Pancreatic cancer is a type of cancer that starts in the tissue of the pancreas. The pancreas is an essential organ located behind the stomach. It helps produce enzymes that your body needs to digest food. It also helps produce two hormones; insulin and glucagon. These hormones are necessary to control the metabolism of glucose in the body.

There are two main types of pancreatic cancer:

• Exocrine tumours: Usually start in the cells that line a part of the pancreas known as the pancreatic duct. Most cases of pancreatic cancer involve exocrine tumours and are adenocarcinomas on histology¹.
• Pancreatic Neuroendocrine Tumours (NETs): Can occur in any part of the pancreas and start in the endocrine cells responsible for releasing hormones. A minority of cases involve neuroendocrine tumours.

Pancreatic cancer may not cause symptoms in the early stages. As a result, pancreatic cancer is often diagnosed after it has spread. Symptoms may include:

• unexplained weight loss
• loss of appetite
• nausea and vomiting
• itchy skin
• lower back or abdominal pain
• jaundice (yellowy skin and eyes)
• dark urine
• ongoing diarrhoea or constipation
• blurred vision
• excessive thirst
• increased urination
• diabetes during later stages

The above symptoms may be related to other conditions and don’t mean you have pancreatic cancer. But they are signs you should see your doctor for a check-up.

There is no clear reason for pancreatic cancer. However, some factors appear to increase the risk. These include:

• smoking²
• excessive alcohol consumption³
• family history of pancreatic cancer⁴
• diabetes or family history of diabetes⁵
• workplace exposure to certain chemicals, such as chromium and nickel and their compounds⁶
•  being obese⁷

Your GP will probably refer you to a specialist if they are concerned about your symptoms and risk factors for pancreatic cancer. Tests to diagnose pancreatic cancer may include:

• Endoscopic ultrasound – An endoscope with an ultrasound probe is passed through your mouth down into your abdomen. It uses sound waves to create detailed images of your pancreas
• Biopsy – If unusual tissue is detected during the endoscopic ultrasound, a small amount of tissue will be removed so it can be examined under the microscope. The biopsy will usually be done at the same time as the endoscopy. Sometimes it’s done later with a needle
• Imaging tests – These might include using a type of MRI scan called a MRCP and a PET-CT scan to create detailed images of the inside of the pancreas and adjacent structures
• Blood tests – Pancreatic cancer can sometimes be detected by testing for specific proteins in your blood called tumour markers

If you are diagnosed with pancreatic cancer, your doctor will give you details about how far your cancer has progressed. Pancreatic cancer is commonly staged with the TNM system, which is used to show how advanced the cancer is. These letters stand for:

• Tumour: Your doctors will measure the size of the tumour and how far it has grown into the pancreas and adjacent tissues
• Nodes: Refers to whether cancer has spread to lymph nodes
• Metastasis: Refers to whether cancer has spread to other parts of the body

Treatment for pancreatic cancer will depend on how advanced it is. Treatments that may be offered include:

• chemotherapy
• endoscopic treatment
• radiation therapy
• surgery

Whether you experience side effects and how severe they are, depends on the type and dose of chemotherapy treatment you are given and your reaction from one treatment cycle to the next. Most side effects are short-term and can be managed. These may include:

• fatigue
• nausea or vomiting
• constipation or diarrhoea
• hair loss
• easily bruising or bleeding
• weight changes
• skin changes
• mood changes
• sores and pain around the mouth

These symptoms tend to improve gradually once treatment stops. Talk to your doctor or nurse if you feel upset or anxious about how long treatment is taking or the impact of side effects.

