ALTHOUGH only the 11th commonest cancer in the UK, Dr Zak says pancreatic cancer has perhaps the worst survival rate, with less than one in twenty alive five years after a diagnosis.

Due to the struggles and ultimately deaths of several high-profile individuals including Apple Founder Steve Jobs and actor Patrick Swayze, there has been a significant increase in awareness of pancreatic cancer over the last few years.

Unfortunately, the pancreas lives in what could be called no man’s land, often making diagnosis difficult. Many go to their doctor several times before the diagnosis is considered.

The pancreas is in the upper abdomen, behind the stomach. A duct running its length allows pancreatic juices to be delivered to the small intestines.

At its end, it meets with the common bile duct, which transfers bile from the liver. They become one channel, this opening into the top portion of the small intestine (small bowel).

In the early stages of pancreatic cancer, there may be few if any symptoms. These are often vague. Indigestion is perhaps the most diagnosed cause at first.

However, if not identified early, pancreatic cancer can rapidly grow. Complaints include jaundice, itching, dark urine, and pale stools.

Over nine tenths of pancreatic cancers arise from cells lining the pancreatic duct. The most common place for a pancreatic cancer to occur is in the head of the pancreas. This is where the pancreatic duct and bile duct become one.

As the tumour grows it stops pancreatic juices entering the small intestine. This will also stop the delivery of bile. Bile then enters the blood stream causing the symptoms of jaundice. These are a yellow tinge to the skin and whites of the eyes. This may be more easily seen in the eyes first. Bile salts in the blood also cause itching.

Pancreatic enzymes are needed to digest fats, so stools end up floating and difficult to flush away. Because they do not have bile in them, they become pale. As the bile ends up being passed in urine, this becomes darker.

Macmillan Cancer Support charity are highlighting the importance of these, especially not ignoring pale stools.

Other symptoms that should prompt concern are upper abdominal and back pain, especially that which is persistent and worsening. New onset diabetes, or a previously controlled diabetes that suddenly becomes difficult to manage, may also be signs of pancreatic cancer.

Though the treatment of early diagnosed pancreatic cancer may result in a good outcome, sadly for many this is not the case.

Hence focus on prevention and early diagnosis are the most important tools in the fight against the disease.

Lifestyle choices play a significant role in the development of pancreatic cancer. Smoking and excess alcohol increase the risk of pancreatitis, or inflammation of the pancreas. Recurrent or chronic pancreatitis increases the risk of change to cancer.

A Body Mass Index of greater than 30 may raise the risk of pancreatic cancer by up to 20 per cent.

It seems that the combination a poor diet, obesity, and smoking have an additive effect.

Though most pancreatic cancers occur over the age of 60, certain genetic conditions, for example having the BRCA-2 gene, are associated with a greater likelihood.

Some families have a predisposition to the disease. Though a formal screening programme does not exist in the UK at the present, those a higher potential for pancreatic cancer can be referred to a specialist.

New developments in identifying pancreatic cancer at an earlier stage have come in the form of both blood and stool tests.

A group at University College San Diego have developed a blood test that identifies abnormal proteins released by cancer cells in the early stages of the disease. This is accurate in 95 per cent of stage one cancers.

Also, in Spain, researchers recently looked at saliva and stool samples of those with pancreatic cancer compared to a control group without the disease. While there were no differences in spit samples, there were significant differences in the stools of those with pancreatic cancer. Promisingly, these changes were detectable with early disease, as well as those where the condition was more advanced. If either or both tests become mainstream, this may make detection of pancreatic cancer much easier and quicker.

At the present time personal efforts may be best focussed on maintaining a healthy lifestyle, good control of diabetes, and not ignoring any changes to your urine or stools.

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