Firstly, the pancreas is a small but essential organ in the abdomen. It is responsible for producing hormones that regulate blood sugar levels and digestive enzymes that help us break down food.
Pancreatic cancer arises from the pancreatic ducts that affect this important organ. It can be complex and aggressive, with a five-year survival rate of 6%. At the usual time of prognosis, 52% of patients have distant metastasis, and 23% have local spread.¹ It can develop in the cells that produce digestive enzymes (exocrine cancer) or in the cells that produce hormones (endocrine cancer).
From this, two main types of pancreatic cancers occur;
- Pancreatic neuroendocrine tumours. Making up 5% of pancreatic cancer starts in the endocrine cells
- Pancreatic adenocarcinoma. The more common form of pancreatic cancer makes up 95% of pancreatic cancer. Beginning in exocrine cells²
The pancreas has two main functions: endocrine and exocrine. The endocrine function of the pancreas involves producing and releasing hormones such as insulin and glucagon, which regulate blood sugar levels. The exocrine function of the pancreas consists of the production and release of digestive enzymes that help to break down food in the small intestine.
When the pancreas becomes damaged or dysregulated, it can lead to various health problems, including pancreatitis, diabetes, and pancreatic cancer. Pancreatic cancer is a severe and often fatal disease that affects the pancreas and its ability to produce hormones and digestive enzymes.
Pancreatic cancer can have a profound effect on the body, particularly on the digestive system and metabolism. When the pancreas is affected by cancer, it can no longer produce the hormones and enzymes necessary to regulate metabolism and digestion.
This results in cancer being a challenging disease to diagnose and treat. This is partly because it often goes unnoticed until it has progressed to an advanced stage. The symptoms of pancreatic cancer are often vague and non-specific, making it difficult to detect the disease early. In addition, no single test can definitively diagnose pancreatic cancer, so a combination of tests, including imaging studies, biopsy, and blood tests, are used to make a diagnosis.³
Causes of pancreatic cancer
The cause of pancreatic cancer is unknown. However, several risk factors have been linked to an increased risk of developing the disease, including:
- Tobacco use constitutes 12% of cases
- Age (most cases occur in people over the age of 60)
- Gender (men to women, 1.3 odds ratio)
- Family history Chronic pancreatitis
- Specific genetic syndromes, such as Lynch syndrome and BRCA2-associated protein-1 (BAP1) gene mutations, increase the risk by three and half times
- Obesity constitutes 12% of cases
- Type 2 diabetes
- Ethnicity (African Americans more than Caucasians)
Signs and symptoms of pancreatic cancer
The symptoms of pancreatic cancer can be vague and non-specific, making it difficult to diagnose early. Some common symptoms include:
- Pain in the upper abdomen or back
- Jaundice (yellowing of the skin and eyes)
- Dark urine
- Light-coloured stools
- Loss of appetite
- Weight loss
- Nausea and vomiting³
See a doctor if you experience any of these symptoms, as other medical conditions can cause them. Only a healthcare professional can determine if you have pancreatic cancer.
Management and treatment for pancreatic cancer
The treatment for pancreatic cancer depends on several factors, including the stage and location of the tumour, the patient's overall health, and preferences. Treatment options include:
- Surgery, is the most common treatment for early-stage pancreatic cancer. Surgery aims to remove cancer and any surrounding tissue that may be affected
- Chemotherapy can be given before or after surgery to shrink cancer, or it can be given as a standalone treatment for advanced-stage pancreatic cancer
- Radiation therapy is a type of treatment that uses high-energy radiation to kill cancer cells. Radiation therapy can be used with surgery and chemotherapy or as a standalone treatment for advanced-stage pancreatic cancer
How is pancreatic cancer diagnosed
Pancreatic cancer is diagnosed through a combination of tests, including:
- Imaging studies, CT scans, Abdominal/endoscopic ultrasounds, or MRI scans to get an overview of the pancreas
- Biopsy of the pancreas tissue to observe the cells to check for signs of cancer
- Endoscopic ultrasound to obtain images of the region
- Bloodd tests look for the amount of bilirubin released into the blood, investigating the levels of CA 19-9 with carcinoembryonic antigen tumour markers which can implicate pancreatic cancer
How can I prevent pancreatic cancer
There is no guaranteed way to prevent pancreatic cancer, but there are steps you can take to reduce your risk. These include quitting smoking, maintaining a healthy weight, eating a balanced diet, and limiting your alcohol intake. In addition, early detection and treatment of conditions such as chronic pancreatitis and type 2 diabetes may also help lower your risk of developing pancreatic cancer.
