Pancreatic cancer

Saturday 1 February, 2014

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On this page: The pancreas | What the pancreas does | What is pancreatic cancer? | What types are there? | How common is it? | What are the risk factors? | What are the symptoms? | Which health professionals will I see?

The pancreas

The pancreas is part of the digestive system. It produces enzymes, which break down food so it can be absorbed and used by the body. It is a long, irregular shaped gland about 13–15cm long that lies between your stomach and spine. It is divided into:

  • a large rounded section, called the head of the pancreas
  • the middle part, known as the body
  • the narrow end, called the tail.

A tube called the pancreatic duct connects the pancreas to the first part of the small bowel (duodenum). Another tube called the common bile duct joins the pancreatic duct and connects the liver and gall bladder to the small bowel. The common bile duct carries bile, a substance that helps to digest fats.

What the pancreas does

It contains two types of glands, the exocrine glands and the endocrine glands, which release substances that help with digestion.

  • Exocrine glands
    These produce juices called enzymes that help break down food. The juices flow from the pancreas into the duodenum through the pancreatic duct. Most of the pancreas is made up of exocrine glands.
  • Endocrine glands
    These are scattered amongst the exocrine glands in small clusters called pancreatic islets (or islets of Langerhans). They release chemical messengers (hormones) that control the amount of sugar in the blood. The hormone insulin decreases blood sugar levels, while the hormone glucagon increases blood sugar levels.

Diagram of the pancreas

What is pancreatic cancer?

Pancreatic cancer occurs when malignant cells develop in part of the pancreas. This may affect how the pancreas works, including the functioning of the exocrine or endocrine glands.

It can occur in any part of the pancreas, but about 70% of pancreatic cancers are located in the head of the pancreas.

Cancer can also spread to nearby lymph nodes (part of the immune system), blood vessels or nerves. Cancer cells may travel through the bloodstream to other parts of the body, such as the liver.

What types are there?

There are two types of pancreatic tumours:

Exocrine tumours

Make up more than 90% of pancreatic tumours. The most common exocrine tumour, called an adenocarcinoma, begins in the lining of the pancreatic duct.

Other types of tumours include adenosquamous carcinomas and undifferentiated carcinomas.

Pancreatic neuroendocrine tumours (PNETs)

Rare types of tumours affecting the endocrine system. They begin in the endocrine cells, which produce hormones that control the growth of cells in the body.

PNETs are categorised as either hormone secreting (functioning) or non-hormone secreting (non-functioning). Functioning tumours are usually named after the type of hormone they produce.

Types of PNETs include:

  • gastrinomas – produce too much gastrin
  • insulinomas – produce too much insulin
  • glucagonomas – produce too much glucagon
  • somatostatinomas – produce too much somatostatin
  • VIPomas – create a hormone-like substance called vasoactive intestinal polypeptide (VIP).

These webpages have information on neuroendocrine tumours affecting the pancreas. Neuroendocrine tumours can also affect other areas of the body, including the lungs, kidneys and bowel. For information about these types of tumours, contact the Unicorn Foundation on 0419 871 975 or call Cancer Council on 13 11 20.

How common is it?

About 2500 Australians are diagnosed with exocrine pancreatic cancer each year. The average age of people diagnosed with this cancer is 71. It is the twelfth most common cancer in men and ninth most common cancer in women.

PNETs are very rare. Fewer than 100 people in Australia are diagnosed with a PNET each year.

What are the risk factors?

Research has shown that people with certain risk factors are more likely than others to develop pancreatic cancer. Risk factors include:

  • getting older – it is most common in people aged over 65
  • smoking – cigarette smokers are 2–3 times more likely to develop pancreatic cancer
  • new onset diabetes – about 15–20% of people with pancreatic cancer have newly diagnosed diabetes
  • chronic inflammation of the pancreas (pancreatitis)
  • a family history of inherited cancer syndromes.
The importance of family history

Most people with pancreatic cancer do not have a family history of the disease. However, about one in 10 people who develop pancreatic cancer have a faulty gene that can run in families.

