Pancreatic cancer: symptoms, diagnosis, and treatment

What is pancreatic cancer?

The pancreas is a small organ located inside the abdomen and behind the stomach. It helps to digest food by creating juices known as enzymes. The main function of these enzymes is to break down food elements, such as fats, sugars, and starches. The pancreas also releases hormones - particularly insulin, which is important for regulating the amount of glucose (sugar) in your bloodstream. 

Pancreatic cancer develops when cells in the pancreas begin to grow and multiply uncontrollably. These abnormal cells can develop into solid tumours or tissue masses and eventually spread to other areas of the body.

There are two major types of pancreatic cancer:

1. Exocrine Pancreatic Cancer

More than 95% of all pancreatic cancers develop from cells in the exocrine gland and pancreatic ducts. The function of the exocrine gland is to create enzymes for digestion.

Exocrine pancreatic cancer is further classified into the following types:

• Adenocarcinoma - develops in the lining of the ducts inside the pancreas.
• Squamous Cell Carcinoma - also develops inside the ducts of the pancreas and is made up of squamous cells.
• Adenosquamous Carcinoma - a more aggressive sub-type of exocrine pancreatic cancer with elements of both squamous cell carcinoma and ductal adenocarcinoma.
• Colloid Carcinoma - develops from a cyst known as an intraductal papillary mucinous neoplasm (IPMN). This type of cancer is easier to treat, mainly because the tumours are confined to a substance known as mucin.

2. Neuroendocrine Pancreatic Cancer

Develops when pancreatic neuroendocrine tumours (NETs) are formed inside the endocrine gland. This type of pancreatic cancer is rare, accounting for less than 5% of cases worldwide.

Pancreatic cancer symptoms

One of the major reasons pancreatic cancer remains undiagnosed in the early stages is because its symptoms are difficult to recognise and easy to overlook. 

The symptoms of pancreatic cancer can be vague, and so an accurate medical diagnosis is often delayed. See your GP or whānau doctor for a thorough checkup, particularly if the following symptoms persist for more than two weeks:

• Abdominal pain
• Unexplained weight loss
• Tiredness or fatigue
• Loss of appetite
• Jaundice
• Dark-coloured urine
• Light-coloured stools
• Unexplained vomiting or nausea
• Blood clots.

The symptoms of pancreatic cancer in women and men are similar. However, as pancreatic tumours grow, the abdomen can distend. This cancer of the pancreas symptom is one that women often notice first.

Pancreatic cancer diagnosis

If your doctor suspects that you have pancreatic cancer, he might suggest the following tests:

• Endoscopic ultrasound (EUS) - a thin telescope is inserted through the throat and an ultrasound is performed. An EUS can provide high-resolution visuals that guide doctors on their next course of action.
• CT scan - a computer tomography (CT) scan generates 2D x-ray images of various parts of your body.
• MRI - using iv (intravenous) contrast, an MRI (magnetic resonance image) uses magnetic force to provide 2D photos of the body organs. For better visibility, doctors may recommend both a CT scan and an MRI.
• Laparoscopy - a light and camera are fed through an incision in the abdomen for doctors to examine the pancreas or surrounding organs.
• Tissue Biopsy - the removal of tissue for microscopic examination, often performed via fine-needle aspiration or laparoscopy.

Pancreatic cancer stages

Once a diagnosis has been made, your cancer will be classified according to its size and spread. This is known as staging. Doctors also use this information to guide the treatment process.

• Stage I - cancer is limited to the pancreas and hasn’t spread to nearby organs, lymph nodes, blood vessels, or tissues.
• Stage II - cancerous tumours have spread to nearby organs or tissues.
• Stage III - cancer has spread to the blood vessels surrounding the pancreas and possibly to nearby lymph nodes.
• Stage IV - cancer has spread to other parts of the body, such as the lungs, liver, or intestines.

Pancreatic Cancer Grouping

Pancreatic cancer patients are grouped into one of the following three categories:

1. Local or Resectable Disease - Stage I and II pancreatic cancer patients. The cancer can be cured using an appropriate medical procedure, such as surgery.
2. Locally Advanced or Unresectable Disease - Stage III patients may have locally advanced disease. The cancer cannot be removed entirely, though certain treatments can contain its spread and improve quality of life.
3. Metastatic Disease - Stage IV patients might use chemotherapy and other treatments to control the cancer. The goal is to prevent or relieve pancreatic cancer symptoms and extend life.

Pancreatic cancer risk factors

Certain risk factors heighten your chance of developing pancreatic cancer. Bear in mind that even if you identify with the following factors, you won’t necessarily experience the disease.

Common risk factors include:

• Family history of pancreatic cancer
• Smoking
• Excessive drinking
• Obesity
• Diabetes.

Treatment options for pancreatic cancer

Depending on your age, health status, and the stage of your cancer, the doctor will suggest one or more of the following treatment options:

Surgery

The decision for surgery is usually influenced by the location of the cancer and its stage. Surgery involves removing all (pancreatectomy) or some parts of the pancreas.

Surgery does not necessarily cure cancer, especially if it has spread to other organs. Surgery only removes the original tumour, which is why it’s not advised for patients with advanced-stage cancer.

Whipple Procedure

Involves the removal of some parts of the stomach, small intestine, pancreas, lymph nodes, and gallbladder. The Whipple procedure is utilised when pancreatic cancer is limited to the head of the pancreas.

Chemotherapy

Eliminates cancerous tumours using drugs that can, in some cases, prevent further growth of cancerous cells in the organ. Your doctor might recommend chemotherapy in combination with other treatments.

Radiation Therapy

X-rays and/or other powerful energy beams are used to kill cancerous cells. Radiation therapy is usually recommended when cancer has spread to other parts of the body.

Immunotherapy

Often used with other treatment options, like chemotherapy, immunotherapy drugs trigger the body’s own defences to fight cancer, either by boosting the immune system or making the cancer cells more obvious targets.

Targeted Therapy

Specifically targets cancerous cells (without affecting normal cells) via drugs, other medical options, or a combination of both.

Pancreatic cancer in New Zealand

Pancreatic cancer is one of the least common forms of cancer in New Zealand. However, according to a 2019 study, deaths from this disease will become the second or third most frequent cause of cancer mortality in this country. Reasons for this include:

• The accuracy of pancreatic cancer diagnosis is improving.
• Testing, diagnosis, and treatments for other cancers are more successful.
• Pancreatic cancer is usually diagnosed in its later stages.

Wait Time for Cancer Treatment

The New Zealand public health system follows a ‘62-day model’ to measure and record treatment for cancer patients. This means patients diagnosed with any type of cancer should ideally receive their first treatment within 62 days. During this period, various tests are performed and treatment options are discussed with health experts.

Wait times for treatment vary from one region to another. Since pancreatic cancer is often diagnosed in its later stages, a lengthy wait time at a public hospital can create further health problems for the patient and affect their chance of a positive health outcome. 

Are you prepared for life’s uncertainties?

You may not have pancreatic cancer, but that’s no guarantee it won’t happen to you or someone you love. Think about how health insurance can cover you for the possibility.

And not all health insurance plans are the same. Some plans only pay for a tiny fraction of your treatment expenses. 

Don’t let this happen to you. When buying health insurance, talk to a Policywise adviser about maximum benefit amounts for cancer treatments, non-Pharmac cover, inclusions, and any exclusions.

We provide clear, easy-to-understand plan comparisons from different insurers so you can choose the policy with the best cover. Our service is free - and it might just change your life for the better.