pancreatic cancer

Pancreatic Cancer 101: Symptoms, Causes, Stages, Treatment & Prevention

Learn all about pancreatic cancer including its symptoms, stages, treatment, types and prevention.

by Elaine Francis, R.N.

What is Pancreatic Cancer?

To understand what pancreatic cancer is and how it can affect you, it helps to understand a little about the pancreas. The pancreas is a thin, pear-shaped organ around 15cm (6 inches) long that is found in the top part of the abdomen, just behind the stomach. It plays an important role in the digestive system and in helping regulate the way our body uses energy from food. Enzymes that help digest our food are created in the pancreas, and so are insulin and glucagon – the hormones that regulate blood sugar and the transfer of sugar from the blood into the cells.

Cancer happens when some cells don’t follow the normal pattern of cell creation and cell death, creating areas of tissue that can grow into tumours. Pancreatic cancer is any cancer that starts in the pancreas, although it can also spread into other areas of the body. This is called metastasising.

Pancreatic Cancer Symptoms

The symptoms of pancreatic cancer aren’t always easy to spot, and a lot of them seem similar to other conditions. Some of the more common symptoms of pancreatic cancer include:

  • Unintended, unexplained weight loss
  • Reduced appetite (compared to a person’s own usual appetite)
  • Abdominal or back pain
  • Jaundice, which causes yellowing of the skin and whites of the eyes, and itchy skin.
  • Fatigue, lack of energy, and feeling weak.
  • Oily stools (poo) – they may float and look pale in colour.
  • Acid indigestion or heartburn
  • Nausea and vomiting
  • Fever, chills, or unexplained sweating

There are many much more common conditions which can cause these signs, and having a number of these symptoms does not necessarily mean you have cancer; it’s always wise to get checked out by a doctor if you’re having trouble with any symptoms.

When to Get Help

It’s always okay to ask a doctor for advice if you’re concerned about any symptoms. Symptoms that need to be urgently assessed include:

  • The whites of your eyes looking very yellow.
  • Severe vomiting that last more than 48 hours, especially if you can’t keep any fluids down.
  • Diarrhoea that lasts more than a few days. It’s important to keep drinking lots of fluids if you have diarrhoea, even if it seems like it’s just coming straight through you.

Pancreatic Cancer Causes & Risk Factors

Cancers are caused by abnormal cell production, but it’s not always clear why some people develop cancer and others do not. There seems to be a genetic element to some forms of pancreatic cancer – if you have a close family member who has been diagnosed with pancreatic cancer, your own risk is a little higher. Around 10% of pancreatic cancers are the type that run in families.

Some of our risk factors for pancreatic cancer cannot be changed, such as:

  • Age: our risk of most forms of cancer increases as we get older
  • Race: People from African-Caribbean or Ashkenazi Jewish backgrounds are more likely to develop pancreatic cancer than Asian, White, or Hispanic people.
  • Certain hereditary conditions, including hereditary nonpolyposis colon cancer; multiple endocrine neoplasia syndrome; hereditary breast and ovarian cancer syndrome; ataxia-telangiectasia, and others.

Some of the risk factors for pancreatic cancer – and some other cancers and serious diseases – are known as ‘modifiable’ risk factors; this means that we may be able to control our risk to some degree. Modifiable risk factors for pancreatic cancer include:

Diet and Obesity

Having a high fat diet and being overweight are two factors that are closely linked to pancreatic cancer

High Alcohol Intake

This can cause pancreatitis and damage to the liver, both of which can be precursors to liver cancer.

Smoking

Smokers have twice the risk of developing pancreatic cancer compared to people who have never smoked.

Exposure to Certain Chemicals

People who work with certain types of pesticides and industrial chemicals may have a higher risk of developing pancreatic cancer, among other conditions.

Some other risk factors may have a mix of modifiable and non-modifiable elements, such as chronic pancreatitis, which may be inherited or have no clear cause, hepatitis infections, and diabetes. The link between diabetes and pancreatic cancer goes both ways – each can make a person more at risk of the other.

Pancreatic Cancer Stages

Doctors may talk about ‘stages’ of cancer, which helps to describe the extent and spread of cancers, and can influence the type of treatment given. The stage at which a cancer is first found is also a predictor of how well treatment will work, and the overall prognosis. Each stage may be broken down to more carefully describe the extent of the tumour, the involvement of lymph nodes, and whether the cancer has metastasised.

