Is pancreatitis a risk factor for pancreatic cancer?

We do not know exactly why pancreatitis is a risk factor for pancreatic cancer. However, research does shown that there is an increased risk of developing pancreatic cancer if you have chronic pancreatitis. Therefore, it is something to be aware of.

What is chronic pancreatitis?

Pancreatitis is an inflammation (swelling and soreness) of the pancreas whereas pancreatic cancer is a tumour in the pancreas. There are two main types of pancreatitis: acute (short term) and chronic (long term).

Chronic pancreatitis is long-term inflammation of the pancreas which causes scarring of the pancreas. This can cause gnawing severe pain in the centre of your tummy and/or going through to your back.

A diagram to show the difference in a healthy and unhealthy pancreas for - is there a link between pancreatitis and pancreatic cancer.

Because the pancreas tissue that is necessary for digesting food is gradually destroyed by this condition, and replaced by scar tissue, people with chronic pancreatitis can develop malabsorption. (Malabsorption is a condition in which there is a difficulty digesting or absorbing nutrients from food.) The insulin-producing cells are embedded in the pancreas and, if the scarring is extensive, pancreatic function is impaired and diabetes can also occur.

Most people with chronic pancreatitis are, or were, heavy drinkers of alcohol, and/or heavy smokers. Some long-term medicines are thought to be associated with chronic pancreatitis, for example certain epilepsy medicines.

How is chronic pancreatitis linked to pancreatic cancer?

Chronic pancreatitis is a risk factor for pancreatic cancer, increasing the risk of pancreatic cancer by 2 to 3 times that of the general population. However, smoking is a risk factor for both pancreatic cancer and chronic pancreatitis, so the relationship between the two is not completely clear.

Furthermore, a pancreatic cancer tumour can sometimes block the narrow tube running down the middle of the pancreas (the pancreatic duct), which means that the pancreas enzymes don’t reach the gut to digest food. This can resemble chronic pancreatitis, which is why it’s important to conduct further tests to make a diagnosis.

Diabetes which has developed recently and not linked to weight gain can also be a warning sign of pancreatic cancer. Pancreatic cancer should therefore be excluded by a CT scan in people with new signs of chronic pancreatitis and especially with new signs of diabetes.

Symptoms of chronic pancreatitis

Chronic pancreatitis presents many symptoms similar to pancreatic cancer, including:

  • Severe tummy pain or digestion problems. These are progressive episodes that happen frequently and are quite severe. Mild pain between the episodes can also be experienced, particularly in people that continue to drink alcohol.
  • Recurring nausea and vomiting
  • Weight loss
  • Loss of appetite
  • Needing to urinate (wee) often, tiredness, and being thirsty (experienced with Type 2 diabetes)
  • Jaundice – yellowing of the eyes or skin

Because of the similarities between the symptoms of chronic pancreatitis and pancreatic cancer, it can be difficult to make the distinction without specialist input, a CT scan (which often needs repeated at an interval of several months) and occasionally an endoscopic ultrasound test, which can involve a biopsy.

Please see the NHS website for more about symptoms of chronic pancreatitis.

How is chronic pancreatitis treated?

Chronic pancreatitis is treated by replacing the enzymes that the pancreas can no longer produce, by taking pills that contain pancreatic enzymes with meals and snacks to help digest the food, controlling diabetes with tablets and/or insulin, and most importantly, trying to make changes in lifestyle that remove the triggers – most importantly alcohol and smoking.

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.

Chronic pancreatitis can be painful, so people may need to take medication to manage the pain. Occasionally, pain relief needs to be quite strong.

Surgery for pancreatitis is not done very often and is becoming even less common. Surgery for chronic pancreatitis can help but should only ever be considered after a prolonged period of discussion with specialist pancreas surgeons.

Find out more about pancreatitis here.