Understanding the disease.
About Pancreatic Cancer.
Pancreatic cancer is one of the most lethal forms of cancer but in most cases the cause is still unknown.
The most common type of pancreatic cancer is pancreatic ductal adenocarcinoma (PDAC), which accounts for 90% of cases. As many patients are not diagnosed until the cancer is advanced, only very few patients are cured. Currently the only way to cure PDAC is with surgery, but the cancer often returns.
In 2015, this aggressive disease killed an estimated 4,600 people in Canada alone.
Pancreatic cancer is a difficult cancer for many reasons:
- It’s mostly lethal; overall survival is only 6%
- There are no good early detection tests
- Most patients have very advanced disease by the time they’re diagnosed
Unlike most other cancers, the rate of pancreatic cancer is actually increasing. No one knows why. For more information on pancreatic cancer, please visit the BC Cancer Agency Website and HealthLink BC.top
1 in 79 Canadians will have pancreatic cancer in their lifetime
20% of patients have a family history of pancreatic cancer
4th leading cause of death from cancer
We know very little about the risk factors for pancreatic cancer. If you smoke or have a family history of specific types of cancer, you may have a higher risk of developing pancreatic cancer.
Smoking has been shown to increase pancreatic cancer risk. However, although smoking rates have decreased in recent years, we have not seen a corresponding decline in the number of people that develop pancreatic cancer.
We know that some pancreatic cancer is hereditary because it is more common in some families. Pancreatic cancer is also associated with some inherited cancer syndromes, including BRCA2, LKB1/STK11 (Peutz-Jeghers syndrome), CDKN2A (Familial atypical multiple mole melanoma syndrome), PALB2 and MMR (hereditary nonpolyposis colorectal cancer).
As we know little about specific risk factors for pancreatic cancer, it makes screening very difficult. Looking for ways to detect pancreatic cancer as early as possible is a major focus of our research. In the future, we hope to be able to offer a screening test based on imaging (similar to the use of mammography for breast cancer) or a biomarker (blood) test.
The incidence of pancreatic cancer is higher in people who have or had chronic pancreatitis (inflammation that causes irreversible damage to the pancreas).
For more information, please visit the Canadian Cancer Statistics website.top
Pancreatic cancer is difficult to diagnose at an early stage because there are often no definitive symptoms until the cancer has advanced.
One or more of the symptoms below may be present:
- Jaundice (yellowing of the skin and the whites of the eyes and dark urine)
- Pain in the upper abdomen and/or upper back
- Loss of appetite
- Unexplained weight-loss
- Diarrhea or constipation
- Nausea and vomiting
- Pale, greasy stools that may float in the toilet
- Onset of Type II diabetes
More information about signs and symptoms can be found on the BC Cancer Agency website or the Canadian Cancer Society website.
If one or more of the signs and symptoms described here is present, certain exams and tests may be done to find out whether they are caused by pancreatic cancer or by some other disease or illness.top
Diagnosis is the process of finding the underlying cause of a health problem. If pancreatic cancer is suspected, the healthcare team will confirm if it is present or not.
The diagnosis can be confirmed in a variety of ways:
These include computed tomography (CT scan), endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). More information about these imagine techniques can be found at Health Links BC.
While imaging techniques may show a mass within the pancreas, only direct examination of the pancreatic tissue allows for the definitive diagnosis of cancer.
The tissue samples may be obtained in two different ways. The first is by a fine needle biopsy carried out during a procedure using an endoscope. The second involves taking tissue directly during diagnostic abdominal surgery.
The tissue samples that are collected during biopsy may be sent to the BC Gastrointestinal and Pancreatic Biobank to help with research.
Direct examination of the pancreatic tissue will allow the health care team to confirm whether or not cancer cells are present. This careful examination will also help to determine the type of tumour. Different types of tumours can affect the pancreas such as:
- Benign tumours
Benign tumours are non-cancerious growths that do not spread to other parts of the body and are usually not life-threatening. Examples are pancreatic pseudocysts and serous cystadenoma.
- Precancerous tumours
Precancerous tumours may develop into cancer. Some examples are mucinous cystic neoplasms and intraductal papillary mucinous neoplasms (IPMNs).
