Suspected Cancer of the Pancreas – what happens next?

  • Reference Number: HEY-992/2018
  • Departments: Upper GI

Introduction

This leaflet has been produced to give you general information about your condition. Most of your questions should have been answered by this leaflet. It explains what is involved and the options that are available to you.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss your concerns with a member of your healthcare team.

Suspected Cancer of the Pancreas

You have been told by your doctor that they suspect you may have pancreatic cancer.  This information will help you understand more about this condition and what will happen next.

The pancreas is part of the digestive system.  It lies deep in the upper part of the abdomen, above the belly button where the ribs meet at the front.  The large rounded section on the right hand side of the body is called the head of the pancreas, the middle part is known as the body of the pancreas and the narrow part on the left hand side of the body is called the tail of the pancreas.  The head of the pancreas lies next to the first part of the small intestine, which is called the duodenum. (See fig A).

The pancreas makes a fluid that contains enzymes (chemicals) that are needed to digest food. The enzymes pass down the pancreatic duct and enter the duodenum. The bile duct drains bile from the liver, into the duodenum, and joins the pancreatic duct as the sphincter of Oddi, just as it enters the duodenum.

If the bile duct is blocked, this stops the flow of bile into the duodenum, which can lead to:

  • Jaundice – yellow skin caused by bile seeping into the bloodstream due to the blockage
  • Dark urine – caused by the jaundiced blood being filtered by the kidneys.
  • Pale stools – caused by lack of bile colouring the stools brown.
  • Itching – caused by bile in the blood stream.

Pain is often not a feature at first, therefore a “painless jaundice” that becomes worse is often the first sign of a disorder with the pancreas. Your doctor may decide he wants to drain any blockage of bile before further tests or investigations.  This is done by passing a fine tube through the skin on the right hand side near the ribs. This tube is left in the main bile duct within the liver; allowing the bile to drain into a drainage bag. This procedure is called a PTC and drain (percutaneous transhepatic cholangiogram) and is always performed within the X-ray department.

The pancreas also produces insulin (a hormone) which enables the body to use sugars and store fats.

What happens next?

There are different approaches that can be used to treat suspected pancreatic cancer, including surgery and chemotherapy. Deciding the most appropriate treatment for you is determined by:

  1. the extent of the disease
  2. your physical fitness

 To assess this you will need to have some further investigations to stage your disease. You will have been introduced to a Clinical Nurse Specialist who will coordinate your investigations, act as your key worker and be a point of contact for you and your family.

Staging Investigations

You may have already had the following:

Ultrasound Scan – This uses sound waves to look at the internal organs, such as the pancreas and the liver. The sound waves are then converted into a picture on a computer.

CT Scan – (Computerised tomography) This is a type of scan which produces detailed pictures of the inside of your body. If you have not already had one, you will be given more information about this prior to the procedure. From these your consultant can decide if this is an early or advanced cancer.

Endoscopic Ultrasound (EUS) – This involves a flexible tube being passed from the back of the mouth into the stomach. There is an ultrasound probe on the end of this tube which uses sound waves to take an internal ultrasound scan of the pancreas and surrounding organs. It is possible to take a biopsy at the same time, however, if surgery is looking possible then a biopsy may not be taken as it will be taken during the operation.

You may need one or more of the following:

ERCP (Endoscopic retrograde cholangio-pancreatography) – This involves a flexible tube being passed from the back of the mouth into the stomach. This enables the doctor to take and x-ray picture of the pancreatic duct and bile duct. The bile duct can be unblocked during this procedure if necessary.

PET Scan – (Positron emission tomography) This is similar to a CT scan but gives us more detailed information about whether your cancer has spread anywhere else in your body. For more information see http://www.alliancemedical.co.uk/sites/default/files/upload/documents/PET-CT-Patient-Guide.pdf

MRI Scan – (Magnetic resonance imaging) This is another detailed scan which looks at different parts of the body using strong magnetic fields.

You may feel concerned that waiting for these tests may cause a delay in you starting treatment. Please be reassured that this is necessary to ensure you receive the treatment most appropriate for you.

During this time you should keep as fit and well as possible. If you smoke, it is vital that you try to stop immediately. Stopping smoking at this stage can have a positive impact for any future treatment.

If you are having problems eating, you must inform you clinical nurse specialist, who will advise you on how to maintain your nutrition to prevent further weight loss, and refer you to a dietician if appropriate.

The multidisciplinary team meeting (MDT)

The results of all of your investigations will be discussed at the Multi-disciplinary Team Meeting (MDT). This consists of a specialist group of doctors and nurses and other healthcare professionals involved in your care that have expertise in your suspected cancer. They can recommend which treatment you should receive, knowing the nature of the tumour and how to achieve the best results for you. This decision will be communicated to you and all treatment options available will be discussed with you so that you can make an informed decision about your treatment.

Follow up out patients appointment

Following the MDT meeting, you will either receive an appointment to see your surgeon or the oncologist to discuss treatment options. Please use this opportunity to ask questions and raise any concerns, so that you and your family fully understand the proposed treatment. Please note you can also contact your clinical nurse specialist at any point, if you require further information, advice or support.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Upper GI Clinical Nurse Specialists on (01482) 624349 or 624350

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

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We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

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