Pancreatic cancer

What is pancreatic cancer?

Pancreatic cancer is a cancer that starts in the pancreas. The pancreas is part of the digestive system. It makes digestive juices and various hormones, including insulin.

About 9,600 people are diagnosed with cancer of the pancreas in the UK each year.

Types of pancreatic cancer

Pancreatic cancer may be described by:

where it is in the pancreas – 6 out of 10 pancreatic cancers start in the head of the pancreas
the type of cell it started from – we have more information about cell types and pancreatic cancer.

This information is about the most common types of pancreatic cancer which start in exocrine cells. We have information about cancers which sometimes start in the pancreas:

Symptoms of pancreatic cancer

Pancreatic cancer may not cause symptoms for a long time. Some people may only have one symptom.

Some possible symptoms are:

Pain in the upper part of the tummy (abdomen) that sometimes spreads out into the back
Signs of jaundice such as yellowing of the skin and the whites of the eyes or itchy skin
Unexplained weight loss.

Most people with these symptoms will not have pancreatic cancer. They may be caused by other more common conditions. But if you have any symptoms, it is important to get them checked by your doctor.

We have more detailed information about pancreatic cancer symptoms.

Causes and risk factors of pancreatic cancer

Doctors do not know what causes pancreatic cancer. But things called risk factors can increase the chance of a person developing it. For example, being older is a risk factor. Most people who develop pancreatic cancer are 65 or over.

Some other risk factors include, smoking, drinking a lot of alcohol regularly and having had a previous cancer.

We have more information about the causes and risk factors of pancreatic cancer.

Tests and diagnosis of pancreatic cancer

If you have symptoms, you usually begin by seeing your GP. If your GP thinks cancer could be causing your symptoms, they will refer you to hospital. If you are aged 60 or older, they may refer you urgently. They may arrange an urgent CT scan or ultrasound within 2 weeks. If you are 40 or older and have jaundice, you should see a specialist within 2 weeks.

Some people are diagnosed with pancreatic cancer after being admitted to hospital because a symptoms is making them unwell.

At hospital you will have tests and get specialist advice and treatment. To diagnose pancreatic cancer, doctors often use information from several tests, along with your symptoms and medical history.

If you are diagnosed with pancreatic cancer, you may need more tests. These are to find out the size and position of the cancer. They will also let doctors know whether it has spread to other parts of the body.

Blood tests

You may have blood tests:

General blood tests

You will have blood tests to check your general health and how well your liver and kidneys are working.
Tumour marker blood tests

You may have a blood test to check for tumour markers. These are chemicals that many pancreatic cancers produce.

Other tests

You may have some of the following tests:

Ultrasound scan

An ultrasound uses sound waves to make a picture of internal organs, like the pancreas and liver.
CT scan

A CT scan takes a series of x-rays, which build up a 3D picture of the inside of the body.
MRI scan

An MRI scan uses magnetism to build up a detailed picture of the inside of your body.
Magnetic resonance cholangio-pancreatography (MRCP)

An MRCP magnetic and radio waves to get a detailed picture of your pancreas, bile ducts and liver. It is a type of MRI scan, but is not available in every hospital. The scan shows any narrowing or blockages in the pancreatic ducts or bile ducts.
PET-CT scan

PET-CT scans give more detailed information about the part of the body being scanned.
Endoscopic ultrasound

An endoscopic ultrasound is when they use a thin flexible tube (endoscope) to look down into your stomach at the pancreas and other organs. It can be used to take samples of tissue (biopsy) or see how far a cancer has spread.
Endoscopic retrograde cholangio-pancreatography (ERCP)

An ERCP is when they pass a thin flexible tube (endoscope) down into the first part of the small bowel (duodenum). They look at the pancreas and take samples of tissue (biopsies).

Biopsy

Your doctor may want to remove a small piece of tissue from the area (biopsy). They look a the sample under a microscope to check for cancer cells. There are different ways of doing a biopsy.

