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Pancreatic cancer Content Supplied by NHS Choices
Introduction

Pancreatic cancer is caused by the abnormal and uncontrolled growth of cells in the pancreas - a large gland that's part of the digestive system.

Around half of all new cases are diagnosed in people aged 75 or over. It's uncommon in people under 40 years of age.

This page covers:

Symptoms

Causes

Diagnosis

Treatment

Recovering from surgery

Symptoms of pancreatic cancer

In the early stages, a tumour in the pancreas doesn't usually cause any symptoms, which can make it difficult to diagnose.

It's important to remember that these symptoms can be caused by many different conditions, and aren't usually the result of cancer. But you should contact your GP if you're concerned, or if these symptoms start suddenly.

The first noticeable symptoms of pancreatic cancer are often:

  • pain in the back or stomach area - which may come and go at first and is often worse when you lie down or after you've eaten
  • unexpected weight loss
  • jaundice - the most obvious sign is yellowing of the skin and whites of the eyes; it also causes your urine to be dark yellow or orange and your stools (faeces) to be pale-coloured

Other possible symptoms of pancreatic cancer include:

  • nausea and vomiting
  • bowel changes
  • fever and shivering
  • indigestion
  • blood clots

You may also develop symptoms of diabetes if you have pancreatic cancer, because it can produce chemicals that interfere with the normal effect of insulin.

Endocrine pancreatic cancer

There are also a number of different endocrine tumours that cause different symptoms, depending on the hormone the tumour produces.

Cancer Research UK has more information on symptoms of endocrine pancreatic tumours.

Causes of pancreatic cancer

It's not fully understood what causes pancreatic cancer, but a number of risk factors for developing the condition have been identified.

Risk factors for pancreatic cancer include:

  • age - it mainly affects people who are 50-80 years of age
  • smoking - around one in three cases is associated with using cigarettes, cigars or chewing tobacco
  • having a history of certain health conditions - such as diabetes, chronic pancreatitis (long-term inflammation of the pancreas), stomach ulcer and Helicobacter pylori infection (a stomach infection)

In about 1 in 10 cases, pancreatic cancer is inherited from a person's parents. Certain genes also increase your chances of getting pancreatitis, which in turn increases your risk of developing cancer of the pancreas.

Cancer Research UK has more information on:

Diagnosing pancreatic cancer

Your GP will first ask about your general health and carry out a physical examination. They may examine your tummy (abdomen) for a lump and to see whether your liver is enlarged.

They'll also check your skin and eyes for signs of jaundice and may request a urine sample and blood test.

If your GP suspects pancreatic cancer, you'll usually be referred to a specialist at a hospital for further investigation. You may have either:

Depending on the results of a scan, further tests may include:

  • an endoluminal ultrasonography (EUS) endoscopy - a type of endoscopy which allows close-up ultrasound pictures to be taken of your pancreas
  • an endoscopic retrograde cholangiopancreatography (ERCP) - a type of endoscopy which is used to inject a special dye into your bile and pancreatic ducts; the dye will show up on an X-ray and highlight any tumours
  • a laparoscopy - a surgical procedure that allows the surgeon to see inside your body using a laparoscopy (a thin, flexible microscope)

A biopsy, where a small sample is taken from a suspected tumour, may also be carried out during these procedures.

NICE guidelines

In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of pancreatic cancer and refer people for the right tests faster.

To find out if you should be referred for further tests for suspected pancreatic cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral.

Treating pancreatic cancer

Cancer of the pancreas is difficult to treat. It rarely causes any symptoms in the early stages, so it's often not detected until the cancer is fairly advanced. If the tumour is large, treating the cancer will be more difficult.

If you've been diagnosed with pancreatic cancer, your treatment will depend on the type and location of your cancer, and how far it's advanced. Your age, general health and personal preferences will also be taken into consideration.

The first aim will be to completely remove the tumour and any other cancerous cells. If this isn't possible, treatment will focus on preventing the tumour growing and causing further harm to your body.

The three main treatments for pancreatic cancer are:

Some types of pancreatic cancer only require one form of treatment, whereas others may require two types of treatment or a combination of all three.

Read more about treating pancreatic cancer.

Recovering from surgery

Recovering from pancreatic cancer surgery can be a long and difficult process.

You'll probably experience some pain after your operation. The staff at your hospital will make sure you have adequate pain relief.

After any type of surgery to your digestive system, your bowel will temporarily stop working. This means you won't be able to eat or drink straight away.

You'll gradually be able to sip fluids, before eventually being able to drink and eat more regularly. You may be referred to a dietitian, who can advise you about what foods you should eat following your operation.

