Pancreatic Cancer

Pancreatic Cancer often starts within the cells of the pancreatic ducts, and these then spread to the rest of the pancreas. As pancreatic cancer grows it infiltrates into surrounding nerves, blood vessels and the lymphatic system, where it can then travel to other organs or locations within the body (this is called metastasis).

Approximately 60% of pancreatic cancers arise in the head of the pancreas, with 15% in the pancreas ‘body’, and 5% in the ‘tail’.

There are many different types of cancers in the pancreas, including:

• Serous Cystadenomas: Benign cystic neoplasms that are twice as common in women, and predominantly occur in people over 70 years old. These are benign and surgery is mostly curative.
• Mucinous Cystic Neoplasms: These can be benign, borderline malignant or malignant and usually arise in the body or tail of the pancreas. They are slow-growing masses that can be removed surgically.
• Endocrine neoplasms: Also known as ‘islet cell tumours’, these account for only 2% of pancreatic neoplasms and they occur in the cells of the pancreas that produce hormones. They can be malignant, with the ability to spread to the liver and lymph nodes.
• Exocrine tumours: These develop in the cells in the pancreas that produce digestive enzymes. More than 90 percent of all pancreatic cancers are exocrine tumours.

Researchers have found – by mapping more than 100 pancreatic cancer cells – that up to 2,000 genetic mutations can play a role in the development of pancreatic cancer. This information helps to explain why pancreatic cancer is so difficult to treat and is paving the way towards the development of more targeted treatments.

In saying this, they estimate that 5-10% of pancreatic cancers could be inherited – with genetic mutations passed down through families, causing susceptibility to pancreatic cancer. These inherited factors include the BRCA2 gene, Peutz-Jeghers Syndrome, Hereditary Pancreatitis, Familiar Atypical Multiple Mole Melanoma, and Lynch Syndrome.

Pancreatic Cancer is difficult to detect, given its hidden location behind the stomach, small intestine and spleen.

Furthermore, symptoms can be vague, and aren’t often noticeable until the cancer is large enough to touch (feel), at which point it will have started affecting nearby organs.

• Pain in the upper abdomen
• Nausea and vomiting
• Weight loss
• Symptoms of jaundice (yellowing skin, eyes, and dark urine) – this will occur if the tumour blocks the bile duct into the digestive system.
• Onset of diabetes mellitus (in 10-20% of people)

Treatment plans will be based on several factors, including the severity and spread of the tumour, and the patient’s general health and age. If the tumour is advanced and has spread throughout the body, combinations of treatments are used to help relieve symptoms and improve, or help to maintain, quality of life.

The most common treatment options for Pancreatic Cancer patients are surgery, endoscopic treatment, chemotherapy and/or radiation therapy. Surgery will depend on the location of the tumour within the pancreas, and the extent to which it has spread:

• Whipple Procedure: This involves the removal of the head of the pancreas, as well as a portion of the bile duct, the gallbladder and part of the stomach.
• Distal pancreatectomy: This procedure involves the removal of the body and tail of the pancreas and, usually, the spleen.

Other surgeries are referred to as ‘palliative’ surgery, and they are performed to significantly ease symptoms and improve quality of life. These will involve bypassing the cancerous tissue by, for example, sewing the stomach directly to the small intestine to allow normal eating behaviours, or re-routing the bile flow from the liver to the intestines.

As an added treatment after surgery, chemotherapy will usually be advised. It may be scheduled in combination with radiotherapy.

In cases where the cancer is very advanced, chemotherapy might be preferred to surgery (which can cause complications for the patient). This treatment is designed to relieve symptoms, rather than cure the cancer.