Pancreatic cancer: causes, symptoms, and treatment

Pancreatic cancer is a potentially treatable cancer that is diagnosed in the pancreas. Fortunately, if treated at an early stage, patients can defeat the cancer, but swift action through surgery and chemotherapy is absolutely paramount.

As part of Pancreatic Cancer Awareness Month, we recently spoke to revered consultant surgeon, Mr Satyajit Bhattacharya, who, in our latest article, provides a reassuring pancreatic cancer patient success story, whilst also outlining the main symptoms and causes of the cancer.

What are the main symptoms of pancreatic cancer to look out for?

One of the main things to watch out for is yellow discolouration of the skin and the eyes, which is usually accompanied by itching of the skin and passing dark urine. This is often one of the first signs of pancreatic cancer.

The other things to watch out for are pain in the upper part of the tummy, back pain, unexplained weight loss, diarrhoea, a recent onset of diabetes, and finally, an unexplained attack of pancreatitis. These are all very common symptoms of pancreatic cancer. Then, in terms of what you might find in a patient, you would typically see a lump in the tummy.

What causes pancreatic cancer?

Pancreatic cancer is one of the most common cancers nowadays. It is common in older people and is slightly more common in males and smokers. There are some genetic factors and medical conditions that can increase the risk of developing pancreatic cancer.

Some people have a family history of the disease. If you have two first-degree relatives with the disease, you are at a higher risk than the average population. Also, people who have chronic pancreatitis are at a higher risk of being diagnosed with pancreatic cancer and so too are people with a chronic inflammation of the pancreas. Occasionally, there are some cancer syndromes such as Lynch syndrome that are associated with a higher risk of suffering from pancreatic cancer. 

How important is it to get as early a diagnosis as possible?

I think it is very important not to neglect any of these symptoms and seek medical advice promptly. Pancreatic cancer can be notoriously difficult to diagnose and very often, patients who present with abdominal pain might go down the path of having an ultrasound, of having an endoscopy, because people are thinking about gallstones, people are thinking about ulcers, which, of course, are more common problems.

It is only after the CT scan of the abdomen that the diagnosis becomes clear. So, bearing that in mind, I think it is important to take your symptoms seriously, see your GP, and get some blood tests done (which would include liver function tests).

There is a particular tumour marker for pancreatic cancer called CA19.9 which may be useful in some patients to make the diagnosis, and, while ultrasound is often the first scan that people go for, it is a CT scan that makes the diagnosis.

How is pancreatic cancer treated?

The diagnosis is made on a CT (plus or minus). Other tests like MR, or ERCP (which is an endoscopy where you might put in a plastic or metal stent to unblock the bile duct and to take tissue samples), can also be performed. Once all of these tests have been done and a diagnosis is made of pancreatic cancer, the treatment really depends on what stage the cancer is at. In other words, is it confined just to the pancreas or has it spread beyond the pancreas but is just around the pancreas surrounding tissues.

For patients who have been diagnosed with the cancer at an early stage (if fit and well and able to withstand surgery), we would recommend that they have an operation. This could be what’s called a Whipple operation (also known as a pancreaticoduodenectomy) where the head of the pancreas is taken away. The other option then would typically be a distal pancreatectomy, where the tail of the pancreas is taken away.

If, however, it has spread, then the next step is usually chemotherapy or drug treatment. After the chemotherapy, in a few instances, there might be the option of then going to surgery, but in some cases, that won’t be a possibility, so the patient would then continue with chemotherapy for a longer period of time.

What are the success rates after treatment of pancreatic cancer?

If you have an operation, between 97 and 98 per cent of people survive the operation and come out of hospital. The next question is will they be cured? This is definitely a more challenging question. If it is pancreatic ductal adenocarcinoma (one of the most common types of pancreatic cancer), then, if a patient has had surgery and then followed on with chemotherapy, you are probably looking at somewhere between 30 and 50 per cent chance of a five-year survival.

There are also a number of other conditions that fall under the umbrella of pancreatic cancer. For example, ampullary cancers (cancers that arise in the bowel at the point where the pancreas is opening into the bowel), or neuroendocrine tumours of the pancreas. These conditions have a much better diagnosis.

There is a proportion of patients who will get cured of the cancer and some will not be cured by surgery. In the group of patients who do not have an operation but have chemotherapy, the chances of a cure are much lower, but we do see a lot of patients responding well to chemotherapy. Although it does not lead to a long-term cure, chemotherapy will buy the patient more time and make them feel better in most instances.

Do you have any patient success stories related to pancreatic cancer that you would like to share?

One patient certainly comes to mind. She had a scan done and it showed a tumour in the body of the pancreas, and I was very concerned that this was a malignant tumour. When I contacted her about this, she was quite reluctant to come in and see me, but I told her that it was urgent and that she needed to come and see me as soon as possible.

She then realised that I was talking about something very serious and she came and saw me the next week. We proceeded to surgery the week after. She then went on to have a distal pancreatectomy where both the body and tail of the pancreas were surgically removed.

She then went on to have chemotherapy and seven years later, she remains free of her cancer and is very well. Prompt action in a patient who had an operatable disease resulted in a cure on that occasion.

Mr Satyajit Bhattacharya is a highly esteemed and mightily experienced London-based consultant surgeon who specialises in pancreatic cancer and pancreatitis. If you are worried about the current state of your pancreas, make sure you book a consultation with Mr Bhattacharya by visiting his Top Doctors profile today.