About Pancreatic Cancer

The pancreas is a glandular organ that plays a vital role in digestion and regulating sugars. It is about 6 inches long and is located high up in the abdomen, behind your stomach.

It is composed of three sections:

• the wide end of the pancreas on the right side of the body – the head;
• the middle section – the body;
• the thin end on the left side of the body – the tail.

Symptoms of pancreatic cancer often do not show in the early stages.  The symptoms may not be specific to pancreatic cancer and they may come and go to begin with.   This can make pancreatic cancer difficult to diagnose.

• Mid Back Pain
  This may start as general discomfort.  Some people experience no pain at all and the level of pain can differ from person to person.
• Unexplained Weight Loss
  The pancreas plays an important role in digesting food and controlling your blood sugar levels.  Pancreatic cancer can affect this and cause weight loss.
• Stomach Pain
  This may start as general discomfort.  Some people experience no pain at all and the level of pain can differ from person to person.
• Jaundice, Yellowing of the Skin or Eyes
  Jaundice can also cause dark pee, pale poo and itchy skin.  If you have jaundice, go to your GP or A&E straight away.
• Indigestion
  The pancreas plays an important role in breaking down food.  Pancreatic cancer may cause feeling full quickly when eating, a bloated tummy, lots of wind and/or burping.
• New Onset Diabetes
  Symptoms of diabetes include feeling very thirsty, peeing more often than usual especially at night, losing weight and feeling tired.
• Pale or Floating Stools
  This can be pale, oily stools that are difficult to flush down the toilet.  Pancreatic cancer may also cause diarrhoea and constipation.
• Loss of Appetite/Nausea
  Some people may experience a decrease in appetite and not feel like eating.  Some may also experience feeling sick or needing to vomit.
• Fatigue/Low Mood
  Fatigue is feeling very tired, even after resting.  Some people may also feel like their mood is low.If you experience two or more of these symptoms speak to your GP right away.  If you have a family history of pancreatic cancer and/or melanoma, breast, ovarian, colorectal cancer make sure to mention this at your appointment.

Age

The risk of pancreatic cancer increases as you age.  However it is important to note almost 30% of cases in Ireland are among those aged 64 and under.  Internationally, the rise of pancreatic cancer in a younger than usual population is being noted.

Smoking

Smoking may be responsible for 20-30% of pancreatic cancer cases. People who smoke are twice as likely to get pancreatic cancer than those who have never smoked.  Quitting smoking can reduce your risk.

Being Overweight or Obese

People who are obese have a 20% increased risk of developing pancreatic cancer.

Diabetes

People who have had diabetes for more than 5 years may be at increased risk.

Race

International statistics show an increased incidence of pancreatic cancer among Black patients. Ashkenazi Jews also have a higher incidence of pancreatic cancer, possibly because the BRCA gene mutation is more prevalent in this group.

Inherited Genetic Mutations and Syndromes

Approximately 10% of pancreatic cancers are hereditary.  The following inherited genetic mutations and family syndromes are associated with increased risk:

BRCA1 AND 2

PALB2

Lynch Syndrome

Familial Adenomatous Polyposis (FAP)

Familial Atypical Multiple Mole Melanoma (FAMMM)

Lynch Syndrome

Hereditary Pancreatitis

Peutz-Jeghers Syndrome

Cystic Fibrosis

Family History

Familial pancreatic cancer is pancreatic cancer that runs in families.

Signs that a family may be at higher risk are:

• families with two or more first degree relatives (parent, brother, sister or child) with pancreatic cancer.
• families with three or more second degree relatives with pancreatic cancer on the same side.

Surveillance for Individuals at Increased Risk in Ireland

A surveillance programme involves monitoring individuals who are at increased risk of pancreatic cancer due to inherited mutations or family history.  This typically involves attending scans between every 6 months to 1 year.

Talk to your health care provider if you believe you are eligible for surveillance.

Staging is used to describe the size of the cancer and if it has spread. Knowing the stage of your cancer helps the team figure out the best treatment plan and can give insight to your prognosis. After initial diagnosis, more tests and surgery may be needed to determine the correct stage.

Staging is based on:

• The primary tumour’s size and location
  • Importantly the multidisciplinary team review the location to see if the tumour touches off certain blood vessels
• Whether the cancer has spread to nearby lymph nodes and blood vessels
• Whether the cancer has spread to other, distant parts of the body

Stage 1

The tumour is only in the pancreas. Stage IA tumours are 2cm or less, and stage IB tumours are larger than 2 cm.

Stage 1 tumours are usually able to be removed by surgery.

Stage 2

This stage is considered locally advanced, which means it has spread outside the pancreas, to nearby blood vessels, to nearby lymph nodes or a mix of these, but has not spread to another organ.  In stage 2A, the tumour extends outside the pancreas but has not spread to major nearby arteries or lymph nodes. In stage IIB, the tumour may extend outside the pancreas and has spread to nearby lymph nodes but not major nearby arteries.

Stage 2 tumours are usually either able to be removed by surgery (resectable) or borderline resectable. Borderline resectable tumours may be able to be removed by surgery, especially if treatments are used to shrink the cancer.

Stage 3

The tumour has spread to major nearby arteries and may have spread to nearby lymph nodes. This stage is considered locally advanced, which means it has spread outside the pancreas, to nearby blood vessels, to nearby lymph nodes or a mix of these, but has not spread to another organ. Stage 3 tumours are usually unresectable, meaning they cannot be removed by surgery.

Stage 4

Stage IV means the cancer has spread (metastasized), to another part of the body. It often spreads to the liver, abdominal wall, lungs, distant lymph nodes or a combination of these. The tumours may be any size. Cancer at this stage is also called metastatic. The cancer cannot be removed by surgery.

Recurrence

Cancer may recur, or come back after treatment. It may come back to the pancreas or to another place in the body, such as the liver.  Recurrent cancer is often treated similarly to metastatic pancreatic cancer.

Staging can also be described as being resectable, borderline resectable or unresectable.

Resectable

Appears removeable with a clear margin (no cancer cells left). Usually treated with surgery.

Borderline Resectable

Appears removeable but with a high chance of some microscopic tumour left behind. Usually treated with chemotherapy and radiotherapy first, followed by surgery.

Unresectable

Appears not removeable with surgery. This is divided into two groups: locally advanced unresectable (tumour involves essential blood vessels near the pancreas) and metastatic unresectable (distant secondary tumours are present).