What is pancreatic cancer?
Pancreatic cancer occurs when malignant cells develop in part of the pancreas. This may affect how the pancreas works, including its exocrine or endocrine functions.
Pancreatic cancer can occur in any part of the pancreas, but about 70% of pancreatic cancers are found in the head of the pancreas. Pancreatic 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.
The pancreas is part of both the digestive system and the endocrine (hormone-producing) system. It is a long, flat gland about 13–15 cm long that lies between your stomach and spine.
The pancreas is divided into three parts:
- 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 with the pancreatic duct and connects the liver and gall bladder to the duodenum. The common bile duct carries bile, a substance that helps the body to digest fats.
The pancreas acts as two glands in one – it functions as a gland to help with digestion (exocrine), and as a gland to control the amount of sugar in the blood (endocrine).
Groups of exocrine cells (acini) produce juices called enzymes that help break down food. The juices flow through the pancreatic duct from the pancreas into the duodenum. Most of the pancreas is made up of exocrine tissue.
Scattered among the exocrine tissue are small groups of endocrine cells called pancreatic islets (or islets of Langerhans). These release hormones that control the level of sugar in the blood – the hormone insulin decreases this level, while the hormone glucagon increases it.
What are the main types?
Two main types of tumours occur in the pancreas:
These make up more than 95% of pancreatic tumours. 1 The most common type, called an adenocarcinoma, begins in the lining of the pancreatic duct. Less common types include adenosquamous carcinomas and undifferentiated carcinomas. The name of the cancer is taken from the type of cells involved. Treatment for exocrine tumours is discussed in two sections – see treatment for early pancreatic cancer and treatment for advanced pancreactic cancer.
Pancreatic neuroendocrine tumours (NETs)
About 5% of pancreatic tumours are pancreatic NETs. 2 These begin in the endocrine cells, which produce hormones to control blood sugar levels. Treatment for pancreatic NETs is discussed in a separate section.
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:
- smoking (cigarette smokers are about twice as likely
- to develop pancreatic cancer)
- type 2 diabetes
- pancreatitis (long-term inflammation of the pancreas)
- certain types of cysts in the pancreatic duct known as intraductal papillary mucinous neoplasms (IPMNs) – these should be assessed by an appropriate specialist
- drinking too much alcohol
- family history and inherited conditions (see below).
Family history and inherited conditions
Most people with pancreatic cancer do not have a family history of the disease. However, about one in 10 people who develops pancreatic cancer has 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. The "degree of relationship" describes how many genes are shared between two blood relatives. First-degree relatives, for example, your parents, siblings or children, share about half their genes with you.
Some inherited syndromes that may increase the risk of pancreatic cancer include Peutz-Jeghers syndrome, the familial breast cancer genes (BRCA1 and BRCA2), familial atypical multiple mole melanoma (FAMMM) syndrome, Lynch syndrome and hereditary pancreatitis.
Some pancreatic NETs are caused by a rare inherited syndrome, such as multiple endocrine neoplasia type 1 (MEN1) or neurofibromatosis.
If you are concerned about your family history or want to know more about genetic testing, talk to your doctor or call Cancer Council 13 11 20.
How common is it?
About 3080 Australians are diagnosed with pancreatic cancer each year. More than 80% are over the age of 60. 3
Pancreatic cancer was estimated to be the tenth most common cancer in males and ninth most common in females in Australia during 2017. 4
Screening tests help detect cancer in people who do not have any symptoms. There are useful screening tests for certain types of cancer, such as breast cancer and bowel cancer. However, there is currently no screening test available for pancreatic cancer.
What are the symptoms?
Early-stage pancreatic cancer rarely causes symptoms.
Symptoms often only appear once the cancer is large enough to affect nearby organs, or has spread.
Symptoms of pancreatic cancer may include:
- jaundice – yellowish skin and eyes, dark urine, pale bowel motions and itchy skin
- indigestion (heartburn)
- appetite loss
- nausea with or without vomiting
- unexplained weight loss
- pain in the upper abdomen, side or back, which may cause you to wake up at night
- changed bowel motions – including diarrhoea, severe constipation, or pale, oily, foul-smelling stools that are difficult to flush away.
Because some pancreatic NETs produce excess hormones, they can also have symptoms such as:
- too much sugar in the blood (hyperglycaemia)
- a drop in blood sugar (hypoglycaemia)
- blurred vision
- excessive thirst
- increased urination.
The symptoms listed above do not necessarily mean that you have cancer; they can indicate other conditions. However, you should see your doctor if you have any of these symptoms.
What can I expect after diagnosis?
It's common to have many questions and concerns about what a diagnosis of pancreatic cancer will mean for you.
You will have various tests to confirm that you have pancreatic cancer, and to work out which type and how far it has progressed. The results will help guide decisions about treatment.
- Treating early pancreatic cancer: About 15–20% of people with adenocarcinoma or another exocrine cancer of the pancreas are diagnosed at an early stage. They may be offered treatment that aims to get rid of all the cancer.
