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Pancreatic Cancer Awareness Month: Combatting the ‘Silent Cancer’

The 1st of November marks Pancreatic Cancer Action Day, the official start of Pancreatic Cancer Awareness Month. Affecting over 8,000 people in the UK each year, Pancreatic cancer has one of the highest incident-to-mortality rates of any disease, however, despite its prevalence, its symptoms remain poorly understood, often left undetected until the condition becomes too advanced to receive the most effective treatment.

The high incident-to-mortality rate of pancreatic cancer is largely down to the fact that symptoms are minimal in the early stages and the disease progresses quickly, meaning it is often undetected until it has spread to other areas of the body, a characteristic that has earnt the disease the title of the “silent cancer”.  

Dr Nick Maisey, Consultant Oncologist at London Bridge Hospital, expands: “Many cases of pancreatic cancer present with vague, non-specific symptoms such as weight loss, abdominal discomfort or a change in bowel habit. Less commonly, patients can develop more specific symptoms such as painless jaundice (a yellowing of the skin and whites of the eyes) or pale coloured stools and dark urine. If patients have any unexplained persistent symptoms, it is sensible to seek medical advice as early as possible as there is a higher chance of a cure when pancreatic cancer is detected at an early stage”. 

The most common form of pancreatic cancer, responsible for over 90% of cases and usually asymptomatic until it has metastasized, is known as adenocarcinoma and is, as Dr Maisey explains, “derived from the glandular cells within the pancreas. There are rarer types of cancer that occur in the pancreas, the most common group being so-called ‘neuroendocrine’ cancers. These cancers can produce excess amounts of gut hormones and so can produce unusual symptoms such as high or low blood sugar, symptoms of stomach ulcers, and diarrhoea.” Due to the prevalent symptoms produced by this more unusual type of pancreatic cancer, this form of the disease is often detected before it has a chance to spread and thus the survival rate is higher than with the more common adenocarcinoma.

While the exact causes of pancreatic cancer are not known, major risk factors include smoking, which is thought to cause nearly 1 in 3 of all pancreatic cancers, and obesity, to which 12% of pancreatic cancers in the UK can be attributed. Dr Maisey further explains: “It is believed that improving your lifestyle factors can reduce the chance of developing pancreatic cancer, and in particular there appear to be links with smoking and obesity. Some cases can be linked with other medical conditions such as chronic pancreatitis and diabetes, but most cases of the disease are sporadic, i.e. they occur without any obvious causal factors”.  

The treatment options available for pancreatic cancer depend greatly on the stage at which the cancer is detected. These include:

 
  • Surgery to remove the cancer
  • Chemotherapy, or a combination of chemotherapy and radiotherapy
  • Surgical bypass of the cancer, for example to allow your stomach to empty properly if it is being blocked by the tumour
  • Insertion of an expandable metal or plastic stent in the bile duct (often to relieve jaundice symptoms)
  • Symptom control and optimisation of quality of life

Dr Maisey expands: “If the cancer is detected at an early stage (i.e. the cancer is localised to the pancreas gland itself) it can be possible to remove the cancer with an operation. However, if the cancer has spread to other organs in the body, or if it is too large for surgery, chemotherapy is often used to treat patients. While it is not always possible to cure the disease, in some situations a combination of chemotherapy and radiotherapy is used to control the cancer and manage the condition.”

With the number of diagnoses steadily rising in the UK and survival rates remaining so low, it is vital further research is conducted and awareness is increased to detect pancreatic cancer at a stage where it is still treatable.