Introduction

Pancreatic cancer is caused by the abnormal and uncontrolled growth of cells in the pancreas a large gland that's part of the digestive system.

Around half of all new cases are diagnosed in people aged 75 or over. It's uncommonin people under 40 years of age.

This page covers:

Pancreatic cancer

Causes

Diagnosis

Treatment

Recovering from surgery

Symptoms of pancreatic cancer

In the early stages, a tumour in the pancreas doesn't usually cause any symptoms, which can make it difficult to diagnose.

It's important to remember that these symptoms can be caused by many different conditions, and aren't usually the result of cancer. But you should contact your GP if you're concerned, or if these symptoms start suddenly.

The first noticeable symptoms of pancreatic cancer are often:

• pain in the back or stomach area which may come and go at first and is often worse when you lie down or after you've 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 have pancreatic 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.

Cancer Research UK has more information on symptoms of endocrine pancreatic tumours .

Causes of pancreatic cancer

It's 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 50-80 years of age
• smoking aroundone in three casesis associated with using cigarettes, cigars or chewing tobacco
• having a history of certain health conditions such 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 person's 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:

• genetic risk factors for pancreatic cancer
• other possible risk factors for pancreatic cancer

Diagnosing pancreatic cancer

Your GP will first ask about your general health and carry out a physical examination. They may examine your tummy (abdomen) for a lump and to see whether your liver is enlarged.

They'll also check your skin and eyes for signs of jaundice andmay request a urine sample and blood test .

If your GP suspects pancreatic cancer, you'll 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 you're 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 endoscopy which allows close-up ultrasound pictures to be taken of your pancreas
• an endoscopic retrograde cholangio pancreatography (ERCP) a type of endoscopy which 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
• a laparoscopy 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 it's often not detected until the cancer is fairly advanced. If the tumour islarge, treating the cancer will be more difficult.

If you've been diagnosed with pancreatic cancer, your treatment will depend on the type and location of your cancer, and how far it's 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 isn't possible, treatment will focus on preventing the tumour growing and causing further harm to your body.

The three main treatments for pancreatic cancer are:

• surgery
• chemotherapy
• radiotherapy

Some types of pancreatic cancer only require one form of treatment, whereas others may require two types of treatment or a combination of all three.

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 won't be able to eat or drink straight away.

You'll gradually be able to sip fluids, before eventually being able to drink and eat more regularly. You may be referred to a dietitian, who can advise you about what foods you should eat following your operation.

After the tumour has been removed, you'll probably have a six-month course of chemotherapy , which greatly increases your chance of being cured. But because cancer of the pancreas is difficult to diagnose and treat, many people don't recover completely.

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.