You may have an inherited family risk if you have two or more first-degree relatives affected by pancreatic cancer, or a history of an inherited syndrome. Some inherited syndromes that may cause pancreatic cancer include Peutz-Jeghers syndrome, the familial breast cancer gene (BRCA1 and BRCA2), familial atypical multiple mole melanoma syndrome, Lynch syndrome and hereditary pancreatitis.

Some PNETs are caused by a rare inherited syndrome, such as multiple endocrine neoplasia type 1 (MEN-1) or neurofibromatosis.

The ‘degree of relationship’ describes how many genes are shared between two blood relatives. A first-degree relative shares about half their genes with you, for example, your parents, siblings or children.

If you are concerned about your family history or if you want to know more about genetic testing, talk to your doctor or visit the Australian Familial Pancreatic Cancer Cohort (AFPaCC) website,

What are the symptoms?

Early stages of pancreatic cancer rarely cause symptoms. Symptoms may go unnoticed until the cancer is large enough to affect nearby organs.

Symptoms of pancreatic cancer may include:

  •  indigestion (heartburn)
  • appetite loss
  • feeling sick (nausea)
  • vomiting
  • weight loss
  • pain in the upper abdomen, side or back, which may cause you to wake up at night
  • changed bowel motions – either diarrhoea, severe constipation, or stools that are pale and hard to flush away
  • jaundice, which causes yellowish skin and eyes, dark urine, pale bowel motions and itchiness
  • onset of diabetes within the last two years, or worsening of existing diabetes – in up to 50% of people with pancreatic cancer, the cancer stops the pancreas from making insulin properly
  • for PNETs, too much sugar in the blood (hyperglycaemia)
  • for PNETs, blurred vision.

See your doctor if you experience any of these. Symptoms of pancreatic cancer are also common to other conditions.

Which health professionals will I see?

If you have cancer, you will be cared for by a team of health professionals who specialise in different aspects of your treatment. This is called a multidisciplinary team or MDT.

Your general practitioner (GP) can be kept informed about all your test results and treatment. They may refer you to specialists and answer questions you have in-between appointments.

Some people in non-metropolitan areas have to travel to attend appointments with specialists. If you need to travel a long way for treatment you may be able to get financial assistance towards the cost of accommodation or travel. To check your eligibility or to apply speak to your GP, the hospital social worker or call Cancer Council on 13 11 20.

Health professional Role
gastroenterologist specialises in diagnosing and treating diseases of the digestive system, including pancreatic ancer and blocked bile ducts
pancreatic surgeon
specialises in surgery to the liver, pancreas and surrounding organs
medical oncologist
prescribes and coordinates the course of chemotherapy
radiation oncologist
prescribes and coordinates the course of radiotherapy
diagnoses, treats and manages hormonal disorders, including diabetes
nurses support and assist you through all stages of your illness
recommends an eating plan for you to follow while you are in treatment and recovery
social worker, psychologist and occupational therapist
link you to support services and help you with any emotional, physical or practical issues
palliative care team
assists with symptom management and emotional support for you and your family

Reviewed by: A/Prof Val Usatoff, Head of Unit, Upper GI/HPB Surgery, Western Hospital, A/Prof of Surgery, The University of Melbourne, Adj Senior Lecturer, Monash University, HPB Surgeon, Alfred Hospital, Deputy Medical Director and HPB Surgeon, Cabrini Hospital and Founding Councillor and Treasurer, Australian and New Zealand HPB Association; Merran Findlay, Acting Cancer Services Development Manager, Senior Oncology Dietitian, Royal Prince Alfred Hospital, NSW; Suzanne Kavanagh, Consumer; Rachelle Ryan, Senior Dietitian Clinical Educator, Royal Prince Alfred Hospital, NSW; Janny Wagenaar, Nurse, Cancer Council Tasmania.
Updated: 01 Feb, 2014