Recent figures show that the incidence of pancreatic cancer has been increasing in recent decades and was the 10th most commonly diagnosed cancer type in Australia in 2015. The risk increases with age and the average age at diagnosis is 70yrs. The disease can be aggressive and outcomes have historically been poor. With increased awareness and scientific advances, this is changing however. Professor Gundara completed research and a clinical fellowship at one of Australia’s leading pancreatic cancer centres (Royal North Shore Hospital) and he has witnessed first-hand how an enhanced scientific understanding of disease can impact on outcomes for diseases like pancreatic cancer.
One of the biggest problems with pancreatic cancer relates to a late diagnosis. Given the position of the pancreas, symptoms often do not occur until the disease has already become inoperable. This is why such important consideration is given to any pancreatic lesion identified, no matter how small, as large tumours have to start somewhere and the best opportunity to cure pancreatic cancer is with surgery, when the tumour is small.
The second problem with pancreatic cancer relates to the absence of effective treatments. Surgery is only good at removing the visible disease, but if it cannot be removed or has already spread systemically throughout the body, outcomes are poor. While treatments do exist, they are relatively crude and often tolerated poorly by patients. It is for this reason that Professor Gundara maintains an active interest in the area. Personalised therapies are here and Professor Gundara’s national and international network of colleagues will assist you in optimising your individual outcome.
Symptoms and diagnosis
Early symptoms of pancreatic cancer result either due to local mass effect and/or tumour infiltration of the nerves adjacent to the pancreas. Most tumours (60-70%) arise in the head of the pancreas and 20% in the body/tail. Tumours in the pancreatic head tend to present sooner with obstruction of the pancreatic and/or bile duct. This may manifest with jaundice, pain or problems with appetite, nausea and vomiting. Unintentional weight loss is also a cardinal symptom.
The diagnosis is usually made through multi-modality investigations. Scans are supplemented by biopsies to achieve a tissue diagnosis of cancer which may be achieved with endoscopic techniques. This may also facilitate placement of stent to open up any obstructed ducts or gastrointestinal structures.
Pre-treatment Investigations
The aims of pre-treatment investigations for pancreatic cancer are to assess the surgical resectability of the tumour and to assess the fitness of the patient. Both patient factors and tumour related factors need to be favourable to facilitate a good outcome. Numerous blood tests, scans and procedures/operations may be required in order to make conclusions and facilitate formulating treatment options for each individual patient. Given the gravity of these decisions for the patient and family, every case of pancreatic cancer should be discussed in a multidisciplinary team meeting.
Surgery
For resectable tumours in the head of the pancreas, a pancreatoduodenectomy (Whipple procedure) is performed. This involves resection of the distal stomach, duodenum, head of the pancreas, bile duct, gallbladder, and local lymph node clearance followed by a reconstruction. Body and tail of the pancreas tumours are resected by performing a distal pancreatectomy and splenectomy.
Once recovered from surgery, the vast majority of patients will benefit from adjuvant chemotherapy. This has been shown to improve survival with the choice of agent dependent on numerous factors including the fitness of the patient.
Patients with borderline resectable or unresectable pancreatic cancer will be offered chemotherapy and/or radiotherapy. During treatment, additional blood tests and scans will be performed to quantify treatment response. For those patients responding to therapy, surgery may become a viable option.
