About pancreatic cancer

What is pancreatic cancer?

Pancreatic cancer is cancer that starts in any part of the pancreas. About 3 in 4 pancreatic cancers are found in the head of the pancreas.

Pancreatic cancer can spread to nearby lymph nodes and to the lining of the abdomen (peritoneum). Cancer cells may also travel through the bloodstream to other parts of the body, such as the liver.

What are the main types?

There are 2 main groups of pancreatic cancer:

Exocrine tumours – These make up more than 90% of pancreatic cancers. The most common type is called adenocarcinoma, and it starts in the exocrine cells lining the pancreatic duct. Less common types include adenosquamous carcinoma, acinar cell carcinoma, squamous cell carcinoma and undifferentiated carcinoma.

Neuroendocrine tumours (NETs) – About 9% of cancers in the pancreas are pancreatic NETs. These start in the endocrine cells.

This information is about exocrine tumours of the pancreas, particularly pancreatic adenocarcinomas.

For more information about how pancreatic NETs are diagnosed and treated, see Neuroendocrine tumours.

How common is pancreatic cancer?

About 4600 people are diagnosed with pancreatic cancer in Australia each year. More than 80% of those diagnosed are over the age of 60.

Pancreatic cancer is about the 8th most common cancer diagnosed in Australia and it affects men and women at about the same rate.

The pancreas

The pancreas is a long, flat gland that lies between your stomach and spine. It is about 13–15 cm long and is divided into 3 main parts:

• the large, rounded end, called the head of the pancreas
• the middle part, known as the body
• the narrow end, called the tail, that sits up next to your spleen.

A tube called the pancreatic duct connects the pancreas to the first part of the small bowel (duodenum). Another tube, called the common bile duct, runs through the head and joins with the pancreatic duct to connect the liver and gall bladder to the duodenum.

The pancreas in the body

What the pancreas does

The pancreas has 2 main jobs. It makes digestive juices (known as its exocrine function) and hormones (its endocrine function).

Exocrine function – The pancreas is part of the digestive system, which helps the body digest food and turn it into energy. Exocrine cells make pancreatic enzymes, which are digestive juices. The pancreatic duct carries these juices from the pancreas into the duodenum, where they help to break down food. Most of the pancreas is made up of exocrine tissue.

Endocrine function – The pancreas is also part of the endocrine system. This is a group of glands that makes the body’s hormones. Endocrine cells in the pancreas make hormones that control blood sugar levels, the amount of acid produced by the stomach, and how quickly food is absorbed. For example, the hormone insulin decreases the level of sugar in the blood, while the hormone glucagon increases it.

Which health professionals will I see?

Your GP will arrange the first tests to assess your symptoms. If these tests do not rule out cancer, you will usually be referred to a specialist, such as a gastroenterologist or surgeon. The specialist will arrange further tests. If pancreatic cancer is diagnosed, the specialist will consider treatment options. Often these will be discussed with other health professionals at what is known as a multidisciplinary team (MDT) meeting. During and after treatment, you will see a range of health professionals who specialise in different aspects of your care.

Health professionals you may see

• pancreatic or HPB (hepato-pancreatobiliary) surgeon – operates on the liver, bile ducts, pancreas and surrounding organs
• gastroenterologist – diagnoses and treats disorders of the digestive system; may diagnose pancreatic cancer, perform endoscopy, and insert stents to clear blocked bile ducts
• medical oncologist – treats cancer with drug therapies such as chemotherapy, immunotherapy and targeted therapy (systemic treatment)
• radiation oncologist – treats cancer by prescribing and overseeing a course of radiation therapy
• endocrinologist – diagnoses, treats and manages hormonal disorders, including diabetes
• radiologist – analyses x-rays and scans; an interventional radiologist may also perform a biopsy under ultrasound or CT, and deliver some treatments
• cancer care coordinator – coordinates your care, liaises with other members of the MDT and supports you and your family throughout treatment; care may also be coordinated by a clinical nurse consultant (CNC) or clinical nurse specialist (CNS)
• nurse – administers drugs and provides care, information and support throughout treatment
• palliative care team – a team of specialist doctors, nurses and allied health workers who work closely with the GP and cancer team to help control symptoms and maintain quality of life
• dietitian – helps with nutrition concerns and recommends changes to diet during treatment and recovery
• social worker – links you to support services and helps you with emotional, practical and financial issues
• psychologist, counsellor – help you manage your emotional response to diagnosis and treatment
• physiotherapist, exercise physiologist – help restore movement and mobility, and improve fitness and wellbeing
• occupational therapist – assists in adapting your living and working environment to help you resume usual activities after treatment