Pancreatic Cancer

Hearing that you or someone you love has pancreatic cancer can feel frightening and overwhelming. You probably have questions about what you may experience, including how to eat well to support your health during treatment and recovery. 

This guide will help you better understand pancreatic cancer, how it’s diagnosed and treated, and how to care for yourself along the way. 

Pancreatic cancer develops when abnormal cells grow and turn into a tumour in your pancreas. 

Your pancreas is a long, flat, organ that lies horizontally behind your stomach that:

• Produces digestive enzymes that help break down carbohydrates, fat, and protein in food. The enzymes are made in exocrine glands in your pancreas.
• Produces insulin and glucagon, hormones that regulate and balance your blood sugar 24/7.

These hormones are produced in endocrine cells in your pancreas.

The most common type of pancreatic cancer is pancreatic ductal adenocarcinoma (PDAC) (1). It begins in exocrine cells that line the ducts that carry digestive enzymes out of the pancreas. 

Neuroendocrine pancreatic tumours are a less common type of pancreatic cancer that starts in pancreatic endocrine cells (1).

Pancreatic cancer is the 12th most common cancer worldwide, but it’s still relatively rare (2). Doctors don’t fully understand what causes it, but they’ve identified these risk factors (1,3):

• Older age (over 60)
• Diabetes
• Obesity and a sedentary lifestyle
• A diet high in red or processed meat 
• Heavy alcohol use
• Family history of pancreatic cancer
• Genetic predisposition (e.g., BRCA2, BRCA1,ATM or CDKN2A genes) mutations
• Smoking
• Chronic Pancreatitis

Pancreatic cancer affects men and women in the same way, but symptoms can vary from person to person. They may include (1,3):

• Abdominal or mid-back pain.
• Indigestion, bloating, or a swollen stomach.
• Nausea or vomiting.
• Loss of appetite.
• Dark coloured urine with pale and pultaceous stools or frank, diarrhoea (so-called “steatorrhea”), with orange and oily stools.
• Fatigue and tiredness.
• Unexplained weight loss.
• Yellowing of your skin or the white part of your eyes — called “jaundice”.
• New-onset diabetes after age 50, or a sudden worsening of blood sugar control in someone who already has diabetes.

Pancreatic cancer usually doesn’t cause symptoms in the early stages. That’s the main reason it’s commonly diagnosed late. 

When symptoms appear, they’re often vague and easily confused with other health conditions. Usually, signs and symptoms are related to digestion or blood sugar because the pancreas plays such an important role in both. 

These symptoms, most often, are caused by something unrelated to cancer. Always tell your healthcare provider about any new or unusual symptoms so they can check you out. The earlier any condition is found, the better your treatment options and outcome.

If your doctor suspects pancreatic cancer, they may order some of these tests (1):

• Blood tests can look for a tumour marker called CA19-9.
• Imaging tests, like a CT (computed tomography), MRI (magnetic resonance imaging), or MRCP (magnetic resonance cholangiopancreatography), can provide pictures of your pancreas, bile and pancreatic ducts.
• EUS (endoscopic ultrasound) uses a thin tube, passed down your throat and into your stomach, to take pictures. 
• A biopsy or tissue sample can be tested for the presence of cancer cells, for example during an EUS or through your abdominal skin. 

Some of these tests can also help with staging, which measures the tumour size and determines whether it has spread to lymph nodes or other organs, surrounding or distant. 

Based on these findings, your cancer team will describe your tumour using one of these categories, which guide your treatment plan:

• Resectable: the tumour hasn't grown into major nearby blood vessels, so surgery to remove it is usually possible as a first step.
• Borderline resectable: the tumour is close to or slightly involves nearby blood vessels. Chemotherapy (and sometimes radiation) is usually given first to shrink the tumour before attempting surgery.
• Locally advanced (unresectable): the tumour has grown extensively into nearby blood vessels, making surgery unsafe at this time. Treatment focuses on chemotherapy and/or radiation, which may sometimes make surgery possible later.
• Metastatic (Stage IV): the cancer has spread to other organs, such as the liver,  lungs, or peritoneum. Treatment focuses on systemic therapy to control the disease and manage symptoms.

The goal of therapy for people with pancreatic cancer is to receive a combination of treatments depending on their cancer stage and aims. Some treatments may remove the cancer, others can control the spread or relieve your symptoms so you feel better.

After a diagnosis, your doctors will help you plan the best treatment, based on your cancer location and stage. Treatments may include:

• Surgery to remove the tumour, along with parts of the pancreas and nearby organs.
• Chemotherapy - strong medicines that travel through your bloodstream to kill cancer cells. 
• Radiation therapy - powerful energy beams to shrink tumours or slow their growth. 
• Immunotherapy and targeted therapy- specialised medicines to help your immune system kill cancer cells or attack them without harming healthy cells.  

Good nutrition during cancer treatment helps you feel better and stronger, improves your quality of life and makes therapy less impactful or more effective (e.g. you may recover faster from surgery and chemotherapy may be more potent against tumour cells). However, it’s often hard to eat well with pancreatic cancer because of changes to your digestive system (e.g. difficult digestion, loss of taste and appetite, change in bowel habits) and medication side effects, but an oral nutritional supplement may help. 

Treatments, recovery, and survival rates have improved significantly through clinical trials and research. But pancreatic cancer is different for each person, and recovery and outlook depend on factors like age, overall health, tumour type, stage, and treatment. Your oncology team can give you the most accurate information about what to expect. 

These things can improve your quality of life during treatment and recovery:

• Care for your mental health. Navigating cancer is mentally exhausting, so lean on friends, family, and behavioural health therapists for emotional support.
• Maintain your nutrition. Work with an oncology dietitian to learn easy ways to eat healthy, prevent weight loss, and get enough protein and calories to help you recover.
• Stay active. Gentle movement and time outdoors can reduce fatigue, improve your strength and the efficacy of any current treatment, and lift your mood.

After treatment, your cancer may go into remission, which means tests and scans detect no sign of the disease. In a minority of patients, remission can last for a long time, but in the majority, the cancer will recur or progress if cancer cells remain in your body.  

Your oncology team will discuss your prognosis, including your chances for remission or recurrence. Stay in close contact with them, even if your cancer is in remission. They’ll monitor you to ensure your cancer stays in remission or keep it from spreading if it recurs.

Pancreatic cancer and its treatments, especially surgery, can reduce digestive enzymes, making it harder to break down fat, protein, and carbohydrates from food now and in the future. This can lead to:

• Malabsorption - difficulty absorbing nutrients, which can cause diarrhoea and steatorrhea.
• Malnutrition - too few nutrients to keep your body healthy, leading to weight and muscle loss. 

These tips can help you eat better during your treatment and beyond:

• Aim for six smaller meals or nutritious snacks each day rather than large meals. 
• Sip on nutritious beverages between meals. Smoothies or protein shakes provide extra nutrition if you are struggling to eat solid foods. 
• Discuss with your healthcare professional whether an oral nutritional supplement is needed. These can deliver maximum protein and calories in a smaller serving.
• Avoid rich foods, which are hard to digest and can upset your stomach. Fruits, vegetables, oatmeal, scrambled eggs, and yoghurt are gentler on your stomach.
• Ask about pancreatic enzymes to replace those your body lacks.