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Pancreatic Cancer

What is pancreatic cancer?

 

A consultant explains what cancer is and why it may develop in any part of the body.

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So cells in the body are continually growing and dying, and they have to be replenished normally. And so the cells normally grow and divide under a very controlled process, but sometimes that controlled process goes wrong and uncontrolled growth leads to cancer. And this can happen in any organ of the body, such as the pancreas, and generate what we know as pancreatic cancer.

The pancreas lies quite high up in the abdomen, at the bottom of the breastbone, just behind the stomach. It is about six inches long and shaped a bit like a cone or a leaf. The pancreas is a gland that works with the alimentary tract and intestines. It has two functions: firstly it releases digestive juices which flow down the pancreatic duct into the duodenum (the first part of the small intestine) and mix with the food. The juices contain enzymes that help to break down the food into very small fragments. Secondly, it produces several important hormones including insulin. Insulin helps to keep the level of sugar in the blood stable. When a cancer develops in the pancreas it interferes with these normal functions.
 
Doctors usually call the wide end of the pancreas “the head”, the thin end “the tail” and the bit in the middle “the body”. Most pancreatic cancers are in the head of the pancreas. The head of the pancreas is closest to the small intestine and the bile duct runs from the liver through the head of the pancreas to open out into the small intestine (duodenum). A common presentation of cancer growing in the head of the pancreas is obstructive jaundice, because the tumour blocks the bile duct.
 
The vast majority of cancers of the pancreas start in the cells which produce the digestive pancreatic juices, called exocrine cells. More than 9 out of 10 (95%) pancreatic cancers are ductal adenocarcinomas (Macmillan Cancer Support 2016). Nearly all of these start in the cells lining the ducts of the pancreas, the tubes that carry the pancreatic digestive juices to the main pancreatic duct and the duodenum. Other types of pancreatic cancer, such as the endocrine cancers (sometimes called neuroendocrine tumours or NET's), cystic tumours and acinar cell carcinomas are much less common. Endocrine tumours, in the pancreas, usually over  produce hormones such as insulin, gastrin and glucagon.
 
Most of the people we interviewed said that they had no idea which type of pancreatic cancer they had. However, some were sure they had the most common type, an adenocarcinoma, and two people (Vicky -Interviews 15 and Peter - Interview 36) knew that they had had a neuroendocrine tumour.
 

A consultant talks about a common type of pancreatic cancer, pancreatic adenocarcinoma, and a...

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And are there different types of pancreatic cancer?
 
Yes, there are two common types and the normal pancreas cells do two things. They’re involved in digestion, generating enzymes that help to break up our food. Or they’re also involved in hormone production, in particular insulin.
 
Now each of those different functions are generated by different cells of the pancreas, and if those cells go wrong they create different types of pancreatic cancer. The common one, we know as pancreatic adenocarcinoma is the one associated with the cells associated with our digestive system. And that’s a particularly aggressive type of cancer.
 

Another one which is less common we call pancreatic neuroendocrine cancer, and this tumour arises from cells that seem to have an hormonal function, sometimes generating the insulin, so you can form things like insulinomas, but sometimes actually arising from other hormonal cells, both in the pancreas and in other parts of the body, whose function we don’t fully understand. But these tumours we call neuroendocrine carcinomas and they tend to have a less aggressive pattern of behaviour. And it’s important to know which type you have because you treat them very differently. 



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Last reviewed September 2018.
Last updated September 2018.
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