After the tumour has been removed, you'll probably have a six-month course of chemotherapy, which greatly increases your chance of being cured. But because cancer of the pancreas is difficult to diagnose and treat, many people don't recover completely.

Treatment can be very effective in helping to ease symptoms and make you as comfortable as possible. Chemotherapy can help shrink your tumour and slow down its growth.

'Surgery has enabled me to see my daughter qualify as a vet'

Alan Bentley was diagnosed with pancreatic cancer and given six months to live.

"I began to feel poorly, like I was operating at 60% of my energy levels. I was lethargic, tired and just didn't know what was wrong. I went to see my local GP, who gave me a blood test, but nothing really came up.

"A couple of months later, I returned to my GP. By this time, my urine was bright orange and my stools were pale in colour. I've since learnt that these are typical symptoms of pancreatic cancer, but my GP still didn't recognise the condition.

"It wasn't until my third visit, when my skin and eyes had turned yellow with jaundice, that my GP looked shocked and referred me immediately to the local hospital.

"I had an ultrasound, and they discovered a tumour in my pancreas. I was 53.

"I was told by the consultant that the chances of an operation to remove the tumour were non-existent, as it was in an inaccessible part of the pancreas. Instead I was offered a bypass, which would give me six months to live.

"I was totally shocked by everything I'd heard and was ready to agree. But after talking to my wife and daughter (who was training to be a veterinary surgeon, so had a medical background), I went back to the consultant. My daughter asked lots of questions, and they both insisted I should be referred to a specialist unit.

"While I was waiting to be referred, I was fitted with a stent (a tube inserted into the bile duct to unblock fluids), which relieved some of the symptoms and made me more comfortable. In the meantime, my wife and daughter contacted my nearest pancreatic specialist unit.

"When I saw the specialist, I was checked for fitness and was recommended the Whipple's procedure (surgery to remove all or part of the pancreas and other organs). Everything you read about this operation is very negative and it is really serious surgery, but I just saw it as a chance to have some extra time.

"The operation took nine hours. The worst thing about it was that they put two drainage holes in my side, which took a long time to heal. I have an 18-inch-long scar across my stomach and I was in hospital for three weeks. I was lucky that I didn't develop diabetes after the operation, but I did lose three stone in weight (initially after surgery, you don't want to eat anything). Now I eat exactly what I ate before the diagnosis, and I haven't had any major problems at all.

"I also had chemotherapy after the operation. For six months, I'd have five days of chemo and then a three-week break. It made me sick the first time and I had a bad skin rash on my face, but that cleared up and I was given medication for the nausea, which helped. However, it wasn't a good experience. You're just beginning to feel better on your third week off and then it starts all over again.

"My advice to anyone dealing with this condition is to make sure you're referred to a proper pancreatic clinic. And don't be put off having the Whipple's procedure. If you can put up with the trauma, it's definitely worthwhile.

"In the end, having a Whipple's has given me wonderful years. It's enabled me to see my daughter qualify as a vet, to see my son settled, and I've had the chance to travel the world. I've had a great support team, and I've tried to be positive all the way along. I feel every bit as good as I did before the diagnosis."

Treatment

Treatment for pancreatic cancer depends on the type, location and stage of your cancer (how far it's spread).

Your age, general health and personal preferences will also be taken into consideration when deciding on your treatment plan.

The first aim will be to completely remove the tumour and any other cancerous cells in your body.

If this isn't possible, the focus will be on preventing the tumour growing and causing further harm.

Sometimes it's not possible to get rid of the cancer or slow it down, so treatment will aim to relieve your symptoms and make you as comfortable as possible.

Cancer of the pancreas is very difficult to treat. In its early stages, this type of cancer rarely causes symptoms, so it's often not detected until it's quite advanced. If the tumour is large or has spread, treating or curing the cancer is much harder.

Cancer Research UK has more information about stages of pancreatic cancer.

Discussing your treatment

Deciding what treatment is best for you can be a difficult process. There's a lot to take in, so it's important to talk about the possible alternatives with a family member or friend.

You should also have an in-depth discussion with your doctor, who can tell you the pros and cons of the treatments available to you.

If at any stage you don't understand the treatment options being explained to you, make sure you ask your doctor for more details.

There are three main ways that cancer of the pancreas can be treated:

Some types of pancreatic cancer only require one form of treatment, whereas others may require two or a combination of all three.

Cancer Research UK has more information about types of treatment for pancreatic cancer.

Surgery

Surgery is usually the only way pancreatic cancer can be completely cured. However, as the condition is usually advanced by the time it's diagnosed, surgery is only suitable for around 15-20% of people.

However, this isn't a suitable option if your tumour has wrapped itself around important blood vessels. If your cancer has spread to other areas of the body, surgically removing the tumour won't cure you.

