Gall Bladder (Cholangio) Cancer

Pancreatic cancer can feel confusing and frightening, especially at the time of diagnosis. Many people and families search online and find information that is either too technical or inaccurate. The purpose of this guide is to explain pancreatic cancer in clear, easy-to-understand language without losing medical accuracy — so you can feel informed, supported, and part of your treatment journey.

What Does the Pancreas Do?

The pancreas is a long, soft organ that sits deep in the abdomen, behind the stomach. Although hidden, it plays two vital roles:

1. Digestive function:
   It produces enzymes that help break down fats, carbohydrates and proteins so your body can absorb nutrients.
2. Hormonal function:
   It releases hormones — especially insulin and glucagon — that control blood sugar levels.

When healthy pancreatic cells begin growing abnormally and multiply uncontrollably, a tumour forms. When this tumour is cancerous, it can spread to nearby tissue, lymph nodes, and sometimes to distant organs such as the liver or lungs.

Most pancreatic cancers are pancreatic ductal adenocarcinomas (PDAC), meaning they start in the ducts that carry digestive juices.

Why Does Pancreatic Cancer Develop?

There is rarely a single cause. Most cases arise from a combination of genetics, age, and environmental or lifestyle factors.

Common Risk Factors Include:

• Smoking
• Obesity or lack of physical activity
• Long-standing diabetes
• Chronic inflammation of the pancreas (pancreatitis)
• Diets high in processed or fatty foods
• Older age

Genetic or Inherited Risk

Around 10% of pancreatic cancers are linked to inherited genetic changes passed down in families. Because of this, it’s now recommended that everyone diagnosed with pancreatic cancer undergo genetic testing, even if there’s no family history.

Genes sometimes linked to pancreatic cancer include:

• BRCA1, BRCA2
• PALB2
• ATM
• Lynch syndrome genes
• CDKN2A
• TP53
• STK11

Genetic testing may guide treatment and can also be important for family members.

Symptoms of Pancreatic Cancer

Early pancreatic cancer may not cause noticeable symptoms. As the tumour grows, signs may include:

• Yellowing of skin or eyes (jaundice)
• Dark urine or pale, greasy stools
• Pain in the stomach area or back
• Unexplained weight loss
• Loss of appetite or feeling full quickly
• Nausea or digestive discomfort
• New-onset diabetes or sudden worsening of existing diabetes
• Fatigue or weakness

Symptoms often develop gradually, which is why many cases are diagnosed later.

How Pancreatic Cancer Is Diagnosed

Diagnosing pancreatic cancer involves several steps. Your care team may include specialists in radiology, gastroenterology, oncology, pathology and surgery.

1. Imaging Tests

These help locate the tumour and check whether it has spread.

• Pancreatic-protocol CT scan (standard first choice)
• MRI with MRCP (magnetic resonance cholangiopancreatography)
• PET-CT or PET-MRI in selected cases, especially when spread is suspected

These scans also help determine whether surgery is possible.

2. Endoscopic Tests

Sometimes scans need to be combined with endoscopic procedures to obtain tissue or relieve blockages:

• Endoscopic ultrasound (EUS):
  A thin scope with an ultrasound probe is passed through the mouth to examine the pancreas closely. A biopsy can be taken during this procedure. This is the preferred biopsy method.
• ERCP:
  Used mostly to treat blocked bile ducts, often by placing a stent to relieve jaundice.

3. Biopsy

A biopsy confirms the diagnosis. This may be:

• EUS-guided biopsy
• CT- or ultrasound-guided needle biopsy
• Biopsy during surgery (rarely, if surgery is already planned)

4. Blood Tests

• CA19-9 tumour marker may be measured to help assess treatment response, although it cannot diagnose pancreatic cancer on its own.

5. Molecular and Genetic Testing

After diagnosis, tumour samples may be evaluated for:

• Biomarkers (e.g., BRCA mutations, MSI-H, KRAS G12C, HER2 amplification)
• Inherited gene changes

These results help guide personalised treatment options.

Staging Pancreatic Cancer

Staging helps determine how advanced the cancer is and guides treatment planning.

Pancreatic cancer is often grouped into:

A multidisciplinary team reviews all results to decide the best approach.

Treatment Options

Treatment is personalised and depends on cancer stage, patient fitness, tumour biology and preference.

1. Resectable or Borderline-Resectable Disease

Surgery offers the best chance for long-term control. Common operations include:

• Whipple procedure (pancreaticoduodenectomy)
• Distal pancreatectomy
• Total pancreatectomy

Treatment may involve:

• Neoadjuvant chemotherapy (before surgery):
  Helps shrink the tumour.
• Adjuvant chemotherapy (after surgery):
  Reduces risk of recurrence. Often used if lymph nodes are involved or if the tumour has aggressive features.

Common regimens include modified FOLFIRINOX or gemcitabine-based combinations.

2. Locally Advanced Pancreatic Cancer

If surgery isn’t possible upfront:

• Chemotherapy is usually the first treatment.
• Chemoradiation or stereotactic body radiation therapy (SBRT) may follow to control tumour growth or symptoms.
• Some patients may become candidates for surgery later.

3. Metastatic Pancreatic Cancer

In advanced disease, treatment aims to:

• Control cancer growth
• Extend life
• Maintain comfort and quality of life

Treatment options include:

First-Line Chemotherapy

• Modified FOLFIRINOX
• Gemcitabine with nab-paclitaxel
• Gemcitabine with cisplatin in patients with BRCA1/2 or PALB2 mutations
• Single-agent chemotherapy for those who are less fit

Second-Line Therapy

If cancer progresses, options may include:

• Liposomal irinotecan-based regimens
• Alternative chemotherapy combinations tailored to prior tolerance

Targeted Therapy & Immunotherapy

If molecular testing shows certain changes, personalised options may include:

These therapies apply only to selected patients based on test results.

Supportive Care: Living With Pancreatic Cancer

Supportive care (sometimes called palliative care) should begin early, not only at the end of life. It helps manage symptoms and maintain quality of life.

Support can include:

• Pain management (including nerve blocks if needed)
• Pancreatic enzyme replacement to improve digestion
• Nutritional counselling and supplements
• Treatment of blockages with stents
• Medication for appetite, nausea or sleep
• Emotional, psychological and practical support

Many patients find that combining active treatment with supportive care allows them to live better with cancer.

Key Takeaways

• Pancreatic cancer is complex, but modern treatment strategies are improving outcomes.
• Diagnosis includes specialised imaging, biopsy and molecular testing.
• Surgery offers the best chance of cure but is only suitable for some.
• Chemotherapy, immunotherapy, and targeted treatments play important roles.
• Supportive care is essential to comfort and quality of life.
• Every treatment plan should be personalised.