For GPs

Pancreatic Cancer

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 small intestine known as duodenum. The pancreas secretes pancreatic juice that contains digestive enzymes that help digest food and hormones that regulate sugar levels.

Pancreatic cancer is abnormal growth of cells in the pancreas. It is often referred 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 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 Of 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 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, sometimes used in combination with radiotherapy, involves the use of anti-cancer medications to prevent the cancer cells from dividing.

      Radiation therapy – External Beam Radiation Therapy is often performed using Intensity-Modulated Radiation Therapy (IMRT), a modern, technology allowing high doses of precisely 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 early stage. Even if it cannot be cured, a combination of treatments can be used to prevent 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.

    • What Are the Side effects of Radiation Therapy?

      Side effects during/soon after treatment (Early or ‘acute’ side effects)

      General – Fatigue is one of the most common side effect which can vary between patients. This may persist for a few weeks after treatment. Loss of appetite accompanied by decreased food intake is also common.

      Local – All other side effects of radiation therapy come from the structures/organs in and just next to where the radiation is being targeted. For the pancreas this means the stomach and bowels. These can cause the following side effects such as gastritis / enteritis (cramping), diarrhoea, nausea and vomiting, which usually have fully settled by 4- 6 weeks after treatment is finished.

      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.

How Do I Enquire About Radiation Therapy With My Healthcare Professional?

The appropriate person to discuss radiation therapy treatment for pancreatic cancer 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.

Visit ‘For GPs and other Health Professionals’ and ‘Talking to your doctor’ sections for further information.

Find your closest radiation oncology Treatment Centre