Pancreatic cancer

Pancreatic cancer | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Pancreatic cancer Pancreatic cancer About pancreatic cancer Treating pancreatic cancer Symptoms of pancreatic cancer Causes of pancreatic cancer Diagnosing pancreatic cancer Recovering pancreatic cancer About pancreatic cancer Pancreatic cancer is caused by the abnormal and uncontrolled growth of cells in the pancreas  a large gland thats part of the digestive system. Around half of all new cases are diagnosed in people aged 75 or over. Its uncommonin people under 40 years of age. Symptoms of pancreatic cancer In the early stages, a tumour in the pancreas doesnt usually cause any symptoms, whichcan make it difficult to diagnose. Its important to remember that these symptoms can be caused by many different conditions, and arent usually the result of cancer.But you should contact your GP if youre concerned, or if these symptoms start suddenly. The first noticeable symptoms of pancreatic cancer are often: pain in the back or stomach areawhich may come and go at first and is often worse when you lie down or after youve eaten unexpected weight loss jaundice the most obvious sign is yellowing of the skin and whites of the eyes;it also causes your urine to be dark yellow or orange and your stools (faeces) to be pale-coloured Other possible symptoms of pancreatic cancer include: nausea and vomiting bowel changes fever and shivering indigestion blood clots You may also develop symptoms of diabetes if you havepancreatic cancer, because it can produce chemicals that interfere with the normal effect of insulin. Endocrine pancreatic cancer There are also anumber of different endocrine tumours that cause different symptoms, depending on the hormone the tumour produces. Causes of pancreatic cancer Its not fully understood what causes pancreatic cancer, but a number of risk factors for developing the condition have been identified. Risk factors for pancreatic cancer include: ageit mainly affects people who are 50 to 80 years of age smoking  around 1 in 3 casesis associated with using cigarettes, cigars or chewing tobacco having a history of certain health conditionssuch as diabetes , chronic pancreatitis (long-term inflammation of the pancreas), stomach ulcer and Helicobacter pylori infection (a stomach infection) In about 1 in 10 cases, pancreatic cancer is inherited from a persons parents. Certain genes also increase your chances of getting pancreatitis, which in turn increases your risk of developing cancer of the pancreas. Cancer Research UK has more information on risk factors and causes on their website Diagnosing pancreatic cancer Your GP will first ask about your general health and carry out a physical examination. Theymay examine your tummy (abdomen) for a lump and to see whether your liver is enlarged. Theyll also check your skin and eyesfor signs ofjaundice andmay request a urine sample and blood test . If your GP suspects pancreatic cancer, youll usually be referred to a specialist at a hospital for further investigation. You may have either: an ultrasound scan a computerised tomography (CT) scan a magnetic resonance imaging (MRI) scan apositron emission tomography (PET) scan where youre given an injection of a very small amount of radioactive medication, known as a tracer, which helps to show up cancers in an image Depending on the results of a scan, further tests may include: anendoluminal ultrasonography (EUS)endoscopy a type of endoscopywhich allowsclose-up ultrasound pictures to be taken of your pancreas an endoscopic retrograde cholangiopancreatography (ERCP) a type of endoscopywhich is used to inject a special dye into your bile and pancreatic ducts; the dye will show up on an X-ray and highlight any tumours alaparoscopy a surgical procedure that allows the surgeon to see inside your body using a laparoscopy(a thin,flexible microscope) A biopsy , where a small sample is taken from a suspected tumour, may also be carried out during these procedures. NICE guidelines In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of pancreatic cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected pancreatic cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . Treating pancreatic cancer Cancer of the pancreas is difficult to treat. Itrarely causes any symptoms in the early stages, so its often not detected until the cancer is fairly advanced. If the tumour islarge, treating the cancer will be more difficult. If youve been diagnosed with pancreatic cancer, your treatmentwill depend on the type and location of your cancer, and how far its advanced. Your age, general health and personal preferences will also be taken into consideration. The first aim will be to completely remove the tumour and any other cancerous cells. If this isnt possible, treatment will focus on preventing thetumour growing and causing further harm to your body. The 3 main treatments for pancreatic cancer are: surgery chemotherapy radiotherapy Some types of pancreatic cancer only require one form of treatment, whereas others may require2types of treatment or a combination of all 3. Read more about treating pancreatic cancer . Recovering from