MEDICAL SERVICES

Pancreatic cancer is a serious illness. If you've been told you have this cancer, you'll probably feel anxious about what lies ahead. If the cancer is diagnosed at an early stage, it may be possible to have surgery to remove the cancer. If your cancer is more advanced, there are treatments that can slow the growth of the cancer and help you live longer.

What is pancreatic cancer?

Your pancreas lies just behind your stomach. It's a gland that helps you break down the food you eat. It also helps you use the energy you get from food.

Usually, cells in your body grow and die in an orderly way. But if you have pancreatic cancer, some of the cells start to grow out of control. They form a lump called a tumour. Cells from the tumour can break off, travel around your body, and cause cancers in other locations (called metastases).

Doctors can't explain why some people get pancreatic cancer and others don't. But it is more common in older people and in people who smoke. You may also be more likely to get pancreatic cancer if other family members have had this cancer.

What are the symptoms?

In the early stages, pancreatic cancer usually doesn't cause any problems, although some people do get vague symptoms, such as a general feeling of being unwell (malaise) or weight loss. Most people first get symptoms when their cancer grows and spreads. For example, if the tumour blocks the flow of bile from your liver, you might get yellow skin (jaundice), dark urine, pale stools, and itching.

As the tumour grows, you may get pain in your back or abdomen. You may also feel very tired, lose your appetite, and lose weight. If the tumour blocks the tube from your stomach to your bowels, you may feel sick and vomit.

These symptoms can be caused by other illnesses that are less serious than pancreatic cancer. But it's important not to ignore them. The sooner your doctor checks them out, the more quickly you can get treatment for whatever is causing them.

Pancreatic cancer

Pancreatic cancer isn't always easy to diagnose. The first doctor you see is likely to be your usual doctor. If your doctor thinks that your symptoms could be due to pancreatic cancer, you'll be referred to specialist doctors for tests to be certain.

The doctors will find out whether you have pancreatic cancer based on your symptoms, a physical examination, blood tests, and scans to look at your internal organs. They may also need to take a small sample of cells from your pancreas (a biopsy). There are different ways to do a biopsy, and your doctors will discuss options with you. The sample of cells from your biopsy will be sent to a laboratory where it will be tested for cancer cells.

If doctors are fairly sure from other tests that you have pancreatic cancer and they want to operate to remove it, you may not need a biopsy. Your doctors will look at the tumour and test it for cancer during the operation.

What treatments work?

Your treatment will depend on the stage of your pancreatic cancer. The stage of cancer describes how far the cancer has spread. Early stage cancers have not spread outside the pancreas, or have not spread very far. Later stage cancers have spread to other parts of your body.

Surgery to remove your cancer

If you have early stage pancreatic cancer, you may be able to have surgery to remove part, or all, of your pancreas.

There are different ways of doing the operation depending on where in your pancreas the cancer is. The most common operation is to remove the part of the pancreas called the 'head'. The surgeon will also remove parts of other organs nearby, such as your duodenum (the first part of your small bowel).

Your doctor will be able to tell you if your cancer is suitable for surgery and how this is likely to help you. Unfortunately, surgery will not work for everyone who is diagnosed with early stage cancer. Some cancer cells may have already gone into your bloodstream before your surgery, but have not shown up in tests. These cells may have travelled around your body and caused cancers in other locations. Surgery on the pancreas cannot get rid of these cancers.

Surgery to remove pancreatic cancer is a big operation. You'll need a general anaesthetic to keep you asleep during surgery. And you're likely to need a couple of weeks in hospital to recover.

Problems (complications) can happen during or after your operation. For example, it's possible for digestive juices from the pancreas to leak into your body. Other problems include bleeding, getting an infection in the wound, and inflammation. Complications may be less likely if you have surgery in a specialist centre that carries out lots of operations for pancreatic cancer.

Pancreatic cancer

Chemotherapy, radiotherapy, and chemoradiotherapy

Chemotherapy uses medicines to kill cancer cells. You'll probably be given these medicines directly into your bloodstream through a tube inserted into a vein (an intravenous infusion). Radiotherapy kills cancer cells by directing high-energy x-rays into parts of your body where there may be cancer. When these treatments are combined, it is called chemoradiotherapy.

These treatments are occasionally used before surgery to shrink the cancer so it is easier to remove. More commonly, they are used after surgery to help kill any cancer cells that were left behind by the operation.

