Penningtons Manches wears purple for Pancreatic Cancer Awareness Month

Posted: 10/11/2015

Pancreatic cancer is the tenth most common cancer in the UK with nearly 24 people being diagnosed with the disease every day.

The latest media attention on pancreatic cancer has been about the removal of the only pancreatic cancer drug, Abraxane, from England’s Cancer Drugs Fund. NICE has recently confirmed that it will not be routinely offered for treating pancreatic cancer on the NHS in England on the basis that the drug’s cost does not justify its benefit to patients. 

This decision is very controversial. The drug will remain available to patients in Scotland and Wales on the NHS reigniting concerns over a postcode lottery for cancer treatment in the UK. 

In the face of this disappointing news for pancreatic cancer patients in England, it is more important than ever to increase the awareness of the disease to encourage early diagnosis.
 
Despite its prevalence, pancreatic cancer is one of the lesser known cancers and is inherently difficult to diagnose because of the common lack of symptoms in the early stages. The key is to try to raise awareness of the signs to look out for.  

What is the pancreas? 

The pancreas is a large gland situated in the abdomen between the stomach and the spine. The widest part is called the head, the middle part is called the body and the thin part is called the tail. It is surrounded by a number of other large organs such as the liver, stomach, spleen and intestines.
 
The pancreas produces enzymes that help break down food so the body can absorb it and it also produces a number of hormones, the most important of which is insulin which helps to regulate the amount of sugar in the blood.

What is pancreatic cancer?

Pancreatic cancer can occur when abnormal cells in the pancreas grow out of control, forming a mass of tissue called a tumour. It can occur in the head, body or tail of the pancreas.
 
There are two main types of pancreatic cancer:

• Exocrine tumours which start in the cells which create the enzymes to help digestion. This accounts for over 95% of pancreatic cancers.
• Endocrine tumours which start in the hormone producing cells and account for less than 5% of all pancreatic cancers. 

The two types of cancer are important to distinguish as they produce different symptoms and are diagnosed using different tests. 

What are the symptoms?

The reason pancreatic cancer is so difficult to diagnose is because there are usually few symptoms in the early stages. 

Symptoms may also come and go which means that people can visit their GP a number of times before pancreatic cancer is even considered. The symptoms can also be common to many other illnesses and may not actually be a sign of pancreatic cancer.

The three most common symptoms of exocrine tumours are:

• Abdominal pain – often a general discomfort in the abdomen which can spread to the back. It can become worse after eating and when lying down. Sitting forward can sometimes relieve the pain.
• Jaundice – the skin and whites of the eyes turn yellow and there can also be dark urine, pale stools and itchy skin. 
• Weight loss – losing weight for no known reason, loss of appetite and difficulty in digesting highly fatty food.

Other symptoms can include:

• Steatorrhoea – stools that are large, pale, oily, floating and smelly (usually the result of undigested highly fatty food)
• Nausea
• Indigestion/heartburn
• Fever and shivering
• Diabetes
• Extreme tiredness/fatigue
• Feeling unusually full after food
• Unexplained acute inflammation of the pancreas (acute pancreatitis).

Most endocrine tumours do not produce a clinical syndrome so they do not cause specific symptoms but can cause some of the most common symptoms noted above.

However, there are some endocrine tumours which overproduce certain hormones which gives rise to different symptoms depending on the hormone that is being overproduced.
 
These are the most common symptoms which could indicate endocrine pancreatic cancer: 

• Gastrinomas overproduce gastrin, which causes peptic ulcers in the stomach or duodenum. Symptoms include severe pain, black tarry stools and diarrhoea.
• Glucagonomas overproduce glucagon. Symptoms include a distinct type of skin rash, anaemia, weight loss and inflammation inside the cheeks and lips
• Insulinomas overproduce insulin, leading to hypoglycaemia. Symptoms may include weakness, drowsiness, dizziness or lack of energy.
• Somatostatinomas overproduce somatostatin, which causes gallstones, diabetes, diarrhoea and steatorrhoea.
• VIPomas overproduce a hormone called vasoactive intestinal peptide. Symptoms include watery diarrhoea, high blood pressure and flushing of the face.

How is pancreatic cancer diagnosed?

Diagnosis can be a lengthy and complex process. Symptoms can be vague and associated with other types of illness which makes it difficult for GPs or specialists to detect. 

As with any illness, if symptoms persist, it is important to go back to the GP until a firm diagnosis is obtained. A GP’s assessment may include the following:

• Examination of eyes and skin for signs of jaundice
• Examination of the abdomen for any swelling and tenderness
• Urine test for bilirubin
• Blood test
• Taking a history of any problems eating or digesting food and any change in bowel habits
• Measuring weight. 

If the GP is unsure, they may make a referral to a gastroenterologist.
 
If there are symptoms which include jaundice, persistent unexplained abdominal pain and unexplained weight loss, this warrants an urgent referral for suspected cancer and this means that a patient must be seen within two weeks of the referral.

What are the risk factors?

There remains a lot of uncertainty about the causes of pancreatic cancer but research has identified a number of factors that are linked to the development of the disease. These include:

• Age – the risk increases with age and is rare in people under 40
• Ethnicity – UK Asian People have a lower incidence of pancreatic cancer
• Smoking
• A high Body Mass Index (BMI) and obesity
• Chronic heavy alcohol use
• A diet with a large amount of processed meat
• A family history of pancreatic cancer.

For any more information on pancreatic cancer, please visit this page. 

November 2015 is Pancreatic Cancer Awareness Month and Penningtons Manches LLP is joining the campaign to raise awareness of the disease by passing on the information above. Employees of Penningtons Manches will also be wearing purple on 13 November 2015, World Pancreatic Cancer Day, to support the aim to raise awareness.

Many cities across the country are also supporting the Purple Lights for Hope campaign and you may notice a number of iconic landmarks and buildings across the country being lit in purple light.

Unfortunately, there can be a failure to diagnose cancer early and we act for a number of patients whose cancer could have been diagnosed sooner. If you or any member of your family have concerns about a delay in diagnosing cancer, please contact our team to discuss further.

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