Quick answer

What is pancreatic cancer?

Pancreatic cancer is an aggressive cancer of the pancreas — often diagnosed late because early symptoms are vague. Red flags include jaundice (yellow skin and eyes), unexplained weight loss, new-onset diabetes in over 50s, pale stools and dark urine, upper tummy pain going through to back, and indigestion not responding to treatment. Only about 10% are suitable for curative surgery. See a GP urgently for jaundice or significant unexplained weight loss — 2-week wait referral. Smoking and chronic pancreatitis increase risk.

Pancreatic cancer — why early diagnosis matters

Pancreatic cancer is one of the deadliest common cancers — ~10,500 UK cases/year — 5-year survival under 10% overall because most present with advanced disease.

Pancreatic ductal adenocarcinoma (PDAC) — 90% of cases

Symptoms — when to investigate

High suspicion:

  • Painless jaundice — pale stools, dark urine, itching
  • Unexplained weight loss
  • Upper abdominal pain → back — worse supine
  • New diabetes + weight loss over 50
  • Thrombosis — migratory superficial thrombophlebitis (Trousseau sign)

Non-specific (still investigate if persistent):

  • Indigestion not responding to PPI
  • Appetite loss
  • Fatigue

See jaundice symptom guide — not always alcohol or hepatitis

Diagnosis pathway

  1. Urgent CT pancreas — dual phase
  2. Tumour markers — CA19-9 — Lewis antigen negative patients may not express
  3. EUS + FNA biopsy — tissue confirmation
  4. Staging — CT chest/abdomen/pelvis — laparoscopy if borderline resectable

Resectability categories:

  • Resectable
  • Borderline — neoadjuvant chemo first
  • Locally advanced — unresectable
  • Metastatic

Treatment

Surgery (curative intent):

  • Whipple (pancreaticoduodenectomy) — head tumours
  • Distal pancreatectomy — body/tail
  • High-volume centre — outcomes differ

Chemotherapy:

  • Adjuvant post-surgery — FOLFIRINOX fit patients
  • Metastatic — FOLFIRINOX or gem/nab-paclitaxel
  • Palliative — symptom control, modest survival gain

Supportive:

  • Biliary stent — ERCP — relieves jaundice
  • Pancreatic enzymes — steatorrhoea
  • Pain team — coeliac plexus block

Risk reduction

  • Stop smoking
  • Healthy weight
  • Limit alcohol — chronic pancreatitis risk

Screening only in high-risk families — BRCA, Lynch, FAMMM — specialist programmes

After diagnosis

Pancreatic Cancer UK support line

Clinical nurse specialist

Advance care planning — realistic hope with aggressive treatment where appropriate

Jaundice + weight loss — GP same week — not wait for painless to mean harmless.

Common questions

What are the early symptoms of pancreatic cancer?
Often none or non-specific — indigestion, appetite loss, fatigue. As tumour grows — weight loss, upper abdominal pain radiating to back, jaundice if bile duct blocked, pale stools, dark urine, new diabetes, deep vein thrombosis without clear cause. Symptoms overlap many benign conditions — persistent or progressive features need scanning.
How is pancreatic cancer diagnosed?
CT pancreas protocol first — identifies mass and staging. MRI or EUS (endoscopic ultrasound) for detail and biopsy. ERCP with stent if jaundiced. CA19-9 tumour marker — not diagnostic alone. Laparoscopy in selected cases before major surgery. Staging determines resectability — only 10–15% resectable at diagnosis.
Can pancreatic cancer be cured?
Surgical resection (Whipple procedure or distal pancreatectomy) offers only curative option — for localised tumours without major vessel involvement or distant spread. Adjuvant chemotherapy (FOLFIRINOX or gemcitabine/capecitabine) after surgery improves survival. Most patients present too late for surgery — palliative chemo extends life and controls symptoms.
What causes pancreatic cancer?
Smoking — strongest modifiable risk — doubles risk. Chronic pancreatitis, obesity, diabetes, family history (BRCA2, Lynch syndrome, Peutz-Jeghers), heavy alcohol. Most cases sporadic without clear cause. Age — peak 65–79.
What is the Whipple procedure?
Pancreaticoduodenectomy — removes head of pancreas, duodenum, part of bile duct and stomach, gallbladder — reconnects bowel. Major operation — 2-week hospital stay, lifelong pancreatic enzyme supplements and often diabetes afterward. Mortality under 5% in high-volume centres.

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