Key Facts
Pancreatic cancer is rare below the age of 45. Most cases affect people over 65.
The cancer is increasing in frequency and is generally more common in men (although this is not reflected in the statistics given below for Europe in 2006).
Cancer of the pancreas is one of the more difficult cancers to treat because of:
- its position
- its relatively fast growth
- its tendency to spread to other areas in the body at an early stage
Whenever possible, patients suffering from pancreatic cancer should be referred to a hospital specialising in its treatment.
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Key Figures
| Total number of new cancer cases in Europe (2006) |
3.2 million |
| Total number of cancer deaths in Europe (2006) |
1.7 million |
| Number of new pancreatic cases (2006) |
59,900 (EEA) |
|
30,700 (men) |
|
29,200 (women) |
|
58,200 (EU25) |
|
29,700 (men) |
|
28,500 (women) |
| Number of pancreatic cancer deaths (2006) |
65,000 (EEA) |
|
32,500 (men) |
|
33,200 (women) |
|
64,000 (EU25) |
|
31,700 (men) |
|
32,300 (women) |
Overall, pancreatic cancer is estimated to account for 2% of all cancers and 6% of all cancer deaths.
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Cancer Types
The two types of pancreatic cancer are:
- ductal adenocarcinomas which develop from the cells that make digestive juices
- cancer developing from the cells in the pancreas which make insulin
About 90% of pancreatic cancers are ductal adenocarcinomas. The remainder develop from the insulin producing cells.
Ductal adenocarcinomas are more aggressive tumours that spread to other areas of the body when the original tumour volume is still quite small – less than 1 cm.
70% of all pancreatic cancers occur in the head of the pancreas, through which the bile duct passes. Tumours in the head of the pancreas frequently cause jaundice by blocking the bile duct, preventing the bile from draining into the intestine.
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Causes of Pancreatic Cancer
There are various risk factors for developing pancreatic cancer. These include:
- Age: pancreatic cancer is rare before the age of 45 and most patients are between 60 and 80 when diagnosed.
- Smokers are three times more likely to get the disease.
- High alcohol consumption increases the risk of developing pancreatic cancer.
- Inflammation of the pancreas (pancreatitis) is a risk factor for pancreatic cancer. It is more common in heavy drinkers.
- Family history: about 10% of people with pancreatic cancer have a family history of the disease.
- Diabetics (particularly long-standing diabetics) are at increased risk of developing pancreatic cancer.
- People who eat too much fat and not enough vegetables may also be at increased risk.
Prevention of Pancreatic Cancer
Avoiding the risk factors set out above will reduce the statistical risk - in particular giving up smoking and taking alcohol in moderation.
Having a healthy low-fat diet, combined with regular exercise combats obesity, which is a risk factor for many cancers including pancreatic cancer.
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Common Symptoms
The common symptoms of pancreatic cancer include:
- Jaundice - due to obstruction of the bile duct. Jaundice is usually painless, although pain can sometimes occur.
- Nausea
- Weight loss
- Weakness
However, often when the jaundice appears there are no other symptoms at all.
In the rarer form of cancer in which the pancreas makes too much insulin, the typical symptoms are:
- dizziness
- feeling faint
- occasionally collapse, muscle spasms and/or diarrhoea.
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Diagnostic Tests
A number of tests are used to confirm the diagnosis of a tumour in the pancreas:
- Ultrasound scan using an endoscope. By using an ultrasound probe attached to a flexible telescope passed into the intestine through the mouth, an image of the tumour can be obtained.
- Computerised Tomography (a CT scan) is a type of X-ray that shows the shape of the body organs in cross section, allowing the localisation of any abnormalities present.
- Positron Emission Tomography (a PET scan) uses small amounts of radioactive material to detect cancer and other diseases in the body.
- ERCP (Endoscopic Retrograde CholangioPancreatography) uses the same sort of telescope as is used for the ultrasound scan. Once the instrument is in position, a radioactive dye is injected into the pancreatic duct. Abnormalities can then be seen on X-rays.
- Magnetic Resonance Imaging (MRI scan) is another way of building-up images of organs inside the body.
To confirm that the tumour is a cancer, a biopsy is taken and some cells from the tumour are examined under a microscope.
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Treatment
The available treatments for pancreatic cancer are:
Pancreatic cancer is one of the more difficult cancers to treat.
Surgery
Surgery to remove the cancer, or even the entire pancreas, is a major operation.
If the cancer has spread to other organs, surgery may not be the best option. As a result of this, it is only used in about 20% of cases.
Chemotherapy and radiotherapy are used before, during and/or after surgery to kill any cells that have spread to other areas of the body.
Radiotherapy
Radiotherapy may be combined with chemotherapy (chemoradiation or concurrent therapy).
External beam radiotherapy is normally given as a series of short regular treatments in a radiotherapy department (each treatment may be referred to as a fraction). External beam radiation may be used in conjunction with surgery, and/or chemotherapy to treat pancreatic cancer.
Stereotactic Radiotherapy
Stereotactic radiotherapy (SRT) is a high-precision radiotherapy treatment which provides radiation focused on the whole tumour, with very little effect to surrounding normal tissues.
Biological treatments - Monoclonal antibody treatment
Monoclonal antibodies are used in the treatment of many forms of cancer. Specific proteins on cancer cells which are necessary for the cancer to develop can be targeted by monoclonal antibodies. As yet there is only limited experience with these agents and treatment with them continues to be evaluated.
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Key Trends
- Pancreatic cancer is increasing in frequency.
- A multidisciplinary approach to the treatment of pancreatic cancer offers the best quality of care.
- Pancreatic cancer is a very aggressive tumour with a dismal prognosis. Once symptoms occur, the disease has often spread to other areas of the body, making treatment extremely difficult.
- New radiotherapy treatments including stereotactic radiotherapy and carbon14 radiotherapy are being used in some centres
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Important Research Areas
- Methods of identifying cancers at an early stage. Early diagnosis should result in more effective treatment.
- The use of genetic and other markers to individualise therapy.
- Further evaluation of pre- and postoperative chemoradiation.
- The evaluation of treatment with biological agents.
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