Where is the pancreas and what does it do?

The pancreas is an organ deep in the upper part of the abdomen. It can be broken down into the head, neck, body and tail. The head is like Flinders Street Station, with many different structures attached to it, like the first part of the bowel after the stomach (duodenum), the bile duct and the pancreatic duct. The tail extends to the left side of the abdomen, where it sits next to the spleen.

There are two main functions of the pancreas. The first is to make enzymes to help break down and digest food. The enzymes are released into the pancreatic duct system, a network of channels that form the main pancreatic duct. This main duct combines with the common bile duct at the ampulla and excretes the bile and pancreatic juice into the duodenum. This is the exocrine pancreas. The second function is to produce hormones that act locally and throughout the body. The most well-known hormone is insulin, which affects sugar levels in the body. This is the endocrine pancreas.

             

Pancreatic cancer (two main types of tumours)

There are two different types of pancreatic tumours, each relating to the different functions of the pancreas. The most common is adenocarcinoma of the exocrine pancreas. The other is a neuroendocrine tumour of the endocrine pancreas, which can sometimes produce hormones.
 

How common is it?

The incidence of pancreatic 13 cases per 100,000 people, making it the 8th most common cancer in Australia, and in 2019 the 5th most common cause of cancer-related death. The majority are pancreatic adenocarcinoma, with the incidence of neuroendocrine pancreatic cancer being less than 1 per 100,00.
 

What are the signs or symptoms?

The signs and symptoms of pancreatic cancer vary and are often subtle. Weakness and fatigue are the most common, followed by upper abdominal and back pain. Jaundice, which includes dark urine, pale stools, in addition to general “yellowing” of the skin and sclera, occurs if the cancer involves the head of the pancreas, and is compressing the bile duct. Other reported symptoms include loss of weight, new onset diabetes (or worsening sugar control in known diabetics), or unexplained clotting events.

Neuroendocrine tumours can present as a result of excess production of their respective hormone. However, the majority of neuroendocrine tumours are non-functioning and cause similar pressure effects as the adenocarcinoma variety.
 

Known causes of pancreatic cancer

There are general risk factors associated with pancreatic cancer including smoking, overweight/obesity and increasing age. There are some conditions that are known to transform into pancreatic cancer, including IPMN and chronic pancreatitis, but only in very particular situations, and over a period of time.

There are hereditary risks related to specific genetic syndromes and if there are multiple first-degree relatives diagnosed with pancreatic cancer.

In most cases, there is no specific risk factor identified.
 

How can you lower your risk?

There is no pancreatic cancer screening programme. Unfortunately, a specific test has yet to be developed. However, people with an identified hereditary risk or a pre-malignant condition should undergo guided imaging surveillance.

Lifestyle risk modification (weight loss, smoking cessation) remains the best form of cancer prevention.
 

What are the treatment options?

Treatment is individualised to everyone’s particular situation, by a large healthcare team. Treatment modalities involve surgery, chemotherapy, radiotherapy, and endoscopic therapies, in addition to pain management, psychological support and palliative care services. The order of treatment varies too. In some instances, chemotherapy and/or radiotherapy is given before surgery.

Overall, survival from pancreatic cancer is improving, as our understanding improves, and treatments develop. However, many people diagnosed will not be suitable for curative treatment. In these situations, multiple modalities are used to ensure optimal symptom control to allow normal activity and life for as long as possible.
 

What is your message for this Pancreatic Cancer Awareness Month?

Pancreatic cancer is relatively common, which has relatively few early signs that the cancer is developing. Be aware that vague symptoms may be enough to diagnose it early. And remember that there are treatment options; many of which are continuing to improve survival.