Surgery for pancreatic cancer is usually only an option for people who have a good general level of health. This is because pancreas surgery is often long and complex, and the recovery process can be slow.

Sometimes the risks of surgery can outweigh the potential benefits.

Your doctor will discuss with you whether surgery is a suitable option. There are several possible surgical procedures, which are outlined below.

Whipple procedure

The Whipple procedure is the most common operation used to treat pancreatic cancer, and involves removing the head of the pancreas.

Your surgeon must also remove the first part of your small intestine (bowel), your gall bladder (which stores bile) and part of your bile duct. Sometimes, part of the stomach also has to be removed.

The end of the bile duct and the remaining part of your pancreas is connected to your small intestine. This allows bile and the hormones and enzymes produced by the pancreas to still be released into your system.

After this type of surgery, about one in three people need to take enzymes to help them digest food.

The Whipple procedure involves long and intensive surgery, but it's easier to recover from than a total pancreatectomy (see below).

Distal pancreatectomy

A distal pancreatectomy involves removing the tail and body of your pancreas.

Your spleen will usually also be removed at the same time. Part of your stomach, bowel, left adrenal gland, left kidney and left diaphragm (the muscle that separates the chest cavity from the abdomen) may also be removed.

Like the Whipple procedure, a distal pancreatectomy is a long and complex operation that won't be carried out unless your doctor thinks it's necessary.

Total pancreatectomy

During a total pancreatectomy, your entire pancreas will be removed. This is sometimes necessary due to the position of the tumour.

Your surgeon will also remove your:

  • bile duct
  • gall bladder
  • spleen
  • part of your small intestine
  • part of your stomach (sometimes)
  • surrounding lymph nodes (part of the immune system)

After a total pancreatectomy, you'll need to take enzymes to help your digestive system digest food. You'll also have diabetes for the rest of your life because the pancreas produces insulin - the hormone that regulates blood sugar.

Removing your spleen can increase your risk of developing infections and may also affect your blood's ability to clot. This means you'll be on penicillin (or an alternative antibiotic if you're allergic to it) for the rest of your life, and you'll need to have regular vaccinations.

Sometimes, you may need to take tablets for a short period to stop the platelets in your blood sticking to each other. Platelets are a type of blood cell that cause your blood to clot (thicken).

Surgery to ease your symptoms

Although surgery may not be a suitable way of removing your tumour, you may be offered it to help ease your symptoms.

This type of surgery won't cure your cancer, but will mean that your condition is easier to manage, and it will make you more comfortable.

To help control jaundice, a stent can be placed in your bile duct using endoscopic retrograde cholangiopancreatography (ERCP). This will help keep the bile duct open and prevent bilirubin - the yellow chemical in bile - from building up and causing jaundice.

If a stent isn't a suitable option for you, you may need an operation to bypass your blocked bile duct. Your surgeon will cut the bile duct just above the blockage and reconnect it to your intestine, which allows your bile to drain away.

These types of surgery are much less intensive than surgery carried out on the pancreas. The recovery time is much quicker, and people find that their jaundice improves significantly.

Chemotherapy

Chemotherapy is a type of cancer treatment that uses anti-cancer medicines to either kill the cancerous (malignant) cells in your body or stop them multiplying.

Chemotherapy treatment is often used alongside surgery and radiotherapy (see below) to help ensure that as much of the cancer is treated as possible.

Chemotherapy may be given:

  • before surgery - to try to shrink the cancer, so there's a greater chance of the surgeon being able to remove all of the cancer
  • after surgery - to help reduce the risk of the cancer coming back
  • when surgery isn't possible - to try to shrink the cancer, slow its growth and relieve your symptoms

Some chemotherapy medicines can be taken orally (by mouth), but some need to be given directly into a vein (intravenously).

Chemotherapy also attacks normal, healthy cells, which is why this type of treatment can have many side effects. The most common side effects include:

  • vomiting
  • nausea
  • mouth sores
  • fatigue
  • increased risk of infection

These are usually only temporary, and should improve once you've completed your treatment.

The chemotherapy medications can also be used in combination, so your doctor may suggest using one medication or a combination of two or three.

Combining chemotherapy medications can give a better chance of shrinking or controlling the cancer, but increases the chance of side effects. Sometimes, the risks of chemotherapy can outweigh the potential benefits.

Read more about chemotherapy.

Radiotherapy

Radiotherapy is a form of cancer therapy that uses high-energy beams of radiation to help shrink your tumour and relieve pain.

Side effects of radiotherapy can include:

  • fatigue
  • skin rashes
  • loss of appetite
  • diarrhoea
  • nausea or vomiting

These side effects are usually only temporary, and should improve after your treatment has been completed.

Read more about radiotherapy.

 
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