Diagnosing pancreatic cancer requires a systematic approach involving various diagnostic tests and procedures to confirm the presence of cancer, determine its stage, and plan appropriate treatment. Here’s an overview of how pancreatic cancer is typically diagnosed:

1. Medical History and Physical Examination: Medical professionals begin by taking a detailed medical history, including symptoms the patient may be experiencing, risk factors such as smoking, family history of cancer, diabetes, and previous medical conditions. A thorough physical examination may reveal signs such as jaundice (yellowing of the skin and eyes), abdominal tenderness, or palpable masses in the abdomen.

2. Imaging Studies: Imaging techniques play a crucial role in diagnosing pancreatic cancer and assessing its extent. Computed tomography (CT) scans and magnetic resonance imaging (MRI) provide detailed images of the pancreas and surrounding structures, helping to identify tumours, their size, location, and whether they have spread to nearby organs or lymph nodes. Endoscopic ultrasound (EUS) combines endoscopy with ultrasound imaging to obtain high-resolution images of the pancreas and surrounding tissues, facilitating the detection of small tumours and guiding biopsies.

3. Biopsy: A biopsy is the definitive method to diagnose pancreatic cancer. It involves obtaining a tissue sample from the pancreas, typically guided by imaging techniques such as EUS or CT scan. During a biopsy, a thin needle is inserted through the skin or through an endoscope into the pancreas to collect cells or tissue for examination under a microscope by a pathologist. Biopsy results confirm the presence of cancer, determine the type (e.g., adenocarcinoma, neuroendocrine tumour) and grade of the tumour, and provide essential information for treatment planning.

4. Tumour Markers and Blood Tests: Blood tests may be performed to measure levels of certain substances in the blood, such as CA 19-9 and CEA (carcinoembryonic antigen), which may be elevated in patients with pancreatic cancer. While these markers are not definitive for diagnosis, they can help monitor treatment response and detect recurrence.

5. Pancreatic Function Tests: Pancreatic function tests assess the ability of the pancreas to produce digestive enzymes and insulin. Changes in pancreatic function may occur with pancreatic cancer, leading to symptoms such as diabetes or malabsorption. These tests help evaluate the impact of cancer on pancreatic function and guide supportive care measures.

Treating pancreatic cancer requires a comprehensive approach tailored to each patient’s specific circumstances, including the stage of the cancer, its location within the pancreas, and the individual’s overall health. Here’s an overview of how pancreatic cancer treatment works:

1. Surgery: Surgery is considered the primary treatment for pancreatic cancer if the tumour is localised and operable. The goal of surgery is to remove the tumour along with a margin of healthy tissue surrounding it. Depending on the location and size of the tumour, surgical procedures may include pancreaticoduodenectomy (Whipple procedure) for tumours in the head of the pancreas, distal pancreatectomy for tumours in the body or tail, or total pancreatectomy for extensive disease. Lymph nodes and nearby tissues may also be removed to reduce the risk of recurrence.

2. Chemotherapy: Chemotherapy uses drugs to kill cancer cells or slow their growth. It may be used before surgery (neoadjuvant chemotherapy) to shrink tumours and make them easier to remove, or after surgery (adjuvant chemotherapy) to destroy any remaining cancer cells and reduce the risk of recurrence. For advanced pancreatic cancer that cannot be surgically removed, chemotherapy may be used as the primary treatment to help control the disease, relieve symptoms, and improve quality of life.

3. Radiation Therapy: Radiation therapy uses high-energy beams, such as X-rays or protons, to target and destroy cancer cells. It may be used in combination with surgery and/or chemotherapy (chemoradiation) to shrink tumours before surgery, reduce the risk of recurrence after surgery, or alleviate symptoms such as pain and obstruction caused by the tumour pressing on nearby organs.

4. Targeted Therapy: Targeted therapy drugs specifically target molecules or pathways involved in the growth and spread of cancer cells. Drugs such as erlotinib and cetuximab may be used to treat pancreatic cancers with specific genetic mutations, such as those in the EGFR (epidermal growth factor receptor) pathway. Targeted therapies are often used in combination with chemotherapy or as second-line treatments for advanced or recurrent pancreatic cancer.

5. Immunotherapy: Immunotherapy drugs boost the body’s immune system to recognize and attack cancer cells. Checkpoint inhibitors, such as pembrolizumab and nivolumab, are being studied in clinical trials for their potential to treat pancreatic cancer by blocking proteins that inhibit immune response. Immunotherapy is currently being explored as a treatment option for pancreatic cancer, particularly in combination with other therapies or in patients with specific biomarkers.

6. Palliative Care: Palliative care focuses on improving the quality of life for patients with advanced pancreatic cancer or those experiencing significant symptoms. It includes pain management, nutritional support, psychological support, and assistance with symptom control to enhance comfort and well-being.

7. Clinical Trials: Clinical trials evaluate new treatments and therapies for pancreatic cancer, including innovative drugs, targeted therapies, immunotherapies, and combinations of treatments. Participation in clinical trials may offer access to promising new therapies that are not yet widely available and contribute to advancements in pancreatic cancer treatment.

In summary, treating pancreatic cancer requires a coordinated effort among healthcare professionals to provide a combination of surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy, and supportive care. The goal is to optimise treatment outcomes, improve quality of life, and provide patients with the best possible care throughout their cancer journey.