What are the risks factors for pancreatic cancer
Some risk factors for pancreatic cancer include:
- tobacco use
- age, gender
- family history
- chronic pancreatitis
- specific genetic syndromes
- type 2 diabetes
How common is pancreatic cancer
Pancreatic cancer is the 10th most common cancer in the UK, affecting men and women at a 1.3 odds ratio. Accordingthe Cancer Research UK, there are around 10,500 new pancreatic cancer cases, and 9,558 people die from pancreatic cancer in the UK every year.
What are the stages of pancreatic cancer
Pancreatic cancer is classified into four stages based on the size of the tumour and the extent to which it has spread to other parts of the body.
The stages are:
Stage 0: There are abnormal cells in the pancreas. This stage is sometimes called "precancer".
Stage IA: Tumour is less than 2 cm
Stage IB: Tumour less than 4 cm but greater than 2 cm
Stage IIA: Tumour is more significant than 4cm but hasn't spread to nearby lymph nodes
Stage IIB: Tumour spread to no more than three nearby lymph nodes
Stage III: Any positive lymph nodes or blood vessels at this stage, surgery, anticancer drugs, and radiation therapy are still viable
Stage IVA: Metastases into nearby organs. It has moved beyond the original sites. This is the late-stage pancreatic cancer is diagnosed since the asymptomatic nature is constant till this stage
Stage IVB: Tumour infiltrates distant organs⁴
The groups can be further divided into groups to plan treatments:
- Resectable pancreatic cancer
- Borderline resectable pancreatic cancer
- Locally advanced pancreatic cancer
- Metastatic pancreatic cancer
- Recurrent pancreatic cancer ⁴
When should I see a doctor?
You should see a doctor if you experience any of the symptoms of pancreatic cancer, including pain in the upper abdomen or back, jaundice, dark urine, light-coloured stools, loss of appetite, weight loss, fatigue, nausea, and vomiting.
In conclusion, pancreatic cancer is a complex and aggressive disease that affects the pancreas, a gland in the abdomen. It is often diagnosed in its advanced stages due to its vague and non-specific symptoms. Treatment for pancreatic cancer may include surgery, chemotherapy, and radiation therapy. Some risk factors for pancreatic cancer include tobacco use, age, gender, family history, chronic pancreatitis, specific genetic syndromes, obesity, and type 2 diabetes. It is essential to see a doctor if you experience any of the symptoms of pancreatic cancer. While there is no sure way to prevent pancreatic cancer, you can reduce your risk by living a healthy lifestyle and avoiding exposure to certain risk factors.
- Puckett Y, Garfield K. Pancreatic cancer. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Apr 4]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK518996/
- Rawla P, Sunkara T, Gaduputi V. Epidemiology of pancreatic cancer: global trends, etiology and risk factors. World J Oncol [Internet]. 2019 Feb [cited 2023 Apr 4];10(1):10–27. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6396775/
- Clinical decision support for health professionals [Internet]. [cited 2023 Apr 4]. Available from: https://bestpractice.bmj.com/info/
- Pancreatic cancer treatment (Adult) (Pdq®)–patient version - nci [Internet]. 2022 [cited 2023 Apr 4]. Available from: https://www.cancer.gov/types/pancreatic/patient/pancreatic-treatment-pdq