November is Pancreatic Cancer Awareness Month
What is pancreatic cancer?
The pancreas is an organ that sits under the liver and behind the stomach, making enzymes to aid digestion and various hormones. For example, the pancreas produces insulin and glucagon to regulate blood sugar.
Cancer develops in this organ when pancreatic cells mutate and grow out of control, forming a tumour. It often starts in the ducts that carry digestive enzymes out of the pancreas, but it can develop anywhere.
Types
The main types of pancreatic cancer are exocrine and endocrine. The most common is exocrine, forming in the cells that create pancreatic digestive juices. Endocrine tumours, also known as pancreatic neuroendocrine tumours (PNETS) or islet cell carcinoma, are less common and form in the endocrine pancreas.
Symptoms
Unfortunately, this cancer often shows no signs or symptoms until it starts to affect organs outside the pancreas, such as those within the digestive system. A lack of symptoms can make it a difficult cancer to diagnose until the later stages.
Some of the first symptoms you may experience or notice could be jaundice, when your sclera (white of your eyes) and skin start to yellow, and stomach or back pain. Your pain might be worse after eating or lying down.
You might also feel tired, lose weight or your appetite unexpectedly, or have pale-coloured stools (poo) and dark urine. Additional digestive symptoms can include feeling or being sick, bloating, diarrhoea or constipation, and gas.
Many people with this cancer are diagnosed with diabetes, which can make you feel thirsty and use the bathroom more often than usual. There is usually no difference in symptoms between genders, but men are more likely to have this cancer.
Advanced symptoms
As your condition progresses, cancer spreads to other parts of your body, causing more symptoms. If it reaches your lungs, you may feel breathless, cough a lot, cough up blood, and have multiple chest infections. If it spreads to your bones, you might experience a worsening backache, hypercalcaemia (high blood calcium levels), low blood cell levels, and weaker bones.
Screening
While there’s no routine screening program for the general population in the UK, you should be aware of the risk factors and symptoms.
People with a higher risk who can ask for screening include those with Peutz-Jeghers syndrome, a fault in the PRSS1 gene along with hereditary pancreatitis, or a fault in a related gene and a close relative, such as a parent or sibling, with pancreatic cancer.
You may also be eligible for screening if you have no gene faults but more than one close relative with this cancer. If your risk is higher and you experience concerning symptoms, we highly recommend booking an appointment with your GP.
Risk factors
There is no known cause for this cancer. However, alongside those mentioned above, there are additional factors that can increase your risk of developing this disease. These include:
- Obesity
- Being over 65
- Pre-existing diabetes
- Smoking and chewing tobacco
- Drinking large quantities of alcohol
- Consuming high amounts of red or processed meat
- Exposure to chemicals, such as pesticides and petrochemicals
If you have a high risk of cancer and experience symptoms, you may need blood tests for tumour markers and a urine test to assess your general health and check for jaundice.
Diagnosis
If you visit your GP for symptoms of this cancer, they will perform a physical exam. They cannot feel your pancreas, but it can allow them to check for lumps or changes in your body, such as yellowing of the skin. Your GP may also use a stethoscope on your stomach to listen for fluid collection and other bowel sounds.
Depending on their findings, your GP may refer you to a specialist treatment centre, such as The Royal Marsden, for further diagnostic tests, such as an endoscopic ultrasound or a CT, MRI, or PET scan. You can also arrange a private referral.
To confirm your diagnosis, we may perform an endoscopic retrograde cholangiopancreatography (ERCP) to X-ray your pancreas, laparoscopy and a biopsy (small tissue sample).
Genetic testing
Genetic tests involve looking for specific mutations that may have led to your cancer or assessing your risk of developing it. We also review your family history to assess your risk.
If we find a gene mutation, we can use this information to inform our treatment plan or help you take steps to prevent cancer from developing. However, not all forms of cancer are preventable. Once you know your genetic risk, you can also decide whether you wish to have regular screening for pancreatic cancer.
Preventing pancreatic cancer
Pancreatic cancer prevention involves several lifestyle changes. Maintaining a healthy lifestyle is vital, which includes not smoking and eating a well-balanced diet rich in fruits and vegetables and low in processed foods.
You should also limit your alcohol consumption and maintain a healthy body weight. We also recommend regular check-ups and discussions with healthcare professionals if you have a family history of known genetic risk.