Caring for people with pancreatic cancer

What is the pancreas?

The pancreas is a large gland that sits deep inside your abdomen, between your stomach, liver and spleen. It has two essential functions, to break down your food and absorb nutrients and to help control blood sugar levels.

How is pancreatic cancer diagnosed?

Pancreatic cancer can be difficult to diagnose in its early stages as the symptoms are similar to other much less serious stomach issues. The key to early detection is to look for a combination of symptoms and risk factors for the disease.

Doctors will use a combination of methods to determine if a patient has pancreatic cancer. These include:

- Symptoms;
- Risk factors;
- Imaging;
- Endoscopy;
- Laparoscopy.

What are the symptoms?

Often, patients won’t experience any symptoms until they are in the latter stages of pancreatic cancer. When patients do have symptoms, they can include:

- Pain in the upper abdomen or back;
- Jaundice;
- Weight loss;
- Appetite loss;
- Nausea with or without vomiting;
- Diarrhoea;
- Constipation;
- Recent type 2 diabetes diagnosis;
- Existing diabetes that’s getting harder to manage;
- Blood clots.

If you are concerned about any of these symptoms, consult your medical team for further evaluation and request an appointment at the Botton-Champalimaud Pancreatic Cancer Centre.

Botton-Champalimaud Pancreatic Cancer Centre
Phone: (+351) 210 480 048
Phone: (+351) 965 927 748
Email: centro.atendimento@fundacaochampalimaud.pt

What are the risk factors

A risk factor is something that can increase a person’s chances of developing pancreatic cancer. When trying to determine if a patient may be at risk, a GP should look into the following risk factors:

- Smoking;
- Obesity; 
- Older age;
- Type 2 diabetes;
- Chronic alcohol consumption;
- Chronic pancreatitis;
- Family history of pancreatic cancer;
- Pancreatic cysts.

What tests can diagnose pancreatic cancer?

A patient’s symptoms and risk factors help determine whether or not a doctor should investigate for pancreatic cancer. If pancreatic cancer is suspected, patients will need to undergo tests to confirm a diagnosis.

The range of testing options available include:

- Imaging – includes CT, PET and MRI scans;
- Endoscopy;
- Laparoscopy.

Family history of pancreatic cancer (hereditary)

Family history is a risk factor for developing pancreatic cancer – but what exactly does that mean?

Is pancreatic cancer hereditary?

Most pancreatic cancers are not linked to family history. Only 5-10% of pancreatic cancers happen because of an inherited predisposition (higher chance) to develop pancreatic cancer.

If you have family members diagnosed with pancreatic cancer, understandably, you might want to know more about your risk.

Pancreatic cancer can be hereditary (passed down in families) in two ways:

- Familial pancreatic cancer is cancer that appears to run in families.
- Genetic mutations linked to pancreatic cancer – where genetic testing shows an inherited mutation or syndrome that may increase the risk of pancreatic cancer.

Familial pancreatic cancer

Familial pancreatic cancer describes having multiple relatives on the same side of the family with a pancreatic cancer history. Sometimes, this type of family history suggests there is a gene mutation (change) passed down in families, even though no mutation is found in genetic testing. 

It’s important to know: one family member with pancreatic cancer doesn't make you at high risk.

Working out if you are at higher risk of pancreatic cancer requires more information. Your doctor will take into account:

- Your family history (within blood relatives);
- Other types of cancers occurring in the family;
- if your family members were young when they developed cancer.

They can advise on your individual situation and refer you to a clinical geneticist or counsellor to help you understand your risk.

Your doctor can also coordinate genetic testing. A single test, called the Pancreatic Cancer Panel, looks for several genetic mutations linked to an increased risk of pancreatic cancer. 

Genetic mutations linked to pancreatic cance

We inherit genes from our parents. A very small number of people inherit an underlying gene mutation or syndrome that may increase their risk of pancreatic cancer, such as:

- Peutz-Jeghers syndrome (STK11 gene); 
- Hereditary pancreatitis (PRSS1 gene);
- Familial melanoma (CDKN2A gene);
- Hereditary breast and ovarian cancer (BRCA2 gene);
- Lynch syndrome (MLH1, MSH2, MSH6 or PMS2 gene);
- Faulty ATM gene;
- Faulty PALB2 gene.

These mutations or syndromes are found through genetic (DNA) testing. 

Screening for pancreatic cancer

Screening is checking for pancreatic cancer when a person has no symptoms. The aim is to potentially diagnose the cancer early which in turn, improves outcomes.

Pancreatic cysts

What is a pancreatic cyst?

A pancreatic cyst is a fluid-filled cavity that has developed in the pancreas. The pancreas is a large gland that sits deep inside your abdomen, between your stomach, liver and spleen.

There are several causes of pancreatic cysts. They can occur when juices from the pancreas collect and irritate the pancreas, or after damage or injury to the pancreas. 

Pancreatic cysts are common and often found on an MRI or CT scan ordered for another reason.

What is the risk of pancreatic cancer with a pancreatic cyst?

A pancreatic cyst is a risk factor for pancreatic cancer.

However, the majority of pancreatic cysts are completely benign (non-cancerous). Most will never change or cause cancer in someone’s lifetime. 

Some pancreatic cysts are high risk and have an increased chance of turning into a cancer in the near future. Your specialist will share their recommendations based on your symptoms and the features of the cyst.  

What is next after a pancreatic cyst diagnosis?

A proper assessment of a pancreatic cyst is essential. This allows your specialist to determine its type and potential risk.

In most cases, pancreatic cysts are best managed in a multidisciplinary approach, with input from specialist gastroenterologists, surgeons and radiologists. 

An assessment of a pancreatic cyst may involve:
- CT scan – pancreas protocol;
- MRI scan – a specific type to see the pancreas in fine detail;
- Eendoscopic ultrasound (and possible biopsy) – helps to determine if a cyst should be removed. 

Should a pancreatic cyst be removed?

The majority of pancreatic cysts do not need to be removed. They will be monitored for changes and will often not require further management.

A small number of pancreatic cysts should be removed due to their size or risk of turning into a cancer. The only way to remove a pancreatic cyst is through surgery. 

Your specialist will discuss the risks and benefits with you. Surgery to remove a pancreatic cyst is usually only recommended if there is a risk of potential pancreatic cancer in the next few years.  
 

Text adapted from the Jreissati Pancreatic Centre website dedicated to World Pancreatic Cancer Day.