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Pancreatitis means inflammation of the pancreas. Pancreatitis as a general term can be confusing, especially in relation to pancreatic cancer. The term covers several distinct conditions and they each have a different relationship to pancreatic cancer. There are three types of pancreatitis;
- Acute pancreatitis
- Chronic pancreatitis
- Hereditary pancreatitis
Acute pancreatitis is inflammation of the pancreas that comes on suddenly, usually in people who haven’t had any form of pancreatitis before. Some people may have another, or repeated episodes of acute pancreatitis, but this is different from chronic pancreatitis.
Around 8 in 10 attacks are caused by excess alcohol or gallstones. Others by trauma, viruses or medical procedures. The cause for some cases is never found.
Symptoms include nausea, vomiting and severe pain the centre of the tummy, which may go through to the back, come on suddenly and last from a few minutes to several hours.
Most people are unwell enough to need admission to hospital straightaway. The diagnosis of acute pancreatitis is made if someone has those symptoms and has a positive blood test for one of the pancreas enzymes (called amylase or lipase). Occasionally the diagnosis is not clear and is made after a CT scan of the abdomen is done. There are unfortunately no specific medicines that can halt acute pancreatitis or prevent it from occurring.
How is acute pancreatitis linked to pancreatic cancer?
Acute pancreatitis is not a direct risk factor for pancreatic cancer. However, the two conditions are linked. Pancreatic cancer tumours can cause an attack of acute pancreatitis, as can various diagnostic tests and treatments for the disease.
Chronic pancreatitis is long term inflammation of the pancreas which can cause healthy pancreas tissue to be destroyed and replaced by scar tissue. This can impair the function of the pancreas and lead to malabsorption, where the body is unable to effectively digest or absorb nutrients from food. This leads to weight loss, bloating, gas, stomach pain and pale greasy stools that float.
Damage can also occur to the insulin producing cells in the pancreas and lead to type 3c diabetes. Symptoms of this include fatigue, extreme thirst, needing to urinate more, blurred vision and dizziness.
Chronic pancreatitis can also cause the same symptoms as acute pancreatitis with severe stomach pain, nausea and vomiting.
Chronic pancreatitis is often the result of lifestyle factors such as heavy alcohol consumption. Some cases can also be caused by long term medication and other causes are unknown.
How is chronic pancreatitis linked to pancreatic cancer?
Chronic pancreatitis is a risk factor for pancreatic cancer, increasing the chances of pancreatic cancer by 2 to 3 times that of the general population.
Furthermore, pancreatic cancer is often misdiagnosed as pancreatitis. A tumour in the pancreas can mimic the symptoms of pancreatitis and therefore confirming the diagnosis with imaging such as a CT scan is important.
How is chronic pancreatitis treated?
Chronic pancreatitis treatments depend on the damage to the pancreas. For some it is treated by replacing the enzymes that the pancreas can no longer produce. Pancreatic enzyme replacement medications are given to take with snacks and meals to help digest food. The involvement of a dietician or dietary advice is very helpful: because fat is not absorbed well in chronic pancreatitis, low-fat diets can lessen symptoms of malabsorption. Vitamin supplements are often advisable.
If diabetes is diagnosed, treatment includes tablets and/or insulin to prevent dangerous blood sugar levels.
Lifestyle changes such as stopping smoking and drinking alcohol are important to prevent chronic pancreatitis becoming worse.
Chronic pancreatitis can be painful. Patients may need to take medication to manage the pain. Occasionally, pain relief needs to be quite strong. Different doses and types may vary dependent on the level of pain.
Surgery for pancreatitis is not done very often and is becoming even less common. Surgery for chronic pancreatitis can help but is only ever considered after consultation with specialist pancreas surgeons.
Rarely, chronic pancreatitis can develop in people (usually young people) who have inherited a faulty gene. When the gene works correctly, it switches off the pancreatic digestive enzymes when they are not needed. When the gene is faulty this doesn’t work correctly and this is called hereditary pancreatitis.
People with hereditary pancreatitis develop severe chronic pancreatitis which starts at an early age (usually between 5 and 26 years of age,) but can occur at any time. The long-standing inflammation in the pancreas in people with hereditary pancreatitis, and the fact that they may have had it since childhood, means that it is a risk factor for pancreatic cancer.
Alcohol and pancreatic cancer
It is not certain if drinking alcohol is a risk factor for pancreatic cancer. However, drinking excessive amounts of alcohol regularly can increase your chance of developing chronic pancreatitis and diabetes, both of which are risk factors for pancreatic cancer.