surgery Recovering from pancreatic cancer surgery can be a long and difficult process. Youll probably experience some pain after your operation. The staff at your hospital will make sure you have adequate pain relief. After any type of surgery to your digestive system, your bowel will temporarily stop working. This means you wont be able to eat or drink straight away. Youll gradually be able to sip fluids, before eventually being able to drink and eat more regularly. You maybe referred to a dietitian, who can advise you about what foods you should eat following your operation. After the tumour has been removed, youll probably have a six-month course of chemotherapy , which greatly increases your chance of being cured.But becausecancer of the pancreas is difficult to diagnose and treat, many people dont recovercompletely. Treatment can be very effective in helping to ease symptoms and make you as comfortable as possible. Chemotherapy can help shrink your tumour and slow down its growth. Treating pancreatic cancer Treatment for pancreatic cancer depends on the type, location and stage of your cancer (how far its spread). Your age, general health and personal preferences will also be taken into consideration when deciding on your treatment plan. The first aim will be to completely remove the tumour and any other cancerous cells in your body. If this isnt possible, the focus will be on preventing the tumour growing and causing further harm. Sometimes its notpossible to get rid of the cancer or slow it down,so treatment will aim to relieve your symptoms and make you as comfortable as possible. Cancer of the pancreas is very difficult to treat. In its early stages, this type of cancer rarely causes symptoms, so its often not detected until its quite advanced. If the tumour is large or has spread, treating or curing the cancer is much harder. Discussing your treatment Deciding what treatment is best for you can be a difficult process. Theres a lot to take in, so its important to talk about the possible alternatives with a family member or friend. You should also have an in-depthdiscussion with your doctor, who can tell you the pros andcons of the treatments available to you. If at any stage you dont understand the treatment options being explained to you, make sure you ask your doctor for more details. There are 3 main ways that cancer of the pancreas can be treated: surgery chemotherapy radiotherapy Some types of pancreatic cancer only require one form of treatment, whereas others may require 2 or a combination of all 3. Cancer Research UKhas more information about types of treatment for pancreatic cancer . Surgery Surgery is usually the only waypancreatic cancer can be completely cured. However, as the condition is usually advanced by the time its diagnosed, surgery is only suitable for around 15 to 20% of people. However, this isnt a suitable optionif your tumour has wrapped itself around important blood vessels. If your cancer has spread to other areas of the body, surgically removing the tumour wont cure you. Surgery for pancreatic cancer is usually only an option for people who have a good general level ofhealth. This is because pancreas surgery is often long and complex, and the recovery process can be slow. Sometimesthe risks of surgerycan outweigh the potential benefits. Your doctor will discuss with you whether surgery is a suitable option. Whipple procedure The Whipple procedure is the most common operation used to treat pancreatic cancer, and involves removing the head of the pancreas. Your surgeon must also remove the first part of your small intestine (bowel), your gall bladder (which storesbile)and part of your bile duct. Sometimes, part of the stomach also has to be removed. The end of the bile duct and the remaining part of your pancreas is connected to your small intestine. Thisallows bile and the hormones and enzymes produced by the pancreas to still be released intoyour system. After this type of surgery, about one in three people need to take enzymes to help them digest food. The Whipple procedure involves long and intensive surgery, but its easier to recover from than a total pancreatectomy. Distal pancreatectomy A distal pancreatectomy involvesremoving the tail and body of your pancreas. Your spleen will usually also be removed at the same time. Part of your stomach, bowel, left adrenal gland, left kidney and left diaphragm (the muscle that separates the chest cavity from the abdomen) may also be removed. Like the Whipple procedure, a distal pancreatectomy is a long and complex operationthat wont be carried outunless your doctor thinks its necessary. Total pancreatectomy During a total pancreatectomy, your entire pancreas will be removed. This is sometimes necessary due to the position of the tumour. Your surgeon will also remove your: bile duct gall bladder spleen part of your small intestine part of your stomach (sometimes) surrounding lymph nodes (part of the immune system) After a total pancreatectomy, youll need to take enzymes to help your digestive system digest food. Youll also have diabetes for the rest of your life because the pancreas produces insulinthe hormone that regulates