Pancreatic cancer

A demanding malignancy, where the position of the organ hides early symptoms — and where supportive care does not follow treatment but accompanies it.

What it is

Pancreatic cancer usually arises in the exocrine part of the gland. It is among the most demanding malignancies, largely because the anatomical position of the pancreas allows a tumour to grow without clear symptoms.

Symptoms and diagnosis

Painless jaundice, persistent upper abdominal pain radiating to the back, unexplained weight loss or new-onset diabetes in later life are findings that need prompt investigation.

Work-up relies on CT with a dedicated pancreatic protocol and endoscopic ultrasound with biopsy.

Genetic testing

Testing for BRCA1/2 and PALB2 has double value: it influences systemic treatment choice and it concerns relatives. For that reason it is discussed with a broader group of patients than in other tumours.

Treatment options

When the tumour is resectable, surgery is combined with chemotherapy before or after. In borderline resectable or locally advanced disease, systemic treatment comes first, aiming to make surgery possible.

Pain control, pancreatic enzyme replacement and nutritional support begin on day one. In pancreatic cancer, supportive care does not follow treatment — it accompanies it.

How this is approached at the practice

Every case is discussed in a multidisciplinary team meeting (MDT) — surgeon, radiation oncologist, pathologist, radiologist and, where needed, psycho-oncologist and dietitian. The treatment decision is not made by one doctor alone.

Before any treatment is proposed, the tumour undergoes full molecular and immunohistochemical characterisation, so the choice targets your specific biology rather than a generic protocol. Every alternative is presented with its trade-offs, and a second opinion is treated as an ally.

Biomarkers tested

Molecular and immunohistochemical characterisation is done before treatment is chosen, so the decision rests on this particular tumour’s biology.

Frequently asked questions

Is there screening for pancreatic cancer?

Not for the general population. Surveillance programmes exist only for very high-risk groups, such as carriers of specific variants or people with a strong family history.

Is new-onset diabetes a warning sign?

In the great majority of cases diabetes has another cause. When it appears suddenly in later life, without risk factors and alongside weight loss, it does merit investigation.