November 21 2019 marks World Pancreatic Cancer Day, a day dedicated to the combined efforts of more than 80 organisations from over 30 countries to inspire action for better outcomes for pancreatic cancer.
It is essential to raise awareness of this specific cancer, particularly as it has the lowest survival rate amongst all major cancers, with only 1% of patients with pancreatic cancer surviving for 10 years or more following their diagnosis.
Pancreatic cancer is caused by the abnormal and uncontrolled growth of cells in the pancreas, a large gland that is part of the digestive system, which produces digestive enzymes and insulin. Pancreatic cancer is the eleventh most common cancer in the UK, with around 9,600 people in the UK being diagnosed with this disease each year.
There are different types of pancreatic cancer, each with differing characteristics and treatments:
- It is estimated that 95 out of 100 pancreatic cancers are exocrine tumours, starting in the cells that make digestive enzymes.
- Fewer than 5 out of 100 of all pancreatic cancers are endocrine tumours, starting in the cells that
- make hormones in the pancreas.
Causes & risks
The causes of pancreatic cancer are not fully understood. However, there is sufficient evidence that the following may increase the risk of pancreatic cancer:
- Age – Pancreatic cancer is more common in older people, mainly affecting those who are 50-80 years of age. Almost half of all new cases are diagnosed in people aged 75 and over and it is uncommon in people under 40 years old.
- Smoking – Around 1 in 3 cases is associated with smoking cigarettes/cigars or with chewing tobacco
- Obesity – Over 1 in 10 pancreatic cancers in the UK are linked to being overweight or obese.
- Having a history of certain health conditions, such as:
- Diabetes – Pancreatic cancer is more likely to occur in people who have long-standing diabetes of more than 5 years.
- Chronic pancreatitis
- Family history – In approximately 10% of cases, pancreatic cancer is inherited. The risk of pancreatic cancer also increases if there is a history of familial ovarian, breast, or colon cancer, hereditary pancreatitis or familial melanoma.
In the early stages, a tumour in the pancreas does not usually cause any symptoms, which can make it difficult to diagnose early. Even with more advanced tumours, the symptoms of pancreatic cancer can also be quite vague and may come and go to begin with, depending on the site of the cancer within the pancreas. The severity can also vary for each person.
The first noticeable symptoms of pancreatic cancer may include:
- Pain in the mid-back or abdomen – Initially, this may be intermittent and is often worse when lying down or after eating. Almost 7 out of 10 people with pancreatic cancer present to their doctors with such pain.
- Unintentional weight loss – This can be an early symptom and can occur without any pain or apparent change in digestion.
- Jaundice – This will present as yellowing of the skin and whites of the eyes. It also may cause dark urine, pale stools and itchy skin
Other possible symptoms of pancreatic cancer include:
- Digestive problems – This includes nausea, indigestion and vomiting.
- Loss of appetite – Pancreatic cancer can also change the way food tastes.
- Changes in bowel movements – Many pancreatic cancer patients experience some combination of diarrhoea, constipation or steatorrhoea (fatty stools).
- New-onset diabetes – This results from the tumour preventing the production of insulin in the pancreas.
It is important to remember that these symptoms can also be caused by other conditions and are often not the result of pancreatic cancer.
At present, there is no established screening test or early detection method for pancreatic cancer, although there are some screening tests currently in development. It is recommended that individuals with a family history of pancreatic cancer are offered scans to check for pancreatic cancer, even in the absence of symptoms.
If pancreatic cancer is suspected following an assessment with your GP, you will be referred for further investigation under the guidance of a specialist. This may involve imaging, such as an ultrasound, CT or MRI scan.
Depending on the results of the scan, further tests may include endoscopic or laparoscopic investigations, which may further lead to a biopsy, where a small sample is taken from a suspected tumour.
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Treatment will depend on the type of pancreatic cancer, its location within the pancreas and the stage of the disease, in conjunction with the patient’s overall health and personal preferences. Where possible, the cancer will be surgically removed and this is usually followed by chemotherapy. If the tumour is large or has spread to other areas in the body, treating the cancer will be more difficult and may include both chemotherapy and radiotherapy. Patients may also be offered treatments to relieve symptoms, such as having a stent inserted or bypass surgery.