blood sugar. Removing your spleen can increase your risk of developing infections and may also affect your bloods ability to clot. This means youll be on penicillin (or an alternative antibiotic if youre allergic to it) for the rest of your life, and youll need to have regular vaccinations. Sometimes, you may need to take tablets for a short period to stop the platelets in your blood sticking to each other. Platelets are a type of bloodcellthat cause your blood to clot (thicken). Surgery to ease your symptoms Although surgery may not be a suitable way of removing your tumour, you may be offeredit to help ease your symptoms. This type of surgery wont cure your cancer, but will mean that your condition is easier to manage, and it will make you more comfortable. To help control jaundice, a stent can be placed in your bile duct using endoscopic retrograde cholangiopancreatography (ERCP). This will help keep the bile duct open and prevent bilirubinthe yellow chemical in bilefrom building up and causing jaundice. If a stent isnt a suitable option for you, you may need an operation to bypass your blocked bile duct. Your surgeon will cut the bile duct just above the blockage and reconnect it to your intestine, which allows your bile to drain away. These types of surgery are much less intensive than surgery carried out on the pancreas. The recovery time is much quicker, andpeople find that theirjaundice improves significantly. Chemotherapy Chemotherapyis a type of cancer treatment that uses anti-cancer medicines to either kill the cancerous (malignant) cells in your body or stop themmultiplying. Chemotherapy treatment is often used alongside surgery and radiotherapy (see below) to help ensure that as much of the cancer is treated as possible. Chemotherapy may be given: before surgeryto try to shrink the cancer, so theres a greater chance of the surgeon being able to remove all of the cancer after surgeryto help reduce the risk of the cancer coming back when surgery isnt possibleto try to shrink the cancer, slow its growth and relieve your symptoms Some chemotherapy medicines can be taken orally (by mouth), but some need to be given directly into a vein (intravenously). Chemotherapy also attacksnormal, healthy cells, which is why this type of treatment can have many side effects. The most common side effects include: vomiting nausea mouth sores fatigue increased risk of infection These are usually only temporary, and should improve once youve completed your treatment. The chemotherapy medications can also be used in combination, so your doctor may suggest using one medication or a combination of 2 or 3. Combining chemotherapy medications can give a better chance of shrinking or controlling the cancer, but increases the chance of side effects.Sometimes, the risks of chemotherapy can outweigh the potential benefits. Read more about chemotherapy Radiotherapy Radiotherapyis a form of cancer therapy that uses high-energy beams of radiation to help shrink your tumour and relieve pain. Side effects of radiotherapycan include: fatigue skin rashes loss of appetite diarrhoea nausea or vomiting These side effects are usually only temporary, and should improve after your treatment has been completed. Read more about radiotherapy Symptoms of pancreatic cancer In its early stages, pancreatic cancer rarely causes symptoms. The pancreas is actually 2 glands in one, and symptoms depend on which part is affected. This is because: the exocrine pancreas produces digestive enzymes, which break down food so they can be absorbed by your body the endocrine pancreas produces hormones  including insulin, which keeps your blood sugar levels stable Most casesof pancreatic cancer arein the exocrine pancreas, and the 3 most common symptoms are: pain in the stomach orback jaundice weight loss Its important to remember that these symptoms can be caused by many different health conditions and arent usually the result of cancer.However, you should contact your GP if youre concerned, or if yousuddenly develop these symptoms. Pain in the stomach orback Pancreatic cancer can cause a dull pain in your upper tummy (abdomen), which mayspread to your back. To begin with, the pain may come and go, but as the tumour becomes larger and more advanced, the pain may be more constant and last longer. The pain is often worse when you lie down or after youve eaten. You may also have pain or tenderness in your abdomen if your liver, pancreas or gallbladder are enlarged. Weight loss Many types of cancer cause weight loss, because the cancerous cells deprive your healthy cells of the nutrients they need. Pancreatic cancer is more likely to cause weight loss than some other cancers because the pancreas produces digestive enzymes, which help food to be absorbed into your body. If a tumour disrupts that production, your body will find it harder to digest food, particularly high-fat foods. This can cause you to lose weight and becomemalnourished. Jaundice Jaundice is caused by a build-up of a yellowish-brown substance called bilirubin in the blood and tissues of the body. The most obvious sign of jaundice is yellow skin and yellowing of the whites of the eyes. It