Key Information on Pancreatic Cancer

The disease is diagnosed too late for surgery in approximately 80-90% of cases and even with surgical intervention, recurrence is common. One-year survival rate is around 20% and five year is under 8%, a figure that has not significantly improved in around forty years. 

The disease affects men and women equally with little variation in these figures. 

Primary care plays an important role in the early diagnosis of all cancers. Being aware of your high-risk patient groups and the symptoms of the disease leads to earlier referral, less appointments before diagnosis and can save lives. 

Risk factors include

• Age (although up to 40% of cases are seen in patients under the age of 69) 
• BRCA genes 
• Diabetes 
• Family history of pancreatic cancer and other familial cancer syndromes 
• Obesity 
• Chronic pancreatitis 
• Peutz-Jeghers syndrome 
• Smoking 

Symptoms Include

• Treatment resistant dyspepsia (indigestion symptoms that are not responding to PPI’s) 
• New onset type 2 diabetes mellitus in patients who are under or normal weight or where there is no other associated metabolic condition or family history of diabetes 
• Back and/or epigastric pain or discomfort that radiates dorsally and can be relieved by leaning forwards. Patients may complain of pain being approximately where a bra strap would sit 
• New onset IBS like symptoms in those over 45 years of age. This is a common misdiagnosis of pancreatic cancer. If a patient has never had IBS like symptoms (bloating, flatulence and change of bowel habit) before, it is important to rule out pancreatic cancer 
• Painless obstructive jaundice presenting as yellowing of the skin and whites of the eyes, pruritus or dark urine 
• Altered bowel movements such as increased frequency, offensive smelling stools, loose bowels and steatorrhea 
• Unexplained weight loss 
• Nausea and vomiting 
• Loss of appetite and anorexia 

NICE Guidelines

NICE guidelines state that patients with any abdominal symptoms or diabetes and weight loss should be referred for a CT (or ultrasound if CT unavailable) within 2 weeks. 

Any patient aged 40 and over with jaundice should also be referred on the two weeks wait pathway. 

Any patient with a diagnosis of new onset diabetes, over the age of 60 with a BMI of less than 30 should be referred for a CT scan. 

Currently, almost half of pancreatic cancer cases are diagnosed as an emergency presentation. These cases are far more likely to be late-stage presentations. Knowing the risk, signs and symptoms associated with pancreatic cancer is vital to increase GP referral and early diagnosis. 

NICE diagnostic and referral guidelines

NG17 – Type 1 diabetes: diagnosis & management. Last updated August 2022. 

NG85 – Pancreatic Cancer in Adults: diagnosis and management. 

NG12 – Suspected cancer: recognition and referral