Pancreatic cancer

Arrange prompt medical assessment for yellow skin or eyes, unexplained weight loss, persistent upper-abdominal or back pain, pale stools or dark urine. Call local emergency services for collapse, severe uncontrolled pain, vomiting that prevents fluids staying down, vomiting blood or passing black stools, sudden breathlessness, chest pain, or a painful swollen leg. These symptoms have many possible causes, but they should not be managed with a home remedy alone.

What is pancreatic cancer?

The pancreas lies behind the stomach and helps with digestion and blood-sugar control. About 95% of pancreatic cancers begin in exocrine cells, which make digestive juices; pancreatic ductal adenocarcinoma is the most common type. Pancreatic neuroendocrine tumours arise from hormone-producing cells and have different behaviour and treatment, so the exact pathology matters.

Early pancreatic cancer often causes few or vague symptoms. This makes timely investigation important, but it does not mean that every digestive symptom is cancer. Outcomes vary with the cancer’s type, extent, biology, response to treatment and a person’s overall health.

Symptoms that need assessment

A tumour in the head of the pancreas may block bile flow, causing jaundice, itching, dark urine and pale or greasy stools. Other possible symptoms include pain in the upper or middle abdomen that may spread to the back, appetite loss, unintended weight loss, fatigue, nausea, changes in bowel habits, or pancreatitis without an obvious cause. A blood clot may occasionally be the first clue.

New or worsening diabetes can sometimes accompany pancreatic cancer, especially when it occurs with weight loss or other concerning symptoms, but diabetes is common and usually has another explanation. It is not a reason for routine pancreatic-cancer screening on its own. Persistent or worsening symptoms deserve review even when an earlier test was reassuring.

Risk is not destiny

Risk increases with age and is associated with smoking, excess body weight, long-standing diabetes, chronic pancreatitis, certain inherited conditions and a strong family history. Most people with one of these factors will not develop pancreatic cancer, and some people who develop it have no recognised risk factor. Stopping smoking and maintaining health-supporting routines are worthwhile, but a diagnosis is never evidence that someone failed to prevent the disease.

Tell the clinical team about cancers on both sides of the family and any previous genetic results. Genetic counselling can explain what an inherited test can and cannot show and what a result may mean for relatives.

How it is diagnosed

Assessment may include liver and kidney tests, blood counts and imaging. A contrast-enhanced pancreas-protocol CT is commonly used to look for a mass, blood-vessel involvement and spread. MRI or endoscopic ultrasound may clarify selected findings. During endoscopic ultrasound, a sample can often be taken for pathology. ERCP is used mainly to relieve or investigate a blocked bile duct rather than as a general first diagnostic test.

CA 19-9 is a blood marker that can be useful for monitoring some diagnosed cancers, but it has low specificity and can be raised by non-cancerous bile-duct or pancreatic conditions. Some people do not produce it. It cannot confirm or exclude pancreatic cancer by itself and is not an effective screening test for the general population.

Stage and resectability guide treatment

The team considers whether disease is resectable, borderline resectable, locally advanced, metastatic or recurrent. This assessment depends on whether the tumour can be removed completely, its relationship to major blood vessels, whether it has spread, and whether an operation is safe for the person. A multidisciplinary team with pancreatic expertise should review complex decisions.

Surgery offers a possibility of long-term control or cure for selected resectable cancers, but it is a major operation and microscopic disease may already exist. Chemotherapy is commonly given after surgery and, in some situations, before it. Borderline tumours often receive treatment before reconsidering surgery. Locally advanced or metastatic disease is usually treated with systemic therapy rather than immediate surgery.

Personalising treatment

The choice of chemotherapy depends on fitness, other conditions, goals and likely side effects. Radiation has a role in selected situations. Clinical trials may provide access to new approaches. Treatment can be adjusted when side effects outweigh benefit; asking about symptom control or quality of life does not mean giving up.

Inherited genetic testing is generally recommended for everyone diagnosed with pancreatic cancer because a result may guide treatment and inform relatives. People with advanced or metastatic disease should also discuss tumour biomarker testing. A small proportion have changes that make targeted therapy or immunotherapy appropriate, so these tests should be interpreted by the oncology team rather than bought as unsupported consumer panels.

Supportive and palliative care

Supportive and palliative care can be provided alongside cancer treatment at any stage. It can address pain, nausea, fatigue, anxiety, sleep, appetite and family needs. A blocked bile duct may need a stent. If the pancreas does not release enough digestive enzymes, prescribed pancreatic-enzyme replacement taken with food can improve digestion and weight maintenance. Diabetes treatment may also need review.

Dietary advice should be individualised by the care team or an oncology dietitian. Small frequent meals may be easier, but restrictive “anti-cancer” diets, supplements and herbal remedies do not replace treatment and may cause weight loss, bleeding or medicine interactions. Tell the team about everything you take.

Who should be screened?

Routine screening is not recommended for asymptomatic adults at average risk because available tests can produce harm without proven overall benefit. This recommendation does not apply to people with certain inherited syndromes or a strong family history. Those at high risk may be offered MRI and/or endoscopic ultrasound through an experienced surveillance programme, ideally with genetic counselling and specialist discussion.

If pancreatic cancer is suspected or confirmed, ask what type it is, whether a biopsy is needed, how resectability was decided, whether the case was reviewed by a specialist team, and which genetic and tumour tests are appropriate. Clear information and early symptom support help people make decisions that fit their priorities.