Early symptoms of pancreatic cancer

Unfortunately, unless associated with tumours arising close to the Ampulla of Vater, the traditional symptoms of pancreatic cancer – jaundice, weight loss, and back pain – are often associated with progressive disease.

The Pancreatic Cancer UK 2011 “Study for Survival” showed that:
– 50% of patients with pancreatic cancer still present to hospitals a as an emergency and are not diagnosed in the community;
– 25% of patients had experienced symptoms for over 12 months before diagnosis; and
– 30% of patients had visited their GP over 5 times before diagnosis.

The 2010 National Cancer Patient Experience Survey (NCPES) found that pancreatic cancer patients visited their GP almost twice as many times as other cancer patients before being diagnosed.

Pancreatic Cancer Scotland has contributed to the development of the Royal College of General Practitioners’ e-learning module on Pancreatic Cancer. The module, “Diagnosing Pancreatic Cancer in Primary Care”, has been designed and written by specialists in the field and overseen by practising GPs.

Common early scenarios that may be associated with pancreatic cancer include:

  1. Persistent new onset dyspepsia that doesn’t respond to PPIs;
  2. New onset diabetes in a thin, middle-aged patient;
  3. New onset dysmotility symptoms in a previously well, middle-aged patient – whilst IBS is common, it rarely develops as a new presentation beyond the 4th decade;
  4. Symptoms of steatorrhoea; and
  5. Any unexplained weight loss demands a diagnosis.

What to do if you suspect pancreatic cancer

If you have any concerns that a patient of yours may have pancreatic cancer, the patient should be referred to your local hospital Upper GI surgical team under the “urgent suspected cancer” system, because cross-sectional imaging (CT) will be required to confirm or exclude the diagnosis.

How do I contribute to the treatment of pancreatic cancer, once diagnosed?

Effective and co-ordinated management between the primary care, community, secondary and tertiary pancreatic service teams are the only way to effectively support a patient and family who are facing the challenges of a diagnosis of pancreatic cancer.

Within each Regional Pancreatic Unit across Scotland, there are clinical nurse specialists whose role is not only to assist in direct patient care within the hospital environment, but hopefully also to enhance communication between hospital and the community. They are also a valuable resource that you can call upon should you have any questions regarding the management of a patient under your care.

For example, the contact number for pancreatic clinical nurse specialists at the West of Scotland Pancreatic Unit is 0141 211 6385.

Sadly, even today, less than 50% of patients with a diagnosis of pancreatic cancer will go on to receive “active” treatment, and the mainstay of management is often the optimization of their holistic care. Real improvements in the quality of life can be achieved from the early and proactive management of issues that may occur with diet and nutrition, maldigestion, symptom control, side effects caused by the treatment of a disease, as well as the psychological, social, and spiritual problems related to the disease or its treatment.

In those patients where potentially curative intervention is not possible, the early introduction and integration of a multidisciplinary palliative care programme, well before any terminal phase, allows for proactive palliative care planning. Palliative care programmes reduce symptom distress and improve patient and family satisfaction, allowing choices regarding future interventions or restrictions, reducing the frequency of inappropriate intervention or terminal hospital admission, leading to an increased frequency of death within the home environment.

What can you do to raise awareness of pancreatic cancer?

In addition to simply discussing pancreatic cancer amongst colleagues, you can use social media to make your “followers” aware of pancreatic cancer by sharing links to this and other web resources such as the Royal College of General Practitioners’ e-learning module on Pancreatic Cancer. This module, “Diagnosing Pancreatic Cancer in Primary Care” has been designed and written by specialists in the field and overseen by practicing GPs.

Within most primary care communities there are regular CPD education sessions, and suggesting pancreatic cancer as a topic would provide a forum for both education and discussion. All of the Tertiary Pancreatic Units in Scotland regularly take part in these sessions and would be open to an approach.

Pancreatic Cancer Scotland also can provide posters and leaflets to raise awareness as a means of providing information on pancreatic cancer for your surgery. Please contact us on this website or on Facebook, and we shall be pleased to supply you with material.