  • Stage 1 Pancreatic Cancer: cancer that is a discreet tumour within the pancreas.
  • Stage 2 Pancreatic Cancer: a tumour which is larger than 4cm in size, which may extend past the boundaries of the pancreas, and which may have spread to a few nearby lymph nodes.
  • Stage 3 Pancreatic Cancer: a cancer that has spread to nearby lymph nodes and may have spread to nearby blood vessels.
  • Stage 4 Pancreatic Cancer: cancer that began in the pancreas but which has spread to other areas of the body.

Prognosis

The prognosis – the likely outlook after diagnosis – for pancreatic cancer depends on the stage at which it is identified and treated, and on how well the patient is – whether they have other underlying conditions or are frail. Pancreatic cancer can develop significantly before it causes clear symptoms, so pancreatic cancer is often diagnosed quite late, when the disease is already spreading. Symptoms for pancreatic cancer are often very similar to the symptoms of other, often less serious, conditions, so pancreatic cancer can be hard to diagnose early. The five year survival rate of pancreatic cancer – the number of people still alive five years after diagnosis – is 9%. Life expectancy can be significantly reduced with advanced cancers of any type, and pancreatic cancer generally has a poor outlook.

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Pancreatic Cancer Diagnosis

Pancreatic cancer may be considered when someone consults a doctor about certain symptoms. Diagnosis pancreatic cancer involves taking blood tests, which can show cancer markers, inflammation, and other signs that organs are affected by disease. The main diagnostic tool for pancreatic cancer is medical imaging.

CT scans and MRI scans are used to build images of the inside of the body, and an experienced radiologist can identify and assess any abnormalities or areas of concern. When pancreatic cancer is diagnosed, some of the scans may be referred to as ‘staging’ scans; these are specifically used to look for the extent and spread of the cancer, in particular whether other organs or body tissues, or lymph nodes are affected.

As the earliest stages of pancreatic cancer often show no clear symptoms, identifying it at this stage often only happens as an ‘incidental finding’; this is where a condition is diagnosed during investigations for an unrelated condition.

Pancreatic Cancer Treatment

The exact treatment for pancreatic cancer depends on the stage at which treatment begins; treatment is planned on an individual basis depending on the extent and spread of the disease. The treatment recommended may include any, or a combination, of:

Chemotherapy

Chemotherapy is a treatment where medications are used to kill cancer cells. The medications may be injected or taken by mouth. Although chemotherapy can be an effective treatment for some cancers, it is associated with a lot of negative side effects, including sickness and diarrhoea, hair loss, general fatigue, and becoming more prone to catching illnesses or finding it difficult to recover from infections.

Radiotherapy

Radiotherapy is a technique where radiation is used to kill cancer cells. The radiation can be targeted at a certain area of the body. It may be used to try and shrink a tumour or stop it from growing further in preparation for surgery.

Surgery

Surgery for pancreatic cancer involves removing some or all of the pancreas. If a tumour is removed from the pancreas, a layer of healthy tissue around the tumour is also taken, and this healthy surrounding layer is examined in a laboratory to look for cancerous cells that may have spread beyond this area. This helps to plan further treatment or to anticipate regrowth of the tumour. There are a few different types of surgery used for pancreatic cancer, and they depend on the area of the pancreas where the cancer is located, other treatment options, and the patient’s general health.

Cancer treatment is nearly always quite hard on the person receiving it, especially people who already have other health conditions, who are frail, or whose cancer has already spread significantly. In some cases the doctors, patient, and family may decide that the most appropriate treatment is one that keeps the patient comfortable as they reach the end of their life, without intensive treatments which may make them more unwell without improving their quality or length of life.

As well as treatment for the cancer, the problem of having a damaged or poorly-functioning pancreas also has to be managed – this may mean following a careful diet, and taking medications to help replicate the functions of the pancreas.

Needing insulin injections is common when the pancreas isn’t working properly, and this means following a diabetic regime – a specialist will teach you about diabetes management. If you need to take insulin, you will have to regularly check your blood sugar with a finger prick test and give yourself injections of insulin. Some people may be able to have a special system like an ‘artificial pancreas’. This is a machine which continually monitors blood sugar and gives a slow flow of insulin through a tiny tube inserted into the layer of fat just under the skin.

Pancreatic Cancer Prevention

Pancreatic cancer is hard to predict, and some of the things that make us at risk for pancreatic cancer can’t easily be changed. It’s important to be aware of our risk factors, and knowing we’re at risk of a disease can help us identify it as early as possible.

