Pancreatic Cancer
What is Pancreatic Cancer?
Pancreatic cancer is a cancer of the pancreas. This is an uncommon but dangerous cancer.
What is the pancreas?
The pancreas is one of the major organs of the abdomen (“belly”). It is less well known compared to many other organs due to its hidden location. Its functions are to:
- Produce enzymes which help in digestion
- Produce hormones which regulate blood sugars (such as insulin) and bowel function
It is an elongated organ which runs from just to the right of the midline below the liver towards the left upper part of the abdomen. It is hidden far back behind all the stomach and bowels. In a way, the shape of the pancreas is like that of a walking cane. To really complicate matters, the head of the pancreas (= the “handle” of the cane) hooks around the major blood vessels supplying the bowel. Also in this region is the bile duct which drains the liver, as well as blood vessels supplying the liver. The tail (= the “end” of the cane) pushes right into the spleen.
The pancreas and its surrounding organs. Note that the head of the pancreas (on the right side of the patient) is closely applied to the small intestine and stomach, large blood vessels of the intestines (the blue and red structures) as well as the bile duct (the green structure). The tail of the pancreas on the other hand touches the inside aspect of the spleen.
What symptoms does it cause?
Due to its well hidden position, diagnosis of pancreatic cancer is often made in its late stages.
The type of symptoms that pancreatic cancer causes depends on its location as it causes symptoms by blocking or compressing surrounding structures:
- When it is situated in the tail of the pancreas (left side), it is often completely asymptomatic until a late stage;
- When it is situated in the head of the pancreas (right side), it can cause blockage of the bile duct causing jaundice. This duct normally drains bile from the liver, and if blocked, will cause jaundice. Jaundice is essentially bile going into the blood causing yellowing of tissues – most obvious usually in the whites of the eyes.
Non-specific symptoms of lethargy, poor appetite and weight loss may also occur.
How is it diagnosed?
Once the diagnosis of a “mass” (lump) in the pancreas is made, the next step usually would be to assess for whether there is evidence of spread. This is done by scans (often CT). With the appropriate CT scan performed of the pancreas, the surgeon can also assess whether or not the mass can be safely removed. If there were no spread and it can be removed, then one may proceed to surgery. In some cases, if further information is required, one may organise a needle biopsy performed using a special endoscope which has an ultrasound at its tip (Endoscopic Ultrasound).
In many cases however, a biopsy is not required for diagnosis before surgery as no biopsy can 100% guarantee that a mass is not cancerous.
How is pancreatic cancer treated?
Surgery to remove the tumour does provide the best possible chance of survival. However, surgery of the pancreas is major surgery with possibility for major complications and even death. The type of surgery performed will depend on the location of the tumour (see pancreatic resection).
If surgery cannot be performed, then the patient will usually be referred to a medical oncologist for consideration for chemotherapy. Sometimes, patients are referred for chemotherapy to “shrink” the tumour first before possible surgery. In advanced cases, the aim of treatment is directed at symptoms rather than tumour control. To have chemotherapy, a biopsy must first be done to confirm the diagnosis. This is usually performed using endoscopic ultrasound (a special endoscope which has an ultrasound at its tip) which will allow accurate biopsy with a needle.
Due to the above complexities and the many different treatments, pancreatic cancer is often managed by a multidisciplinary team approach. The surgeons at CESA all work within a Multi-Disciplinary Team environment.