The pancreas is a narrow gland that lies deep in the abdomen between the stomach and the spine. It is about 15cm long and is made up of the head, body and tail. The head lies next to the first part of the small intestine (duodenum) and the lower end of the bile duct. The pancreas has two key functions as part of the digestive system. It produces the hormone insulin that controls the level of sugar in the body, and produces pancreatic enzymes that aid in the chemical breakdown of food so nutrients can be absorbed in the intestine. These enzymes flow down the pancreatic duct into the small intestine. More than 90% of pancreatic cancers start from the cells in the inner lining of the pancreatic ducts. These are called adenocarcinomas. The most common site is in the head of the pancreas. The other types of pancreatic cancer are much less common and include:
Pancreatic cancer often causes obstruction of the lower end of the bile duct (which goes though the head of the pancreas), which causes jaundice, itchiness and pale coloured stools. Other symptoms include loss of appetite, weight loss, pain, and fatigue. These symptoms can also occur in other non-cancerous conditions. Pancreatic cancer is usually diagnosed with radiology tests such as ultrasound, CT scan or MRI scan. A biopsy is sometimes needed.
If diagnosed early, pancreatic cancer can be removed by surgery. However, if the cancer has spread from the pancreas to outlying tissues and organs, surgery to remove the pancreas may not be possible. The main treatment for pancreatic cancer that is diagnosed at an early stage is surgery. Chemotherapy and radiotherapy can also be used, sometimes in combination. If the cancer is obstructing the bile duct and cannot be removed surgically, a stent (plastic or metal tube) can be inserted to maintain the flow of bile and prevent jaundice. Chemotherapy can also be used if the cancer has spread to other parts of the body. The prognosis after treatment of pancreatic cancer depends on the stage and the treatment given. If the cancer is completely removable with surgery, cure is possible. If surgical removal is not possible, the symptoms caused by the cancer can often be alleviated.
More than 630 people in New Zealand are diagnosed with pancreatic cancer each year and rates are rising 10 to 15% each year. This is one of the deadliest forms of cancer with just a 12% 5-year survival rate and by 2025 it is expected to become the 4 largest cause of cancer deaths in New Zealand.
Most people with pancreatic cancer do not have a family history of the disease. However, about one in 10 people who develops pancreatic cancer has a faulty gene that can run in families. You may have an inherited family risk if you have two or more first-degree relatives affected by pancreatic cancer, or a history of an inherited syndrome.
The "degree of relationship" describes how many genes are shared between two blood relatives. First-degree relatives, for example, your parents, siblings or children, share about half their genes with you.
Some inherited syndromes that may increase the risk of pancreatic cancer include Peutz-Jeghers syndrome, the familial breast cancer genes (BRCA1 and BRCA2), familial atypical multiple mole melanoma (FAMMM) syndrome, Lynch syndrome and hereditary pancreatitis. Some pancreatic NETs are caused by a rare inherited syndrome, such as multiple endocrine neoplasia type 1 (MEN1) or neurofibromatosis.