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Pancreatic Cancer

About the pancreas

The pancreas is a narrow gland that lies deep in the abdomen between the stomach and the spine. It is about 15cm long and is made up of the head, body and tail. The head lies next to the first part of the small intestine (duodenum) and the lower end of the bile duct.

The pancreas has two key functions as part of the digestive system. It produces the hormone insulin that controls the level of sugar in the body, and produces pancreatic enzymes that aid in the chemical breakdown of food so nutrients can be absorbed in the intestine. These enzymes flow down the pancreatic duct into the small intestine.

What is Pancreatic Cancer?

The majority of pancreatic cancers start from the cells in the inner lining of the pancreatic ducts. These cells are known as exocrine cells which make enzymes to help digestion. Pancreatic cancers which form in this way are called exocrine tumours or adenocarcinomas, and make up over 90% of all pancreatic cancers.

The other types of pancreatic cancer are much less common and are mostly classified as endocrine tumours. Pancreatic neuroendocrine tumours (NETs) are a group of tumours that start in hormone-producing cells and account for around 5% of pancreatic cancers.

The most common site is in the head of the pancreas although tumours can also grow in both the body and tail of the pancreas. The symptoms produced by pancreatic cancer vary according to the location of the tumours and the tumour type. Exocrine tumours are aggressive and difficult cancers to treat, and generally have a far worse prognosis (likely outcome) than pancreatic neuroendocrine tumours. Read about the symptoms and risk factors of pancreatic cancer here.

Panreatic cancer treatment

The only curative treatment for pancreatic cancer is surgery. If diagnosed early and there are no obvious signs of spread to other organs, pancreatic cancer can be removed by surgery. Unfortunately, no other therapies can cure pancreatic cancer.

Most surgeries attempting to cure pancreatic cancer are concentrated on tumours that start in the head of the organ. This surgery is called a pancreaticoduodenectomy and is commonly known as the Whipple's procedure. The Whipple's proceedure involves the removal of:

  • Head of the pancreas
  • Lymph nodes near the pancreas
  • Gallbladder
  • Part of the common bile duct
  • Part of the stomach
  • Duodenum (first part of the small intestine)
  • A small portion of the jejunum (second part of the small intestine)

Chemotherapy can be used for all pancreatic cancer patients, including those who have undergone successful surgery to remove the tumour to help reduce the chance of the tumour recurring. For patients who are not able to undergo surgery, chemotherapy is used to slow the growth of the tumour and help lengthen life expectancy.

Radiotherapy can also be used, sometimes in combination with chemotherapy, to help reduce the chances of the cancer recurring. In some instances, radiotherapy can be used in advanced cases to try and reduce the tumour size enough to allow surgery.

If the cancer is obstructing the bile duct and cannot be removed surgically, a stent (plastic or metal tube) can be inserted to maintain the flow of bile and prevent jaundice.