Every year around 3,000 patients in Australia are diagnosed with pancreatic cancer. The pancreas is an eggplant-shaped organ of the digestive system. It is located behind the stomach and sits close to the first section of the small intestine known as the duodenum. The pancreas secretes pancreatic juice that contains digestive enzymes that help digest food and hormones that regulate sugar levels.
Pancreatic cancer is an abnormal growth of cells in the pancreas. It is often referred to as a “silent disease” as it is frequently diagnosed in the later stages of growth. The cancerous cells can surround nerves and blood vessels and spread to other organs, such as the liver. Unfortunately, pancreatic cancer has a low survival rate.
What are the causes of Pancreatic Cancer?
The causes of pancreatic cancer are not known, but factors that put some people at higher risk include smoking, age, family history, obesity and physical inactivity, and chronic pancreatitis.
What are the symptoms of Pancreatic Cancer?
Early pancreatic cancer rarely cause symptoms. Symptoms may go unnoticed until it is large enough to affect nearby structures. The most common presenting symptoms in patients with pancreatic cancer are abdominal pain, jaundice (yellowing of skin or eyes, dark urine), diarrhoea, and weight loss.
What are the treatments for Pancreatic Cancer?
Treatments for pancreatic cancer differ from patient to patient depending on the patient (mainly age and other medical problems), stage and location of cancer. This may include surgery, chemotherapy, or radiotherapy, or a combination of one or more of these treatments.
Surgery – The most common surgical procedure is called “Whipple’s surgery”. If this is suitable, the head of the pancreas, duodenum, gall bladder, bile duct and part of the stomach is removed.
Endoscopic treatment – If the tumour is blocking the bile duct, a stent may be inserted to allow bile to drain from the liver.
Chemotherapy – Chemotherapy is often used prior to surgery to assist control of the tumour and reduction of the tumour size . It is often used in combination with radiation therapy to help control the tumour growth when surgery is not possible.
Radiation therapy – External Beam Radiation Therapy is often performed using Intensity-Modulated Radiation Therapy (IMRT) or volumetric arc therapy (VMAT), modern technologies allowing a high dose of accurately targeted radiation to be delivered to the pancreas or pancreatic bed (after surgery) using x-rays, with minimal impact on the surrounding tissues. The treatment uses x-rays so patients are not radioactive after treatment. External Beam Radiation Therapy is usually delivered once a day, Monday to Friday, over a number of weeks, the treatment itself taking around 10-15 minutes per day.
Pancreatic cancer can sometimes be cured with treatment. This is most likely in people whose cancer is found at an early stage. Even if it cannot be cured, a combination of treatments can be used to prevent the tumour from spreading, to relieve symptoms and to maintain a better quality of life.
How effective is radiation therapy for Pancreatic Cancer?
Surgery is the main stage of treatment for pancreatic cancer. Radiation therapy is sometimes offered as an adjunct to surgery to improve the outcome. When the tumour is not resectable, radiation therapy might offer symptom control and restrain the growth of the tumour.
What are the side effects of Radiation Therapy?
The side effects of radiation therapy are described as acute or late.
Acute side effects are those that happen during and within a few weeks after treatment. They are usually more temporary and tend to resolve, although this is not always the case. Sometimes severe acute side effects can result in late effects.
Late side effects are side effects that can occur 3 months after completing radiotherapy. Late side effects are less common. They may not show themselves during or immediately after radiation therapy but occur later on. The risk with late side effects is that they could be permanent or irreversible and become a more long term situation.
www.eviq.org.au is a resource for patients written by oncologists that provides detailed information on side effects.
Acute side effects
- Nausea and vomiting – sometimes patient need to be admitted for hydration intravenously
- Diarrhoea due to irritation of the small and large bowel
- Loss of appetite with loss of weight is common
- Skin reaction
- Rarely – irritation of the food pipe or stomach that can cause bleeding
Some patients cannot get enough nutrition while the above side effects occur and occasionally need a feeding tube either via the nose (naso-gastric tube) or stomach (gastrostomy tube) to support them while they are having treatment.
Late side effects
- Inadequate function of the pancreas causing high sugar levels and diabetes
- Inadequate function of the pancreas causing loose bowel motions and inadequate digestion of food
- Inflammation of the liver or deterioration in thethe function of the liver
- Deterioration in the function of the kidney – this is uncommon
- Narrowing or ulceration (can cause bleeding) of the stomach, small or large bowel
- Very rare – another tumour in years to come as a result of the radiation therapy.
Some side effects around changes in bowel habits and blood sugar levels, may need longer term management as treating the pancreas can make these problems more obvious and long term. This is uncommon but will be monitored for.
It is important to report these symptoms to the doctor looking after you as some of these symptoms can be managed.
What can help reduce side effects?
Resting as needed can help with fatigue in some patients. For bowel symptoms such as diarrhoea, it is important to keep hydrated, the doctor may prescribe medication to reduce this. Similarly with nausea and vomiting, and cramping, the doctor will advise you about which medication is suitable for you. These side effects are rarely severe with modern targeted radiation therapy and commonly settle quickly after treatment.
The appropriate person to discuss radiation therapy treatment for pancreatic cancer with is a Radiation Oncologist. You can ask your Surgeon or General Practitioner for a referral to a Radiation Oncologist for a discussion about whether radiation therapy is a good option for you.
Find your closest radiation oncology Treatment Centre.
Page last updated: 28/10/2020