Pancreatic Cancer
Published: 29 May 2022
Published: 29 May 2022
Pancreatic cancer has an unfortunately high mortality rate due to the lack of obvious symptoms in its early stages. In many cases, by the time it’s diagnosed, the cancer has already advanced significantly.
In fact, the five-year survival rate for pancreatic cancer is just 10.7%, compared to 69% for all cancers overall (AIHW 2021).
Pancreatic cancer is the eighth most common type of cancer in Australia, with 4,261 new cases estimated in 2021 (Cancer Australia 2022). However, it’s becoming more common, possibly due to Australia’s increasing life expectancy (AIHW 2021).
The pancreas is a thin, tadpole-shaped organ. It sits tucked behind the stomach and under the liver, and is part of both the digestive and endocrine systems (Healthdirect 2020; Better Health Channel 2014a).
The role of the pancreas in the digestive system is to create and excrete digestive enzymes into the duodenum to help break down partially-digested food. It’s also responsible for secreting sodium bicarbonate to neutralise stomach acid during the digestive process. The portion of the pancreas responsible for digestive tasks is known as the exocrine pancreas (Healthdirect 2020; Better Health Channel 2014a).
On the other hand, the endocrine pancreas is responsible for producing the hormones insulin and glucagon, which are used for blood glucose regulation (Better Health Channel 2014a).
The pancreas consists of:
(Cancer Council 2022)
Pancreatic cancer occurs when malignant cells develop in the pancreas. In 70% of cases, cancer is found in the head of the pancreas (Cancer Council 2020, 2022).
There are two types of pancreatic cancer:
(Cancer Council 2022)
Pancreatic cancer has one of the lowest survival rates among all cancers, with the third-highest mortality rate after lung cancer and colorectal cancer (AIHW 2021; Cancer Australia 2022).
The specific causes of pancreatic cancer are unknown, but identified risk factors include:
(Cancer Council 2022)
There are often no obvious symptoms in the early stages of pancreatic cancer. In some cases, symptoms may not develop until the cancer has grown large enough to affect other organs, or has spread (Cancer Council 2022).
The first noticeable symptom is typically jaundice, which occurs due to a build-up of bilirubin. This can occur if the tumour blocks the common bile duct, allowing bilirubin to accumulate (Cancer Council 2022).
Other possible signs and symptoms include:
(Cancer Council 2022)
Note that pancreatic cancer symptoms are often vague, and the condition can present similarly to other conditions (Better Health Channel 2014b). Differential diagnoses include pancreatitis, cholangitis (inflammation of the bile duct), cholecystitis (inflammation of the gallbladder), choledochal cyst, peptic ulcer disease, cholangiocarcinoma and gastric cancer (Puckett & Garfield 2022).
Unlike other cancers such as breast cancer and colorectal cancer, there are no reliable screening tests for pancreatic cancer (Cancer Council 2022).
Instead, patients should be sent for an urgent abdominal CT scan and/or referred to a specialist if they meet one of the following criteria:
Criteria | Action to be taken |
---|---|
Patient is over the age of 60 and is experiencing unplanned weight loss in addition to any of the following symptoms:
|
|
Patient is over the age of 40 and is experiencing jaundice | Referral to a specialist |
Patient has one of the following risk factors that put them at five times the risk of pancreatic cancer:
|
Referral to a specialist |
(Adapted from Loveday et al. 2019)
A suspected diagnosis might be confirmed through:
(Cancer Council 2022)
Pancreatic cancer generally uses the TNM (tumour-nodes-metastasis) staging system (Cancer Council 2022):
Stage | Description | Percentage of cancers diagnosed at this stage |
---|---|---|
Stage I | The cancer is small and can only be found in the pancreas | 20% |
Stage II | The cancer is large but has not spread outside the pancreas, or is small and has spread to some nearby lymph nodes | |
Stage III | The cancer has spread to nearby major blood vessels or lots of nearby lymph nodes | 30% |
Stage IV | The cancer has metastasised to distant areas of the body (e.g. liver, lungs or abdominal lining). It may or may not have spread to the lymph nodes | 50% |
(Cancer Council 2022)
As a general rule:
(Cancer Council 2022)
Surgical resection (either a Whipple procedure, distal pancreatectomy or total pancreatectomy, depending on the location of the tumour) is the most effective method of treating pancreatic cancer, but unfortunately, most cases are diagnosed too late for surgery to be a viable option (Cancer Council 2022).
In some cases, the patient might need to undergo chemotherapy or chemoradiation prior to the procedure in order to shrink the tumour. Chemotherapy or chemoradiation might also need to be administered after surgery to ensure that any remaining cancer cells are destroyed (Cancer Council 2022).
If surgery is not an option, the patient will receive palliative care to alleviate their symptoms and help them live as comfortably as possible. Palliative care might include:
(Cancer Council 2022)
Remember that a cancer diagnosis can be highly distressing for patients and their loved ones. When caring for patients with pancreatic cancer, always ensure you provide empathetic care and access to appropriate support where necessary. You should also ensure patients and their families are properly informed about the diagnosis, what symptoms to expect, and what treatment options are available.
Question 1 of 1
At what stage is pancreatic cancer most commonly diagnosed?