Pancreatic Cancer

Pancreatic cancer is a serious cancer that is often diagnosed late because early symptoms are vague. It is less common than many cancers but carries a significantly lower survival rate. New developments in genetics, earlier imaging, and neoadjuvant chemotherapy are slowly changing outcomes.

Symptoms

• Persistent upper-abdominal pain going to the back.
• Painless jaundice (yellow eyes, dark urine, pale stool) — a classic cancer-in-the-head-of-pancreas sign.
• Unexplained weight loss, loss of appetite.
• New-onset diabetes in an adult who wasn't at risk — sometimes the first clue.
• Nausea, fatigue.
• Itching (from jaundice).
• Greasy stools from poor fat digestion.

Risk factors

• Smoking (biggest modifiable).
• Chronic pancreatitis.
• Long-standing diabetes; new-onset diabetes in middle age without usual risk factors.
• Obesity.
• Heavy alcohol.
• Family history; inherited syndromes (BRCA, Lynch, familial pancreatic cancer).
• Age.

Evaluation

Contrast CT of the abdomen is usually first. Endoscopic ultrasound (EUS) with FNA biopsy confirms. MRI/MRCP, PET-CT for staging. CA 19-9 blood test — supportive, not diagnostic.

Treatment

• Surgery (Whipple or distal pancreatectomy) — the only curative route; possible in a minority. Done at high-volume specialist centres.
• Neoadjuvant chemotherapy before surgery — increasingly standard.
• Adjuvant chemotherapy after surgery.
• Chemotherapy +/- radiation for unresectable and metastatic disease.
• Targeted therapy for specific genetic subtypes.
• Palliative care should begin at diagnosis — managing jaundice (stenting), pain, nutrition is genuinely life-changing.

An aggressive diagnosis deserves aggressive care and aggressive palliation. Quality of life and symptom control are equal partners to tumour control.