also causes your urine to be dark yellow or orange and your stools (faeces) to be pale-coloured. Bilirubin is a waste product produced by the liver, and passed out of the body through the bile duct andinto the intestine. Jaundice is more often a sign of conditions such as gallstones or hepatitis than it is of cancer. However, a tumour can sometimes develop in the head of the pancreas and block the bile duct, causing bilirubin to build upin the body. Diabetes The pancreas produces thehormoneinsulin. Without it, the body cant move glucose (sugar) out of the blood and into your cells. The main symptoms of diabetes include: excessive thirst urinating frequently  particularly at night extreme tiredness weight loss and loss of muscle bulk You may develop diabetes if you havepancreatic cancer, because it can produce chemicals that interfere with the normal effect of insulin. Other possible symptoms Other possible symptoms of pancreatic cancer include: itching (if you have jaundice) nausea and vomiting bowel changes fever and shivering indigestion blood clots Endocrine pancreatic cancer Endocrine pancreatic tumours, also known as neuroendocrine tumours, are uncommon. There are a number of different endocrine tumours that cause different symptoms, depending on the hormone the tumour produces. Causes of pancreatic cancer The exact cause of pancreatic cancer isnt fully understood. However, there are a number of risk factorsthat can increase your chances of developing it. Age Pancreatic cancer can affect people of any age, but itmainly affects people who are aged 50 to 80. Almost 50% of people diagnosed with cancer of the pancreas are aged 75 or over. Smoking Research has found that about one in three cases of pancreatic cancer is associated with smoking and other tobacco use. Smoking cigarettes, cigars or chewing tobacco can all increase your risk of developing cancer of the pancreas. This is because tobacco smoke contains harmful chemicals and toxins that can cause irritation and inflammationwithin your bodys organs andtissues. Diabetes If you have diabetes , your risk of developing pancreatic cancer is thought to beincreased. However, its important to remember that diabetes is very common and most people with diabetes wont develop pancreatic cancer. As well as diabetes being a risk factor for pancreatic cancer, its also thought that a cancerous tumour that grows in the pancreas could be responsible for some cases of diabetes. Chronic pancreatitis and hereditary pancreatitis Chronicpancreatitis (long-term inflammation of the pancreas) increases your risk of getting pancreatic cancer, butisnt responsible for many cases. Chronic pancreatitis is often caused by long-term alcohol misuse . Although its a veryrare condition, if you have hereditary pancreatitis, yourrisk of developing pancreatic cancer is 50 times greater than the rest of the population. Helicobacter pylori infection Helicobacter pylori are bacteria that cause stomach ulcers, and is a known risk factor for stomach cancer. Research has shown that a Helicobacter pylori infection may slightlyincrease your risk of getting pancreatic cancer. However, the risk is thought to be small because most people withthis infection dont get cancer of the pancreas. Other known risk factors There are also a number of other factors that have been associated with an increased risk of pancreatic cancer. These are: long-term hepatitis tooth or gum disease heavy alcohol use a previous history of certain types of cancer previously having radiotherapy diet , weight and level of physical activity The Cancer Research UK website hasmore information about these other possible risk factors for pancreatic cancer . Diagnosing pancreatic cancer In the early stages, pancreatic cancer often causes no symptoms. This can make it difficult to diagnose. If you visit your GP with symptoms of pancreatic cancer ,they will probably examine your eyes and skin for signs of jaundice. They may also test your urine for bile, or carry out a blood test . This is because jaundice can sometimes be a sign of pancreatic cancer. Your GP may also examine your tummy (abdomen) to feel for any swelling or abnormality. The pancreas is quite well-hidden within the body because its covered by part of the bowel. This can make it difficult to feel for tumours during a physical examination. Ifyour GP suspects pancreatic cancer, youll be referred for further testing at a hospital. In 2015, the National Institute for Health and Care Excellence ( NICE ) published guidelines to help GPs recognise the signs and symptoms of pancreatic cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected pancreatic cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . Ultrasound scan An ultrasound scan is a painless procedure that uses high-frequency sound waves to produce an image of the inside of your body. Ifpancreatic cancer is suspected, youll be referred for an ultrasound scan of your abdomen to see if your pancreas appears abnormal. However, this type of scan can often miss pancreatic cancer, because ultrasound waves arent very goodat penetrating deep into body tissues. Computerised tomography (CT) scan A computerised