Pancreatic Cancer

Signs or symptoms of a recurrence

The five year survival rate for people with pancreatic cancer is very low compared to most other types of cancer. Even after potentially curative surgery the cancer may come back months or years later. It may return in the area of the pancreas (recurrence) or spread to other parts of the body via the blood or lymph systems. A tumour formed by cells that have spread is a ‘metastatic tumour’ or a ‘metastasis’. These ‘secondary’ tumours are made up of the same type of cells as the original ‘primary’ tumour.
Routine follow-up tests may indicate a recurrence even before new symptoms develop. This happened after Audrey had recovered from her initial treatment, which included a Whipple’s operation, chemotherapy and radiotherapy.
Similarly, Michael’s recurrence was identified on a routine CT scan done in his follow-up.
When a recurrence causes symptoms they may be like those before the original diagnosis (see ‘Signs and symptoms of pancreatic cancer’), but other symptoms may also occur. Because many other conditions can cause similar symptoms people can find it hard to know whether to act on minor symptoms occurring during their remission - they may have nothing to do with the cancer. Ann had had a Whipple’s operation, followed by chemotherapy and although she felt well most of the time, on occasions she wondered whether the cancer had come back.
However, when she experienced a recurrence of the bowel symptoms she had had before the original diagnosis two years previously Ann was very sure this time that her cancer must have recurred. She went to her GP, who arranged a CT scan (for more about CT scans see ‘Other diagnostic investigations’).
Other people we interviewed also recalled the symptoms that led to doctors finding a recurrence. Helen had a Whipple’s operation in 2007 and hoped that she had been cured. However, in 2009 she felt exhausted and suspected something was wrong, so asked for an earlier check-up appointment. A CT scan revealed ‘secondary tumours’ in the liver.
In 2005 John (Interview 40) had a Whipple’s operation followed by chemotherapy. After that ended he resumed work in the ship building business for a while before retiring. In June 2009 he developed pain under his rib cage. He went back for more tests, including a Positron Emission Tomography (PET) scan. This type of scan can show how the body is working, as well as what organs look like. It scans the whole body. With a PET scan people first have an injection of a very small amount of a radioactive drug (tracer). Then they rest for about an hour while the radioactive tracer spreads through the body. The scan produces an image of the radioactive tracer in the body.
 
By looking at the PET scan doctors could see that John had cancer in both his lungs, which they suspected had spread from his pancreas. The lung specialist did a bronchoscopy (looking into the major air passages). He wanted to biopsy one of the tumours in John’s lungs but was unsuccessful, so could not confirm that they had spread from the pancreas.
In 2004 David (Interview 09) had a Whipple’s operation, followed by chemotherapy and radiotherapy. After the treatment ended he felt very well indeed for two years. Then he started to feel unwell again, but at first CT scans and blood tests looked normal. David felt ill for over a year. Eventually after more CT scans and a PET scan, his doctors identified a recurrence.
Although some people had not had potentially curative surgery, they had had chemotherapy or radiotherapy and hoped that their cancer was at least in remission. Peter (Interview 43), for example, had had chemotherapy and CyberKnife treatment (see ‘CyberKnife stereotactic radiotherapy and its side effects’). He was considered suitable for CyberKnife treatment because his doctors did not think that the cancer had spread. After this treatment Peter hoped that his cancer had gone. He enjoyed a full life which included playing golf. However, eleven months later Peter developed jaundice and doctors discovered that his cancer had come back and had spread. He had to start chemotherapy again.
People reacted to the news that their cancer had come back in many different ways, including, shock, disappointment, sadness, acceptance and optimism (see ‘Learning of a recurrence’).

Family members of some of the people who had died of pancreatic cancer recalled that the person they had cared for or had supported during their final months with the disease had developed other more debilitating symptoms before they died (see ‘Symptoms of more advanced disease’).  

Last reviewed June 2015
Last updated June 2015

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