Cancer of the Pancreas

The pancreas lies behind the stomach. It is a lengthy organ with a head nestling in the loop of the small intestine on the right side, a body in its mid-section and a tail that is situated on the left side, just in front of the spine.

The pancreas has two functions; one is to release insulin and the other is to produce the pancreatic juice which contains enzymes that aid the digestion of food. This pancreatic juice is passed along the main pancreatic duct to enter the small intestine at the head of the pancreas. Most pancreatic tumours start in the cells of the pancreatic duct system and are more frequently situated in the head of the pancreas than in the body or tail.

Symptoms

The most common sign of pancreatic cancer is vague pain in the upper abdomen which spreads to the back. This pain may be worse after eating or when lying down and sometimes can be relieved by sitting up or leaning forward. If the growth arises in the head of the pancreas it may block the bile duct as it enters the intestine and cause jaundice, because bile is being retained in the liver instead of passing into the intestine.

Diagnosis

The diagnosis of a pancreatic tumour while the growth is still reasonably small causes great difficulty, because this cannot be seen on ordinary X-ray pictures of the upper abdomen. It can only sometimes be outlined on a barium swallow, which may demonstrate a narrowing in the stomach or duodenum, caused by pressure from a pancreatic tumour. More recently, radioactive, CAT and ultrasound scanning have all been used to try to look at the interior of the body, by creating an image of the organ and examining its outline. These methods may eventually lead to an earlier diagnosis of pancreatic cancer, which like other cancers can only be firmly established by a positive biopsy.

Treatment

The only recognised treatment for pancreatic cancer is surgery but because of the depth of the pancreas in the upper abdomen and the difficulty in diagnosing it at an early stage, surgical results are very disappointing, as the tumour is usually inoperable by the time the diagnosis is made.

Palliative surgery has, however, an important place in the relief of symptoms due, for instance, to the blockage of the common bile duct as it enters the duodenum. This can be achieved with the help of a by-pass operation, thereby relieving the jaundice.

Neither radiotherapy nor chemotherapy have so far proved useful in the treatment of pancreatic cancer on account of their limited effectiveness.