When we have modifiable risk factors for pancreatic cancer, working to change those factors is the best way to prevent pancreatic cancer. The best thing we can do to prevent pancreatic cancer is to follow a health lifestyle. A good diet, low in fat and high in fruit, vegetables, wholegrains and lean protein is a good start when you’re trying to stay well and reach or maintain a healthy weight.

Cutting out smoking is one of the best things you can do for lots of different aspects of health, and pancreatic cancer is no exception. Reducing alcohol intake significantly lowers the risk of developing several serious conditions affecting the pancreas and liver; conditions known to be closely linked to developing pancreatic cancer.  

Making positive changes in our lifestyles can be difficult, and many people find it helpful to have support when making these changes. Help with stopping smoking, reducing our alcohol intake, or following healthy diets for weight loss can have a huge impact on our ability to maintain good habits. Local support groups or GPs can help. The lifestyle changes which help prevent pancreatic cancer are exactly the same as those we make to reduce our risk of many other forms of cancer, cardiovascular diseases like heart attacks and strokes,

Pancreatic Cancer Support Groups in Singapore

Throughout diagnosis, treatment, and beyond, you will meet a number of different professionals from a multidisciplinary team dedicated to supporting people through cancer. The doctors and nurses may be your first port of call for advice, or there are a number of other groups created for people living with cancer. Practical support at home can also help ease day-to-day life for anyone affected by cancer.

‘Cancer’ is a word that is loaded with connotations and emotions, and it’s very normal to feel overwhelmed with thoughts and feelings when you or a loved one has a diagnosis of cancer. There are resources and support groups available locally, nationally, online and worldwide. Within Singapore, The Singapore Cancer Society and National Cancer Centre offer advice, information and support to anyone affected by cancer, and CanHOPE are a non-profit cancer counselling and advice service.

Also, here at Homage, our trained care professionals are able to provide companionship, nursing care, night caregiving, home therapy and more, to keep your loved ones active and engaged. 

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References
  1.  Rawla, P., Sunkara, T., & Gaduputi, V. (2019). Epidemiology of Pancreatic Cancer: Global Trends, Etiology and Risk Factors. World journal of oncology, 10(1), 10–27. https://doi.org/10.14740/wjon1166
  2. Lucenteforte, E., La Vecchia, C., Silverman, D., Petersen, G. M., Bracci, P. M., Ji, B. A., … & Duell, E. J. (2012). Alcohol consumption and pancreatic cancer: a pooled analysis in the International Pancreatic Cancer Case–Control Consortium (PanC4). Annals of oncology, 23(2), 374-382. https://doi.org/10.1093/annonc/mdr120
  3. Lynch, S. M., Vrieling, A., Lubin, J. H., Kraft, P., Mendelsohn, J. B., Hartge, P., … & Stolzenberg-Solomon, R. Z. (2009). Cigarette smoking and pancreatic cancer: a pooled analysis from the pancreatic cancer cohort consortium. American journal of epidemiology, 170(4), 403-413. https://doi.org/10.1093/aje/kwp134
  4. Andreotti, G., & Silverman, D. T. (2012). Occupational risk factors and pancreatic cancer: a review of recent findings. Molecular carcinogenesis, 51(1), 98-108. https://doi.org/10.1002/mc.20779
  5. Tas, F., Sen, F., Odabas, H. et al. (2013) Performance status of patients is the major prognostic factor at all stages of pancreatic cancer. Int J Clin Oncol 18, 839–846 https://doi.org/10.1007/s10147-012-0474-9
  6. Kamisawa, T., Wood, L. D., Itoi, T., & Takaori, K. (2016). Pancreatic cancer. The Lancet, 388(10039), 73-85. https://doi.org/10.1016/S0140-6736(16)00141-0
  7. Cobelli, C., Renard, E., & Kovatchev, B. (2011). Artificial pancreas: past, present, future. Diabetes, 60(11), 2672-2682. https://doi.org/10.2337/db11-0654
About the Writer
Elaine Francis, R.N.
Elaine Francis is a registered nurse with 17 years’ experience in healthcare. She turned to writing to follow her passion for realistic medical communication. She loves translating medical jargon into accessible language for the people who need to understand it most. When she’s not writing or working on a busy cardiology unit, she spends her time telling her children to hurry up.
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