Key Information on Pancreatic Cancer
Pancreatic cancer is a rarer cancer and you may only see a patient with pancreatic cancer a few times over the course of a career. However, pancreatic cancer is the fifth biggest cancer killer in the UK and is expected to rise. As survival improves in other cancers, pancreatic cancer receives just 3% of research funding and has no routine screening test.
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 7%, 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
- Family history of pancreatic cancer and other familial cancer syndromes
- Chronic pancreatitis
- Peutz-Jeghers syndrome
- 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 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.
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.
Download a full copy of the NICE Referral and Pancreatic Cancer Guidelines here: NG12 Guidance 20150724