These treatments are also often offered to people with more advanced cancer who aren't able to have surgery. By killing cancer cells and slowing down the growth of the cancer, these treatments can help people live longer. They can also help improve the symptoms caused by the cancer.

All of these treatments can cause side effects, which some people find difficult to cope with. You and your doctors will discuss the possible benefits and risks of treatment so you can decide what approach is right for you.

Other treatments to help with symptoms

Surgery to remove your cancer, chemotherapy, and radiotherapy can all help to improve your symptoms. Your doctor may recommend the following treatments as well.

Medicines to help with pain

People with pancreatic cancer sometimes get pain in their abdomen, in their back, or in both their abdomen and back. If you have pain, be sure to discuss this with your doctors. There are lots of pain medicines that can help, ranging from over-the-counter options to stronger prescription medicines. If one medicine doesn't help enough, your doctor can recommend other options.

Medicines to help with digestion

Your pancreas helps you digest food, but it may not be able to do its job very well if you have pancreatic cancer, or if you've had surgery on your pancreas to remove your cancer. To help, doctors recommend taking pancreatic enzyme supplements. These medicines can improve your digestion and help you maintain your weight. Your doctors will also monitor your diet and may recommend taking other supplements as well.

Treatments to help with blockages

Some common symptoms of pancreatic cancer are caused by the cancer blocking the common bile duct. This stops bile flowing from your liver to your small bowel. You may get jaundice, itching, nausea, and an uncomfortable feeling in your bowels if this happens.

If you are able to have surgery to remove your cancer, this should remove the blockage. However, if you can't have this surgery, or can't have it straight away, your doctors may instead recommend having a small tube (called a stent) fitted inside the duct to open it up.

Pancreatic cancer

Another way doctors can relieve the blockage to the bile duct is to cut the duct just above the blockage and rejoin the duct to your small bowel. After your operation, bile will bypass all or part of your bile duct and drain into your bowel. This is called a biliary bypass.

Taking part in clinical trials

Doctors are still learning what treatments work best for pancreatic cancer. There are many studies under way testing new treatments.

The only way you can normally get one of these treatments is to take part in a clinical trial. Your doctor will be able to tell you if there are trials going on in your area that might be suitable for you. But bear in mind that you may not get the new treatment when you take part in a clinical trial. Studies usually compare a new treatment with a standard treatment. Nobody knows before the study which treatment they will get or whether one might work better than the other.

What will happen to me?

It’s not possible to say exactly what will happen to you, because pancreatic cancer affects everyone differently. There are striking success stories, and some people do live for many years after they discover they have pancreatic cancer. However, most do not.

What happens to you depends to a large extent on how far your cancer has spread when it’s diagnosed. If doctors can remove the tumour by surgery, they may be able to cure you. But in most people the cancer has spread by the time doctors find it. Treatments won’t cure your cancer, but they can help shrink your tumour, slow down the progression of your cancer, and improve your symptoms.

 

QUESTIONS TO ASK YOUR DOCTOR

 

Pancreas cancer: questions to ask your doctor

Being diagnosed with a serious illness such as pancreas cancer can be a shock. You may find it hard to think of everything you want to ask your doctor.

It might help to make a list of questions before your appointment. You could also take notes during your visit, or bring a close friend or relative with you to ask questions and jot down information.

Here are some questions you may want to ask.

General questions

• How advanced is my disease? What is the stage of my cancer?

• Has my cancer spread?

• Do I need more tests to check if it has spread?

• What treatment choices do I have?

• Can you operate?

• Will you be able to help with my symptoms (such as pain)?

• What help or support can I get to help me cope?

• Can I get help with my diet and exercise?

Questions about surgery

• Why do you think I should (or shouldn’t) have surgery?

• Will surgery mean I live longer?

• What kind of operation do you recommend?

• What are the risks of surgery?

• Where would I go to have surgery? Is it a specialist centre?

• How will I feel after the operation?

• Will it be painful afterwards? And how can this be treated?

Pancreas cancer: questions to ask your doctor

• Will I need to change my diet?

• How long will I be in hospital?

• When will I get back to my normal activities?

Questions about medicines and other treatments

• What treatments do you recommend?

• Why do I need these treatments? What are the benefits?

• Will they help me live longer or will they just help my symptoms?

• What are the side effects of these treatments?

• Can the side effects be treated?

• How should I expect to feel during treatment?

• How will treatment affect my normal activities?

• How long will treatment go on?

• Will I need to be treated in hospital or can I have treatment as an outpatient?

• How will I know if the treatment is working?

• Are there any clinical trials I could join?