- Treating advanced pancreatic cancer: Most people with adenocarcinoma or another exocrine cancer of the pancreas are diagnosed at an advanced stage. Treatment will aim to manage symptoms, control the cancer and improve quality of life.
- Treating pancreatic NETs: About 5% of pancreatic cancers are neuroendocrine tumours (NETs). There are additional treatment options for both early and advanced pancreatic N ETs.
- Managing your diet: People with pancreatic cancer often need to adapt to changes in how their body processes food, either because of the cancer itself or because of the treatment.
For an overview of what to expect during all stages of your cancer care, visit Cancer Pathways – pancreatic cancer. This is a short guide to what is recommended, from diagnosis to treatment and beyond.
Where should I have treatment?
Treatment for pancreatic cancer is highly specialised, so you
may need to travel for treatment. This is especially the case with surgery for early pancreatic cancer. There is strong evidence that outcomes are better with an experienced surgeon who performs the operation several times a year.
Specialised treatment centres that see a lot of people with pancreatic cancer are also associated with better outcomes. Seeing a multidisciplinary team at these centres allows you to access a wide range of treatment options. To find a specialised pancreatic centre, talk to your GP or call Cancer Council 13 11 20.
If you live in a rural or regional area and have to travel a long way for appointments or treatment, ask your doctor what support is available to coordinate your journey. You may also be able to get financial assistance towards the cost of accommodation or travel. To check whether you are eligible or to apply, speak to your GP or the hospital social worker, or call Cancer Council 13 11 20.
Which health professionals will I see?
Your GP will usually arrange the first tests to assess your symptoms. If you need further tests, you will be referred to a specialist, who will make a diagnosis and advise you about treatment options. Because pancreatic cancer is a challenging cancer to treat, it is important to see a multidisciplinary team (MDT) in a hospital or treatment centre that regularly treats this disease. The MDT is a group of health professionals who meet regularly to discuss and plan your treatment. It may include some or all of the health professionals listed below.
|pancreatic or HPB (hepato- pancreato-biliary) surgeon
||specialises in surgery to the liver, pancreas and surrounding organs
||specialises in diagnosing and treating diseases of the digestive system, including pancreatic cancer and blocked bile ducts
||prescribes and coordinates chemotherapy, hormone therapy and targeted drug therapies
||prescribes and coordinates radiation therapy
||diagnoses, treats and manages hormonal disorders, including diabetes
|nuclear medicine specialist*
||coordinates the delivery of radioactive treatment and scans
||analyses x-rays and scans, may do biopsy under ultrasound or CT, and delivers some treatments
|cancer care coordinator/clinical nurse consultant/clinical nurse specialist
||coordinates your care, liaises with other members of the MDT, and supports you and your family throughout treatment
||administer drugs and provide care, information and support throughout your treatment
|palliative care team
||specialise in pain and symptom control to maximise wellbeing and improve quality of life
||supports and educates patients about eating and managing weight changes and digestive/bowel problems
||links you to support services and helps you with emotional, practical or financial issues
||use counselling to help you manage your emotional response to diagnosis and treatment
|physiotherapist and occupational therapist
||helps with restoring movement and mobility and preventing further injury, and can tailor an exercise program for you
||assists people with medical conditions to exercise and improve their overall health, fitness, strength and energy levels
||assists in adapting your living and working environment to help you resume your usual activities
Expert content reviewers:
Dr Lorraine Chantrill, Senior Staff Specialist Medical Oncology, The Kinghorn Cancer Centre, St Vincent's Hospital, and Honorary Research Fellow, Garvan Institute of Medical Research, NSW; Jennifer Arena, Pancreatic and Neuroendocrine Cancer Care Coordinator, Northern Sydney Cancer Centre, Royal North Shore Hospital, and Northern Cancer Institute, NSW; Dr Michael Briffa, Southern Adelaide Palliative Services, Flinders Medical Centre, SA; Rachel Corbett, 13 11 20 Consultant, Cancer Council Victoria; A/Prof Nick O'Rourke, The University of Queensland, Chairman of General Surgery, Head of Hepatobiliary Surgery, Royal Brisbane and Women's Hospital, QLD; Steve Pendry, consumer; Caley Schnaid, Accredited Practising Dietitian, Northern Cancer Institute and Wellac Lifestyle, NSW; Deane Standley, Consumer.
1. RC Gandy et al., “Refining the care of patients with pancreatic cancer: the AGITG Pancreatic Cancer Workshop consensus”, Medical Journal of Australia, vol. 204, issue 11, 2016, pp. 419–22.
2. DS Klimstra et al., “The pathologic classification of neuroendocrine tumors: a review of nomenclature, grading, and staging systems”, Pancreas, vol. 39, issue 6, 2010, pp. 707–12.
3. Australian Institute of Health and Welfare (AIHW), Australian Cancer Incidence and Mortality (ACIM) books: Pancreatic cancer, AIHW, Canberra, December 2017.
4. Australian Institute of Health and Welfare, Cancer in Australia 2017, AIHW, Canberra, 2017..