Pancreatic Cancer (youtube @thesurgicalscholar)

What is pancreatic cancer?

Cancer refers to irreversible changes in normal cells which cause them to multiply, disrupt function and spread.

The commonest form of pancreatic cancer is a deadly disease with-out treatment. It tends not to cause many symptoms and there is a delay in diagnosis. This delay in diagnosis means that effective treatments cannot be given in time.

What are the symptoms?

The symptoms vary according to tumour location. The pancreas is divided in to head, and body and tail. Most of the tumours arise in the head of the pancreas, whilst those in the body and tail are more likely to be associated with delay in diagnosis. Pancreatic cancer causes an insidious, gnawing, visceral pain, even when the tumour is quite small (<2cm). It tends to be below the breast bone and travels to both sides and the back. It is made worse by lying down, and is improved by changing to a curled position. Sometimes pancreatic cancer presents with acute pancreatitis. New onset back pain should arise suspicion in the mind of healthcare worker.

Jaundice is another important presentation, it is progressive and painless. There is intense itching and patient notices loss of appetite, dark urine and yellowing of whites of the eye. Sleep is affected, patient may feel depressed and develop an aversion to smoking.

Patients may develop diarrhoea, excessive wind and foul smelling stool that tends to float. This is because the pancreatic enzymes do not reach the intestine and some of the food goes undigested. This is called steatorrhoea.

In some patients, new onset diabetes may belie pancreatic cancer. Worsening of existing diabetes may also be a feature. Other less common features associated with pancreatic cancer include inflammation of blood vessels or of a clot in the vein (thrombophlebitis or unprovoked deep vein thrombosis).

Typically, patients visit their healthcare provider multiple times over several months before a diagnosis is made. Delay in diagnosis is a well recognised significant issue. The most important feature of treatment – early diagnosis – is lost.

How is it diagnosed?

Early diagnosis requires an alert clinician and urgent scan (CT or MRI). Blood tests may help, such as determining the tumour markers and whether or not patient is jaundiced. A biopsy is definitive, when a small piece of the tumour is sampled, usually with endoscopy.

What is the treatment?

Surgically removal of the cancer is the aim of the treatment. Chemotherapy and when indicated radiotherapy may be needed. Pancreatic cancer is best managed by experienced team who are up to date in their practice.

Is pancreatic cancer preventable?

Rarely pancreatic cancer may have a genetic component but most arise without any identified factors. Smoking increases the risk by several fold and is associated with up to 25% of the cases. Obesity, alcohol and diet have an impact too. Chronic pancreatitis predisposes to cancer over time.