Dr. Jeffrey Shum MD, FRCSC, FACS
HPB Surgery & Critical Care Medicine

Pancreatic cancer — a patient summary

 

1) What is pancreatic cancer and how common is it?

• Pancreatic cancer most often means pancreatic adenocarcinoma, a cancer that starts in the cells that make digestive enzymes.

• In Canada about 7,100 people are expected to be diagnosed with pancreatic cancer each year and it is one of the cancers with the highest number of deaths relative to cases because it’s often found late. (Canadian Cancer Society)

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2) Early signs and when to see a doctor.

Common symptoms that should prompt medical review (especially if new, persistent or unexplained):

• Yellowing of the skin or eyes (jaundice), dark urine, pale stools

• New, unexplained upper abdominal or back pain

• Unintentional weight loss, loss of appetite

• New-onset diabetes or sudden worsening of diabetes control

• New persistent nausea or indigestion
  If someone has these symptoms they should see their family doctor promptly — many Ontario programs also provide rapid/urgent referral pathways from primary care to specialists for patients with alarm symptoms. (Canadian Partnership Against Cancer)

 

3) How is pancreatic cancer diagnosed?

Diagnosis is usually done using a combination of tests:

1. Imaging

   • A contrast-enhanced CT scan of the pancreas using a pancreas protocol (CT with arterial and venous phases) is the most common first-line imaging test. MRI/MRCP can be used when CT is inconclusive or to better see the biliary/pancreatic ducts.

2. Endoscopic ultrasound (EUS) with fine needle biopsy

   • If tissue confirmation is needed (for example before chemotherapy), an EUS-guided biopsy is commonly used.

3. Blood tests

   • Routine blood work (liver tests, bilirubin) and tumor markers such as CA19-9 may be measured. CA19-9 is not a screening test by itself but is useful in monitoring and in context with imaging and symptoms.

4. ERCP / biliary stenting

   • If biliary obstruction (jaundice) is present, an ERCP (endoscopic retrograde cholangiopancreatography) may be performed to place a stent and relieve the obstruction.
     Your cancer team will use the imaging and biopsy results to stage the cancer (how far it has spread), which is the key factor that determines treatment options. (Canadian Cancer Society)

 

4) Staging — why it matters

• Resectable: tumour confined so surgery could remove it with clear margins.

• Borderline resectable / locally advanced: tumour involves nearby blood vessels in a way that makes immediate surgery risky; often treated first with chemotherapy (sometimes with radiation) to try to shrink it so surgery becomes possible.

• Metastatic: cancer has spread beyond the pancreas to other organs (commonly liver, lungs); treatment is usually systemic (chemotherapy) and palliative.
  Stage is the single most important predictor of outcomes and determines the treatment plan. (Canadian Cancer Society)

 

5) Treatment options (by stage) — what patients in Ontario are most commonly offered

Resectable disease

• Surgery is the main chance for cure. Types include:

  • Whipple procedure (pancreaticoduodenectomy) for tumours in the head of the pancreas.

  • Distal pancreatectomy (often with splenectomy) for tumours in the body or tail.

• Adjuvant chemotherapy after surgery is standard to reduce recurrence risk. Recent regimens used include multi-drug combinations (your oncologist will decide based on fitness and tumour factors). (Canadian Cancer Society)

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Borderline resectable / locally advanced

• Often started with neoadjuvant chemotherapy (chemo given before attempting surgery) to shrink the tumour and treat micrometastatic disease.

• Some patients may also receive chemoradiation in selected circumstances. After good response to chemo, re-assessment for surgery is done at specialized centres. (Canadian Cancer Society)

 

Metastatic disease

• Systemic chemotherapy is the main treatment, intended to prolong life and improve symptoms. Common regimens used in Canada/Ontario include gemcitabine-based therapy (e.g., gemcitabine +/- nab-paclitaxel) or FOLFIRINOX/modified FOLFIRINOX for patients who are fit enough. Choice depends on overall health, liver function and patient preference. (Cancer Care Ontario)

 

Palliative and supportive treatments (important at any stage)

• Biliary stenting to relieve jaundice and itching.

• Pancreatic enzyme replacement for digestion problems after surgery or when the pancreas function is low.

• Pain control with medications or procedures (e.g., celiac plexus block) when needed.

• Nutrition support, diabetes management if endocrine function affected, and addressing weight loss (often with dietitian involvement).

• Early palliative care to help with symptoms, emotional support, and advance care planning is recommended and available through Ontario cancer centres. (Canadian Cancer Society)

 

6) Genetic testing and clinical trials

• Some pancreatic cancers are associated with inherited mutations (e.g., BRCA1/2). Ontario cancer centres increasingly offer genetic counselling/testing because the results can influence treatment choices (certain targeted therapies) and family counselling.

• Clinical trials are available at major Ontario centres (e.g., Princess Margaret / UHN, London Health Sciences, others). Ask your oncologist about eligibility. (Zane Cohen Centre for Digestive Diseases)

 

7) What to expect — prognosis and survival

• Prognosis depends mainly on stage at diagnosis, whether the tumour can be completely removed surgically (negative margins), overall health, and response to treatment. People with resectable disease who undergo a successful operation and adjuvant therapy have the best chance for long-term survival; those with metastatic disease have shorter median survival but systemic therapies can extend life and improve quality of life. Exact survival numbers vary by study and by year; provincial/national statistics are updated regularly. (Canadian Cancer Society)

 

Questions patients may wish to ask.

• What is the exact location and stage of my tumour? Is it considered resectable?

• What tests do you recommend next (CT, EUS, biopsy, genetic testing)?

• What are my treatment options and what do you recommend for me — why?

• What side effects should I expect from treatment and how will we manage them?

• Am I a candidate for clinical trials or genetic testing?

• Who will be coordinating my care (surgeon, medical oncologist, radiation oncologist, palliative care)?

• What support services are available (nutrition, pain, mental health, financial/transportation)?

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