- Cancerous tumours
Cancerous tumours are growths that are malignant, meaning they have the potential to spread to other parts of the body. There are many types of cancerous tumours of the pancreas including:
- Pancreatic ductal adenocarcinoma (PDAC)
- Mucinous cystadenocarcinoma (MCN)
- Pancreatic neuroendocrine tumors (pNET)
More than 90 per cent of pancreatic cancers are the first type, adenocarcinomas (PDAC), cancers that develop within the pancreatic ducts that carry digestive enzymes.
Patients with this type of cancer often have non-specific signs and symptoms. Symptoms may include pain, weight loss or jaundice (yellowing of the skin). Another, although much less frequent solid tumour of the pancreas, is the mucinous cystadenocarcinoma (MCN). These tumours have a better prognosis than PDAC. A common precursor lesion to MCN is called an intraductal papillary mucinous neoplasm (IPMN), which usually grows along the pancreatic duct causing sometimes obstructive symptoms. These are very important to recognize because they represent a potentially curable precursor lesion to invasive pancreatic cancer.
Pancreatic neuroendocrine tumors (pNET), also referred to as endocrine pancreatic cancer, are much less frequent than non-endocrine cancers within the pancreas. Since they can produce highly active hormones they may present with very dramatic symptoms such as high sugars, a severe skin rash, severe diarrhea, or hot flashes.
Please see the BC Cancer Agency website for more information about diagnosis.top
Treatment options are limited for patients diagnosed with pancreatic cancer. Those whose cancer is detected earliest have the most options.
Surgery to remove the tumour is the standard treatment for early stage pancreatic cancer. Depending on the location or size of the patient’s cancer, one of three procedures is selected:
- Whipple procedure – removal of tumours in the head of the pancreas or the opening of the pancreatic duct
- Distal pancreatectomy – removal of part of the pancreas for early tumours in the tail or body of the pancreas
- Total pancreatectomy – removal of the entire pancreas
For more information about surgical procedures, please read these resources provided by Vancouver Coastal Health.
As pancreatic cancer is often diagnosed when it is already advanced, surgery is not an option for some patients.
Chemotherapy (the use of anti-cancer drugs) is generally given after surgery to prevent cancer recurrence. It is also used for patients who are unable to have surgery because the cancer has grown into the neighboring blood vessels or spread to other organs.
Radiation Treatment is occasionally used to treat pancreatic cancer when the tumour cannot be removed with surgery, but has not spread to other organs.
Please see the BC Cancer Agency website for more information about treatment.top
- Medline Plus
- Mayo Clinic
- Patient UK
- Patient Information from Up-To-Date
- American Cancer Society
- American Society of Clinical Oncology
- US National Cancer Institute
- Lustgarten Foundation
- JAMA Patient Page
- Pancreatic Cancer Action Network
- Sol Goldman Pancreatic Cancer Research Center
- BC Cancer Foundation
- VGH & UBC Hospital Foundation
- The University of British Columbia, Faculty of Medicine
For Researchers and Health Care Professionals
- Pancreatic Cancer Action Network
- Sol Goldman Pancreatic Cancer Research Center
- Family Practice Oncology Network: Pancreatic Cancer Webcast
- All Party Parlimentary Group (UK): A Plan of Action for Pancreatic Cancer
The next Pancreatic Cancer Education Day is planned for December 2, 2017 in Vancouver. Check the ‘News and Events’ section of this website for upcoming events.
On December 3rd 2016, Pancreas Centre BC together with Pancreatic Cancer Canada held the third annual Pancreatic Cancer Education Symposium for patients, families and their supporters in Vancouver, BC. The presentations were recorded and are available to view below:
- An overview of pancreatic cancer and surgical advances
- Pancreatic Cancer: An Introduction
- Research & Clinical Trials
- Screening & Surveillance
- Pancreatic Cancer: Questions and Answers
- The Pancreas
- Hereditary Cancer
- Interdisciplinary Support
Click on the links below for more videos:
- Education and videos from patient forums in Toronto sponsored by Pancreatic Cancer Canada
- Education forums organized by the BC Cancer Agency