.
A sudden change in blood sugars or onset diabetes.
A change in bowel movements, from severe diarrhea or constipation.

Having one or more of the symptoms listed above does not necessarily mean you have pancreatic cancer. It is important to discuss any symptoms with your doctor.


Tests

Screening

In a very small number of patients with a strong family history of pancreatic cancer, that may include two or more first degree relatives affected by pancreatic cancer or a known genetic abnormality, screening using endoscopic ultrasound (EUS) surveillance may be considered.  The true value of screening is unknown and is performed as part of research studies. Research has shown that early detection and treatment of pancreatic cancer greatly improves survival rates.

Who is eligible?

  • People with at least two close relatives known to have pancreatic cancer.
  • People who carry a BRCA2 gene fault and have a family history of pancreatic cancer.
  • People with Peutz-Jeghers Syndrome.
  • People with hereditary Pancreatitis.
What is involved?

  • Questionnaire.
  • Genetic Counselling.
  • Endoscopic Ultrasound and Blood Test.

To register for Familial Pancreatic Cancer Screening email info@pancare.org.au

Diagnosis

When patients present with symptoms, there are a number of tests that can be done to diagnose pancreatic cancer including:

  • Imaging tests including CT scan, PET scan, ultrasound and MRI
  • Blood tests
  • Tissue sampling tests, needle biopsy, endoscopy and laparoscopy

Treatment

Pancreatic cancer is potentially curable in a small number of cases if it can be removed, but the vast majority of cases are not diagnosed until too late. Pancreatic cancer (adenocarcinoma) is one of the most devastating cancers with generally poor progress. There is however hope, in particular when surgery is possible.

When imaging suggests that the entire tumor can be removed and there is no evidence of obvious spread to other organs, surgical removal can be considered and may achieve cure. No other therapy can cure pancreatic cancer. Five-year survival rates approach 25% if the cancers are surgically removed while they are still small and have not spread to the lymph nodes.

Most curative surgery is designed to treat cancers in the head of the pancreas, near the bile duct. Some of these cancers are found early enough because they block the bile duct and cause jaundice. There is evidence that surgical complications are lower and survival is improved when pancreatic cancer surgery is performed at specialised centers, compared to surgery performed at hospitals where pancreatic cancer surgery is not commonly performed.

About 10-25% of pancreatic cancers are contained within the pancreas at the time of diagnosis allowing surgery to be considered. In many cases cancer cells too few to detect may already have spread to other parts of the body. This may explain why the cancer recurs in a large portion of patients after surgical removal.

The type of surgery performed is guided by the location of the tumour. In cases of cancers within the head of the pancreas, a pancreaticoduodenectomy is most commonly performed. Also known as the Whipple procedure, this operation removes:

  • Head of the pancreas
  • Lymph nodes near the pancreas
  • Gallbladder
  • Part of the common bile duct
  • Part of the stomach
  • Duodenum (first part of the small intestine)
  • A small portion of the jejunum (second part of the small intestine)

This is very complex operation and outcomes are generally optimal when the surgery is performed by a specialised surgeon who has performed many of these operations at a hospital with extensive experience in pancreatic surgery. Even in the most experienced centers, there is a 1-5% chance of death related to surgery within the first 30 days after surgery. Complications occur in 30-50% of patients. However, most complications do not cause major long-term debility and can be managed by relatively simple means.

In cases of tumours located within the tail or body of the pancreas a distal pancreatectomy may be indicated. This removes only the tail of the pancreas and a portion of the body of the pancreas. The spleen is often removed in this operation.

The entire pancreas may need to be removed in some cases of very advanced cancers or when multiple cancers are found within the pancreas. This is called a total pancreatectomy and removes the entire pancreas and the spleen. In such cases patients develop diabetes and require insulin injections.

Chemotherapy is offered to all patients with pancreas cancer, even when tumor removal is achieved. This reduces the risk of the cancer returning. . Chemotherapy is often used on its own to treat pancreas cancer that has spread and may lengthen survival. Given the generally poor prognosis of pancreatic adenocarcinoma, patients should strongly consider being involved in treatment trials if they are available. Always ask your oncologist if a clinical trial for treatment of pancreatic cancer is available in your region.

Radiation therapy combined with low dose of chemotherapy may be used to reduce the chances of the cancer returning locally. Radiotherapy is rarely required for the treatment of pancreatic cancer. Sometimes radiotherapy is administered in cases of more advanced cases to try and reduce the tumor size, with the hope of allowing subsequent surgical removal. It may also be offered to treat certain symptoms or when there is residual cancer noted after surgical removal of the tumor.

Complementary and Alternative Therapies

Complementary and Alternative Medicine refers to therapies that extend outside of the normal practices of conventional medicine used by either a medical doctor or a doctor of osteopathy.

Complementary medicine is used together with conventional medicine while alternative medicine is used in place of conventional medicine.  Integrative medicine combines the use of CAM practices that have shown significant effectiveness and safety with traditional medicine.

You read more about these options here.


Find a specialist

Click here to read our tips on finding the right specialist for you.




 

Telephone Support Group

Pancreatic Cancer Telephone Support Group (TSG)

These groups offer free, professionally facilitated support from the comfort of your home or workplace, wherever you are in Australia.

They are open groups and you can dial in whenever you feel well enough on an ongoing basis.

The Pancreatic TSG meets the first and third Wednesdays of the month from 3pm – 4pm and accepts new members at any time.

The Advanced Cancer TSG meets the first and third Tuesday of the month from 2pm – 4pm. This group is for people with a variety of cancers, including pancreatic cancer.

If interested, the Carers’ TSG meets the second and fourth Monday of the month from 2pm – 4pm. This group is for members caring for people with a variety of cancers, including pancreatic cancer.

These programs are offered by Cancer Council New South Wales in conjunction with Cancer Council Victoria.

How does it work? 

Members are telephones by Cancer Council so there are no costs to participate. You can be called on a landline or a mobile.

2014 CCA_logo_full_colourTo find out more, call Cancer Council NSW national referral line on 1300 755 632 or email tsg@nswcc.org.au

 

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