tomography (CT)scan produces a detailed image of the inside of your body using a series of X-ray images. Your doctor can use the results of a CTscan to check for abnormalities and assess the size of the tumour. Magnetic resonance imaging (MRI) scan A magnetic resonance imaging (MRI) scan also produces an image of the inside of your body, but it uses strong magnetic and radio waves instead of X-rays. MRI scans are carried out in a tube-shapedMRI scanner. Its a noisy procedure thatcan feel claustrophobic. It also takes longer than other types ofscans. Like a CT scan, an MRI scan allows your doctor to check for signs of cancer in other parts of the body. Positron emission tomography (PET) scan A positron emission tomography (PET) scan can help to show where the cancer is and whether it has spread to other parts of the body. Before the scan, youll be given an injection of a very small amount of a radioactive medication, known asa tracer. The amount ofradiation is very small and no more than you would receive from a normal X-ray. The most common tracer used is a radioactive form of glucose (sugar).Youll then rest for about an hour to allow the tracer to travel to areas in your body where glucose is used for energy. The scan itself can take up to an hour and produces an image of the tracer in your body. The tracer shows up cancers because they use glucose in a different way to normal tissue. Endoluminal ultrasonography (EUS) If a small shadow is seen on a CT or MRI scan but its not obvious what itis, another test called endoluminal ultrasonography (EUS) can be carried out. During EUS, a thin, flexibleinstrument calledan endoscope is passed through your mouth and guided towards your stomach. An ultrasound probe attached to the tip of the endoscope will then be used to take close-up pictures of your pancreas. Before the procedure, you may be given a sedative to help you relax. EUS can also be used to take a biopsy for further examination. Endoscopic retrograde cholangiopancreatography (ERCP) Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used to insert a plastic tube or stent into the bile duct ifsomeone hasjaundice. During ERCP, an endoscope is passed through your mouth and guided towards your stomach. The endoscope can then be used to inject a special dye into your bile and pancreatic ducts. After the dye has been injected, an X-ray will be taken. The dye will show up on the X-ray and will highlight any tumour thats blocking the bile and pancreatic ducts. During the procedure, tissue samples may be taken. These samples can be looked at under a microscope to see whether the cells are cancerous. ERCP can take 30 to 60 minutes. As with EUS, youll usually be given a sedative to help you relax. Laparoscopy Alaparoscopy is a surgical procedure that allows the surgeon to access the inside of your abdomen and pelvis. During the procedure, a smallincision will be made in your abdomen, and a laparoscope (a thin,flexible microscope) will be inserted. This will allow the surgeon to see inside your body and make sure the tumour hasnt spread before recommending its removal. This procedure will be carried outunder a general anaesthetic (where youre put to sleep so you dont feel any pain or discomfort). Biopsy A biopsy involves taking a sample from a suspected tumour, whichcan then be tested to see if its cancerous (malignant) or non-cancerous (benign). A biopsy can be carried out during an EUS, ERCP or laparoscopy usinga small instrument attached to the endoscope to collect a number of cells. Its also possible for abiopsy to be carried out using a long, thin needle thats passed through your abdomen. The needle will be guided towards the tumour using an ultrasound or CT scan. Recovering pancreatic cancer Recovering from pancreatic cancer surgery can be a long and difficult process. Youll probably experience some pain after your operation. The staff at your hospital will make sure you have adequate pain relief. After any type of surgery to your digestive system, your bowel will temporarily stop working. This means you wont be able to eat or drink straight away. Youll gradually be able to sip fluids, before eventually being able to drink and eat more regularly. You maybe referred to a dietitian, who can advise you about what foods you should eat following your operation. After the tumour has been removed, you will probably have a 6-month course of chemotherapy , which greatly increases your chance of being cured. However, as cancer of the pancreas is difficult to diagnose and treat, many people dont recovercompletely. Treatment can be very effective in helping to ease symptoms and make you as comfortable as possible. Chemotherapy can help shrink your tumour and slow down its growth. 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Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Brain, nerves and spinal cord Chronic pancreatitis Other health sites Cancer Research UK: Pancreatic cancer Macmillan Cancer Support: Pancreatic cancer Pancreatic Cancer UK Pancreatic Cancer Action Lab Tests Online UK: Cancer Antigen 19-9 (CA 19-9) Test Care Information Scotland Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852