What is the pancreas?

The pancreas is an organ that produces digestive enzymes. It is located close to the gall bladder, which stores bile that has been produced in the liver. The pancreas shares a common duct with the gall bladder, which allows secretions from both systems to enter the intestine.

Cancers in these areas are very serious as they are hard to detect in their early stages and may not show any symptoms until it is far too late to treat them successfully.

 

Pancreatic cancer

Pancreatic cancer affects around 8,000 people every year in the UK. Around two-thirds cases are first diagnosed in patients aged 70 or over, with a slight gender bias towards men. Pancreatic cancer is extremely rare in the under-40 age group.

Initially, pancreatic cancer will display few or no symptoms and so it can be difficult to diagnose in its early stages. As the cancer advances, it will cause a number of symptoms, including:

• Upper abdominal pain
• Unexplained weight loss
• Jaundice or yellowing of the skin
• Nausea and vomiting
• High temperature accompanied by shivering
• New-onset diabetes

However, these symptoms are common and can be caused by a number of conditions, and even if you experience several of them at once, it is unlikely that you have cancer. Even so, you should still seek medical attention sooner rather than later.

 

Bile duct cancer

Cancer of the bile duct is much more rare than pancreatic cancer, with just 1,000 cases per year in the UK. It is more common elsewhere in the world. As with pancreatic cancer, bile duct cancer generally affects the older population and is more common in men than in women.

Two types of bile duct cancer occur and these are classified depending on where the tumour first forms:

• Intrahepatic bile duct cancer forms in the bile ducts within the liver.
• Extrahepatic bile duct cancer forms in the bile duct outside the liver.

Bile duct cancer may not show any symptoms at all until it is in the later stages, and so it is very difficult to treat effectively. When symptoms finally do show, they include:

• Light or clay-coloured faeces
• Darkened urine
• Jaundice, or yellowed skin
• Weight loss
• Itching
• Fever/shivering
• Upper abdominal pain or back pain (although pain is very often not a feature until very late in the disease).

 

Diagnosing pancreatic and bile duct cancers

Since the symptoms of these cancers are so similar to other conditions, such as gallstones, they can be difficult to diagnose. Diagnostic tests will include:

• Blood tests
• Biopsies
• Ultrasound
• CT scan
• MRI scan.

 

Treating pancreatic and bile duct cancer

If pancreatic or bile duct cancer is diagnosed early enough, then surgery can be performed to remove the tumour. Unfortunately, in the majority of cases, neither cancer shows any symptoms in this early stage, so it is almost impossible to identify them early enough. Fewer than 20% of pancreatic cancers are suitable for surgery, and even fewer bile duct cancers are caught in time for surgery to be effective.

If surgery is not possible, then a lot can still be done to improve the symptoms of the tumour. This usually means inserting a prosthetic tube (stent) into the bile duct. This is done endoscopically using a procedure called endoscopic retrograde cholangiopancreatography (ERCP), which is often performed as a day case, with no overnight stay required. An ERCP entails you being sedated while a flexible telescope is inserted through the mouth into the duodenum, the point where the bile duct opens into the upper intestine.

Chemotherapy is often also recommended for biliary and pancreatic tumours when surgery is not possible.

Research is active at the moment to find new diagnostic tests that can identify these types of cancers earlier. With timely surgery followed by specific radiotherapy and chemotherapy, it is possible to extend survival.

 

Pancreatic cancer and bile duct cancer: treatment at The Physicians' Clinic

The Gastroenterologists within the team at The Physicians' Clinic have an international reputation for the management of all types of pancreatic and biliary tract cancers. There are imaging facilities on-site and two of our gastroenterologists perform ERCP and other diagnostic procedures at state-of-the-art endoscopy units in nearby private hospitals.