Pancreatic cancer has the highest mortality rate among all main cancer types. It is the fourth leading cause of cancer death in Australia, with a one-year survival rate of approximately 20% and five-year survival rate of 8%. In 2022, there was an estimated 4,534 newly diagnosed cases of pancreatic cancer and an estimated 3541 deaths due to the disease.
There is no recommended population screening program for pancreatic cancer in Australia. Although the aetiology of pancreatic cancer is unknown, the current prevention strategies involve reducing risk factors. The two most effective prevention strategies include avoiding tobacco smoking and maintaining a normal body weight.
Symptoms of pancreatic cancer
The majority of pancreatic cancer cases present with non-specific symptoms or are asymptomatic until the advanced stages of the disease. The two main types of pancreatic cancers, exocrine and endocrine, often present different symptoms. However, exocrine pancreatic cancers are much more common, accounting for more than 95% of all pancreatic cancer cases.
The following symptoms should be investigated:
- Jaundice that is progressive, accompanied by unexplained weight loss and abdominal pain that may radiate to the back (the jaundice may also be accompanied by dark urine, light-coloured stools, and itchy skin). Note that the incidence of pancreatic cancer in people below 40 years is extremely low. The cause of jaundice in people aged under 40 years is more likely to be caused by other conditions such as alcoholism or hepatitis.
- Acute pancreatitis where the cause is not alcohol ingestion and gallstones are not evident
- New-onset diabetes
- Pain which is often severe, unrelenting and of a short duration
- Unexplained weight loss
- Pale and greasy stools
- Constipation
- Nausea and vomiting
- Lethargy
- Enlargement of gall bladder
- Blood clot in the leg without a clear risk factor
- Incidental lesions found on radiology
Patients who present with jaundice should be referred for tests within 48 hours and followed up rapidly. Other symptoms require review within two weeks (NICE 2015).
Assessments by the general practitioner
Depending on the presenting symptoms and risk factors, examinations by the GP should include the following.
Where there is suspicion of pancreatic cancer, consider:
- An abdominal CT scan with pancreatic protocol
- Serum CA 19-9 and liver function tests
- Early referral (strongly indicated), usually prior to a definitive diagnosis being made.
Where jaundice is present, the following should be performed urgently:
- Liver function tests
- Abdominal ultrasound
- CT where appropriate
An abnormal result should be discussed face to face with the patient and information provided.
