Pancreatic cancer in the limelight

Pancreatic cancer has been brought to the forefront by the deaths of several prominent figures, including actor Alan Rickman, Apple co-founder Steve Jobs and actor Patrick Swayze. Almost 9,000 people are diagnosed with pancreatic cancer each year in the UK. It is the 10th most common cancer in the UK and affects men and women equally.

What is the pancreas?

The pancreas is a 15 cm long spongy, tube-shaped organ located in the back of the abdomen, behind the stomach. It has two major roles in the body: to make digestive juices (enzymes) that help the intestines break down food, and to produce hormones -- including insulin -- that regulate the body's use of sugars and starches. Pancreatic cancer occurs when malignant (cancerous) cells grow, divide and spread in the tissues of the pancreas.

Symptoms of pancreatic cancer

Pancreatic cancer is called a "silent" disease because symptoms tend not to show in the early stages. As the cancer grows and spreads, pain often develops in the upper abdomen and sometimes spreads to the back. The pain may become worse after the person eats or lies down. Other symptoms may include jaundice, nausea, loss of appetite, weight loss, fatigue and weakness. Shown here - jaundice causing yellowing of the skin and the white (conjunctiva) of the eyes.

Causes of pancreatic cancer

Although the exact cause of pancreatic cancer is not known, smoking is the main risk factor, with smokers two to three times more likely to develop the disease than non-smokers. Pancreatic cancer tends to affect people aged between 50 and 80, but can occur at any age. Chronic pancreatitis and long-term hepatitis B infection increase the risk of pancreatic cancer. Diabetes also increases the risk but the majority of those with diabetes will not develop pancreatic cancer. Family history of pancreatic cancer, long-term heavy alcohol consumption, and obesity also play a part.

Diagnosing pancreatic cancer

The challenge of this disease is finding it early. A doctor cannot see or feel a tumour during any routine examination. To help make the diagnosis, imaging tests are performed (such as an ultrasound or CT scan) to view pictures of the abdomen and determine the extent of the problem. The green region shown in this coloured CT scan appears to be cancer in the pancreas and liver. These studies also help determine the most appropriate treatment. The diagnosis comes from a biopsy, taking a tissue sample from the tumour, performed either with a needle through the skin or during an operation.

Treatment: Surgery

Surgery can cure the cancer if it has not spread outside the pancreas. Since side effects depend on the extent of the surgery, the tumour is removed leaving as much of the normal pancreas intact as possible. Unfortunately, with pancreatic cancer, the malignant cells usually have spread outside the pancreas at the point of diagnosis. Surgery still may be performed, even if the tumour is too large to remove. The surgery would involve procedures to help lessen some of the symptoms and prevent certain problems related to the size of the cancerous mass.

Treatment: Radiotherapy

Radiotherapy uses high-powered radiation to kill cancer cells. Radiotherapy is usually given five days a week for several weeks or months. This schedule helps to protect normal tissue by spreading out the total dose of radiation. Radiation is also being studied as a way to kill cancer cells that remain in the area after surgery. Radiotherapy can help relieve pain or digestive problems caused by large cancerous masses.

Treatment: Chemotherapy

Chemotherapy uses drugs to destroy cancer cells and stop them from growing or multiplying. Treatment may consist of just one drug or a combination of drugs. It may be given by mouth or by injection. The drugs enter the bloodstream and travel through the body, making chemotherapy a good choice for cancer that has spread. It is also useful after surgery to kill any cancer cells left behind.

Treatment: Targeted therapy

Newer medications have the ability to attack specific parts of the cancer cells. Targeted therapies appear to have fewer side effects than chemotherapy and are less harmful to normal cells. Targeted therapy is currently being studied for treatment of pancreatic cancer.

Image shows a colour enhanced, magnified view of a pancreatic cancer cell.

New cancer treatment: Immunotherapy

Also called biological therapy, immunotherapy aims to boost a person's immune system to fight disease. Immunotherapy is not yet available for pancreatic cancer, but is being actively researched, as well as vaccines that arm the immune system to attack cancer cells.

Treatment: Palliative care

Palliative therapy is used to ease symptoms and manage pain regardless of the stage of the disease or the need for other therapies. The goal of palliative care is to improve quality of life not just in the body, but in the mind and spirit. While palliative therapies are clearly appropriate at the very advanced stages of the disease, they are also helpful when given in tandem with other cancer treatments still working to fight the disease.

Getting support

Living with pancreatic cancer isn't easy. A support system is vital to help cope with the emotional and practical aspects of this aggressive disease. Many avenues for support exist within the local community and beyond, both for the patient and their family and friends. Several cancer organisations exist to help navigate the day-to-day treatment issues and the "big picture" concerns about the future.

Is prevention possible?

Although there's no one definite action you can take to prevent pancreatic cancer, start by avoiding the risk factors you can control.

• If you smoke, quit now.
• If you are overweight, lose weight to achieve a healthy weight
• Reduce consumption of processed meats

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