Pancreatic cancer

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 that line this duct and 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 causes of pancreatic cancer are unknown but smokers are at greater risk. It is more common over the age of 65 and is relatively uncommon in people under 50. About 500 Victorians develop pancreatic cancer each year.

The role of the pancreas
The pancreas has two major roles in the digestive system:

• It produces enzymes to help break down food.
• It produces insulin, which controls the amount of sugar in the blood. Problems with insulin production can lead to diabetes.

• Age – it is more common in people over the age of 65 years
• Inheriting a damaged gene
• Diabetes – between 10 and 20 per cent of people with pancreatic cancer also have diabetes
• Having had surgery to remove all or part of your stomach (gastrectomy).

• Persistent pain in the abdomen
• Loss of appetite
• Feeling sick (nausea)
• Weight loss
• Change in your bowel habits (diarrhea or constipation)
• Severe back pain, in some cases.

• Yellowing of the skin and eyes and itchy skin (jaundice)
• Dark urine
• Pale faeces (bowel motions or poo).

• Blood tests – to check how well your liver and kidney are working and to measure for a protein known as CA19.9. Pancreatic cancer often sends CA19.9 into the blood. It is not used to diagnose pancreatic cancer, but it gives your doctor important information about the cancer.
• CT scan – a special x-ray taken from many different angles to build a three-dimensional picture of your body. A dye may be injected to further highlight internal organs.
• Magnetic resonance imaging (MRI) – similar to a CT scan but uses magnetism instead of x-rays to build three-dimensional pictures of your body.
• Ultrasound – sound waves create a picture of your pancreas.
• Endoscopy (also called endoscopic retrograde cholangio-pancreatography, ERCP) – a thin telescope is inserted down your throat to allow the doctor to see inside your digestive system. This device may also be used to inject dye into the pancreas and bile duct to allow images of these organs to appear on x-ray pictures.
• Laparoscopy – the internal organs are examined with an instrument inserted into the abdomen through a small cut.
• Tissue biopsy – a small sample of the pancreas is removed with a needle and examined in a laboratory.
• Positron emission tomography (PET) scan – an injection with a glucose solution containing a very small amount of radioactive material is given. The scanner can ‘see’ the radioactive substance. Cancerous cells show up as ‘hot spots’ – areas where the glucose is being taken up.

• Surgery – is used when the cancer has not spread beyond the pancreas. The cancer and part of the pancreas and part of the small bowel are removed in an operation called ‘Whipple’s resection’. Some of the bile ducts, gall bladder and stomach may also be removed. This is major surgery and you need to be fit enough to have it.
• Radiotherapy – radiation may be used after surgery to destroy any cancer cells that may remain in the body. It may also be given as the main treatment when surgery is not possible, in combination with chemotherapy.
• Chemotherapy – either tablets or injections of anti-cancer medications may be used after surgery. The drugs work by stopping cancer cells growing and reproducing. Chemotherapy may be given with surgery or alone to help control the symptoms of an advanced cancer.

• Endoscopic treatment – the cancer may cause jaundice because it is blocking the bile duct. Endocscopic surgery relieves the pressure by inserting a metal or plastic tube into the bile duct to keep it open. Similar treatment can relieve a section of the small bowel if the cancer is pressing on it.
• Surgery – a blockage in the small bowel can be bypassed by surgery that attaches a loop of bowel directly to the stomach.
• Tablets – there may be a lack of pancreatic enzymes to properly digest fats, which results in diarrhoea. Tablets containing these enzymes can control this.
• Pain-relieving drugs – oral medication is usually given to control pain, but pain-killing medication can be injected into the nerves of the back if the pain is particularly severe.

• Your doctor
• Specialist
• The Cancer Council Victoria, Cancer Helpline Tel. 131 120
• Multilingual Cancer Information Line, Victoria - see the CCV website for contact details

• The pancreas is a gland that secretes digestive enzymes and insulin.
• The symptoms of pancreatic cancer are often vague and are common to many other disorders.
• Pancreatic cancer is often only diagnosed in its later stages, which makes it difficult to treat.

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