Pancreatic cancer (pancreatic adenocarcinoma): symptoms, tests and treatment

The pancreas is an organ in the top part of the tummy. The NHS says it helps you digest food and makes hormones such as insulin. Cancer Research UK describes it as lying quite high in the abdomen, behind the stomach, and as having a head, body and tail. Pancreatic cancer is cancer found anywhere in the pancreas, and the NHS says how serious it is depends on where in the pancreas it is, how big it is, whether it has spread and your general health.

Cancer Research UK explains that the cancer can start in cells that make digestive juices, called pancreatic exocrine cancers, or in the cells that make hormones, called pancreatic neuroendocrine tumours (PNETs). Your pathology report names the exact type of cell the cancer started in, which guides treatment.

The NHS says pancreatic cancer may not have any symptoms, or they might be hard to spot. It lists the following. Some are common and may be caused by other conditions, and having them does not definitely mean you have pancreatic cancer, but it is important to get checked.

• The whites of your eyes or skin turning yellow (jaundice), which may come with itchy skin, darker pee and paler poo than usual.

• Loss of appetite or losing weight without trying to.

• Feeling tired or having no energy, or a high temperature, or feeling hot, cold or shivery.

• Feeling or being sick, diarrhoea or constipation, or other changes in your poo.

• Pain at the top part of the tummy and back, which may feel worse when eating or lying down and better when leaning forward.

• Symptoms of indigestion, such as feeling bloated.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if the whites of your eyes or your skin turn yellow, you have been sick for more than 2 days, you have had diarrhoea for more than 7 days, or you have symptoms you are worried about but are not sure where to get help. It says to see a GP if you have lost a noticeable amount of weight, have other symptoms that get worse or do not get better after 2 weeks, or have a digestive condition whose symptoms are not improving after 2 weeks of your usual treatments.

The NHS adds that if you have another condition such as irritable bowel syndrome, you may get symptoms like these regularly and get used to them, but you should be checked if your symptoms change, get worse or do not feel normal for you. The GP may feel your tummy and arrange a pee sample or blood test, and may refer you urgently, which does not definitely mean you have cancer.

The NHS says anyone can get pancreatic cancer and it is not always clear what causes it. You might be more likely to get it if you are over 65 (it is not very common in people under 40), have certain medical conditions such as chronic pancreatitis, or have a history of pancreatic cancer in your family. It says many pancreatic cancers are also linked to lifestyle, and that you cannot always prevent it, but trying to lose weight if overweight, cutting down red and processed meat, avoiding drinking more than 14 units of alcohol a week and quitting smoking can lower your chances.

The NHS says that if a GP refers you to a specialist, tests can include blood tests, scans such as ultrasound (sometimes from inside the body using an endoscope), CT, PET or MRI, a biopsy, a small operation to look inside the tummy (laparoscopy), and an ERCP, where an endoscope is passed through the mouth to the stomach and X-rays are taken of the pancreas. You may not have all of these. It can take several weeks to get results. Your team includes a clinical nurse specialist who is your main point of contact.

Cancer Research UK explains that the stage means the size of the cancer and whether it has spread, with exocrine pancreatic cancer staged using the TNM system or a number system with 4 stages, and that knowing the stage, type and grade helps doctors decide about treatment.

The NHS says pancreatic cancer can be difficult to treat. Treatment may include surgery, chemotherapy, radiotherapy and supportive care, and the team will help you manage side effects, including changes to diet to help you digest food.

You will have regular check-ups during and after treatment, and the NHS says you do not need to wait for the next check-up if you have symptoms or side effects you are worried about. The NHS says the specialist team helps you manage side effects, including changes to your diet to help you digest your food. It signposts Pancreatic Cancer UK and Macmillan Cancer Support, whose free helpline it says is open every day from 8am to 8pm.

If the cancer cannot be cured, the aim of treatment is to control symptoms and help you feel as well as possible, and a palliative care or symptom control team works alongside your cancer team. Talk to the team about what matters most to you, so that treatment decisions reflect your priorities.

On the NHS the route is GP, urgent referral for scans and specialist assessment, then a multidisciplinary team that agrees treatment, with the clinical nurse specialist as main contact. Some people see a private hepatobiliary surgeon or oncologist for a quicker assessment or second opinion. Ask which team will perform surgery and who your main contact is.