• Get as much rest as possible
• Aim for a wholefood, varied diet, but we also encourage you to eat foods that interest you rather than what you think you should eat
• Appetite changes are common, and you may experience taste changes or nausea. Help manage this by eating small, frequent snacks and avoiding smells that make you nauseous
• Drink lots of water
• Reach out to support groups and others who have had chemotherapy
• Ask your team about topical treatments for your skin if it becomes irritated
• Stay out of the sun as much as possible throughout your treatment
• Record your side effects in a diary or journal
• Take some gentle exercise, such as walking, if you feel up to it. Light to moderate exercise can reduce treatment-related fatigue and improve your mood. Plan your exercise for times in the day when you know you have more energy
• It is important to acknowledge when you are fatigued and rest when you need to.
• Ask for and accept help from family, friends and neighbours
• Be open with employers about your treatment and discuss flexible working options if you need them

General side effects include:

• sore throat
  
• tiredness
• bloating from air introduced during the procedure
• pancreatitis (inflammation of the pancreas) 

General side effects include:

• soreness and swelling around the treatment area
• tiredness and lethargy for a few weeks after you finish

Specific side effects (depending on the area being treated):

• diarrhoea
  
• bloating
• nausea and vomiting

Most of these side effects will ease soon after treatment is finished. Your team will discuss any long-term considerations with you, depending on the tumour type

General side effects include:

• swelling and pain
  
• diarrhoea or constipation
• nausea
• tiredness
• loss of appetite
• sometimes the loss of insulin producing cells from the pancreas can cause diabetes

Other pancreatic cancer  information, resources and support services are available to assist you during your cancer journey. These include:

Cancer Council Australia

13 11 20

cancer.org.au

Australian Cancer Research Foundation

02 9223 7833

acrf.com.au

Pancare

1300 881 698

pancare.org.au

References

1. Epidemiology of Pancreatic Cancer: Global Trends, Etiology and Risk Factors. World J Oncol. 2019 Feb; 10(1): 10–27. Published online 2019 Feb 26. doi: 10.14740/wjon1166. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6396775/
   
2. Cigarette Smoking and Pancreatic Cancer: A Pooled Analysis From the Pancreatic Cancer Cohort Consortium. Am J Epidemiol. 2009 Aug 15; 170(4): 403–413. Published online 2009 Jun 26. doi: 10.1093/aje/kwp134. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2733861/
3. Association between Alcohol Consumption and Pancreatic Cancer Risk: A Case-Control Study. PLoS One. 2015; 10(4): e0124489. Published online 2015 Apr9. doi: 10.1371/journal.pone.0124489. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391718/#:~:text=A%20pooled%20analysis%20of%2014,drinks%20per%20day%20%5B19%5D.
4. Family history of cancer and risk of Pancreatic Cancer: A Pooled Analysis from the Pancreatic Cancer Cohort Consortium (PanScan). Int J Cancer. Author manuscript; available in PMC 2011 Sep 1. Published in final edited form as: Int J Cancer. 2010 Sep 1; 127(6): 1421–1428. doi: 10.1002/ijc.25148. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2926939/
5. Family History of Diabetes and Pancreatic Cancer as Risk Factors for Pancreatic Cancer: The PACIFIC Study. Cancer Epidemiol Biomarkers Prev. 2013 Oct; 22(10): 10.1158/1055-9965.EPI-13-0518. Published online 2013 Aug 21. doi: 10.1158/1055-9965.EPI-13-0518. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808252/#:~:text=In%20conclusion%2C%20this%20population%2Dbased,diabetes%20(OR%3A%201.95).
6. Occupational exposures and pancreatic cancer: a meta-analysis. https://oem.bmj.com/content/57/5/316
7. Obesity and Pancreatic Cancer: Overview of Epidemiology and Potential Prevention by Weight Loss. Pancreas. 2018 Feb; 47(2): 158–162. doi:10.1097/MPA.0000000000000974. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018023/#:~:text=Large%20epidemiological%20studies%20have%20shown%20the%20link%20between%20obesity%20and%20pancreatic%20cancer.&text=A%20large%20population%2Dbased%20case,increased%20risk%20of%20pancreatic%20cancer.