Not everyone needs a biopsy. Your doctor will explain if it would be helpful in your situation.

We have more information on having a biopsy for pancreatic cancer.

Surgery to look inside the tummy

If other tests have not confirmed a diagnosis, you may have a small operation to look inside the tummy at the pancreas. This is called a laparoscopy.

The surgeon puts a thin tube called a laparoscopy through a small cut they make in your tummy. You have this done under a general anaesthetic.

Rarely if a laparoscopy is not suitable you may have a bigger operation called a laparotomy instead. This is when the surgeon makes a larger cut in the tummy so they can see the pancreas.

Staging and grading of pancreatic cancer

The results of your tests help your doctors find out more about the size and position of the cancer and whether it has spread. This is called staging.

A doctor decides the grade of the cancer by how the cancer cells look under the microscope. This gives an idea of how quickly the cancer might grow or spread.

Knowing the stage and grade of pancreatic cancer helps doctors decide the best treatment for you.

Treatment for pancreatic cancer

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

Your cancer doctor or specialist nurse will explain the different treatments and their side effects. They will also talk to you about certain things to think about when making treatment decisions.

We have more information about how different treatments are used for pancreatic cancer.

Treatment for pancreatic cancer may include:

Surgery

If you have early stages of pancreatic cancer, you may have surgery to remove all or part of the pancreas. Surgery may also be used to relieve symptoms.
Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It is the most common treatment for pancreatic cancer. You may have it to control the cancer and its symptoms. Some people who have surgery may have chemotherapy to try to shrink the cancer first. Or chemotherapy may be given after surgery.
Treatment for symptoms

Most people with pancreatic cancer have treatments to control symptoms and make them feel more comfortable. This is an important part of your treatment and care. It's sometimes called supportive care.
Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells. It is not often used to treat pancreatic cancer. It may be given with chemotherapy (chemoradiation) to shrink a cancer before surgery. It can also be given if the cancer has just started to spread but surgery isn't possible. It is also used to manage symptoms such as pain.

Research is going on to find more effective treatments for pancreatic cancer.

You may have some treatments as part of a clinical trial. Or you may be invited to take part in a trial of a new drug or treatment.

Coping with advanced cancer

For many people it will not be possible to cure pancreatic cancer. But your doctor and nurse will talk to you about treatment, such as chemotherapy, that may control it and help you to live for longer. There are also different ways that symptoms caused by the cancer can be treated or managed. This is called supportive care. Making sure you have the best quality of life possible is an important part of your treatment and care.

Finding out you have advanced cancer can be difficult to cope with. You may feel shocked and find it hard to understand or accept. You may have questions about what to expect. Your doctor and specialist nurse are there to help.

We have more information about coping with advanced cancer.

After pancreatic cancer treatment

After your treatment, you will have regular follow-up appointments. You will also have follow-up appointments if you are having supportive care. You may keep going to the hospital for these appointments, or you may go to your GP. Sharing the appointments between the GP and hospital is sometimes called a shared care agreement.

You may continue to have regular scans and blood tests, including CA 19-9 tests. Tell your doctor or specialist nurse as soon as possible if you have any problems or new symptoms between appointments.

About our information

References

Below is a sample of the sources used in our pancreatic cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

British Society of Gastroenterology. Guidelines for the management of patients with pancreatic cancer peri-ampullary and ampullary carcinomas. 2005.

European Society for Medial Oncology. Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2015. 26 (Supplement 5): v56 to v68.

Fernandez-del Castillo. Clinical manifestations, diagnosis, and staging of exocrine pancreatic cancer. UpToDate online. Jan 2018.

Fernandez-del Castillo C, et al. Supportive care of the patient with locally advanced or metastatic exocrine pancreatic cancer. UpToDate online. Feb 2017.

Winter JM, et al. Cancer of the pancreas, DeVita Hellman and Rosenberg’s Cancer: Principles and Practice of Oncology (10th edition). Lippincott Williams and Wilkins. 2016.

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.