Pancreatic tumours represent one of the deadliest forms of cancer, known for their late detection, aggressive nature, and limited treatment options. Often silent until they reach an advanced stage, these tumours carry a grim prognosis, particularly when diagnosed as pancreatic adenocarcinoma. This comprehensive guide explores the causes, types, symptoms, diagnostic techniques, treatment options, and prognosis for pancreatic tumours.
What Are Pancreatic Tumours?
Pancreatic tumours are abnormal growths that occur in the pancreas. They can be either benign or malignant, with the most dangerous form being pancreatic adenocarcinoma, a type of cancer that originates in the exocrine cells. Less common but clinically significant are neuroendocrine tumours, which arise from hormone-producing cells.
Tumours are categorized by their location:
- Head (most common)
- Body
- Tail
- Ampullary (periampullary region)
Causes and Risk Factors
Pancreatic cancer does not have a single cause, but several risk factors increase its likelihood:
- Smoking: A major modifiable risk factor.
- Chronic Pancreatitis: Long-term inflammation can lead to mutations.
- Diabetes Mellitus: Especially new-onset diabetes can be a sign.
- Family History & Genetics: Mutations in BRCA2, Lynch syndrome, and MEN1.
- Diet and Obesity: High-fat diets and obesity are associated risk factors.
Symptoms Based on Tumour Location
Head of Pancreas:
- Painless progressive jaundice
- Dark urine, pale stools
- Itching and weight loss
- Courvoisier’s sign: Palpable gallbladder without pain
Body of Pancreas:
- Epigastric pain radiating to the back
- Anorexia, weight loss
- Steatorrhoea (fatty stools)
Tail of Pancreas:
- Often silent until metastasis
- Anaemia, ascites, fatigue
General Signs:
- New-onset diabetes mellitus
- Malabsorption due to loss of digestive enzymes
- Loss of appetite and unexplained weight loss
Types of Pancreatic Tumours
1. Pancreatic Adenocarcinoma
- Accounts for 90% of pancreatic malignancies
- Hard, infiltrating mass, most commonly in the head
- Poor prognosis due to early metastasis
- Common spread: liver, lung, peritoneum
- Symptoms: obstructive jaundice, pain, anorexia, weight loss
2. Periampullary Carcinoma
- Originates near the ampulla of Vater
- Often presents with early jaundice
- Higher resectability and better prognosis (up to 50%)
3. Neuroendocrine Tumours
Rare (4–12 per million population)
Classified into:
- Functioning (Insulinoma, Gastrinoma, VIPoma, etc.)
- Non-functioning (often incidental)
May be part of MEN type 1 syndrome
Slower growth and better prognosis (up to 60–90% in localized cases)Diagnostic Approach
Clinical Evaluation
- History of symptoms: jaundice, weight loss, diabetes
- Physical exam: palpable gallbladder, abdominal mass
Imaging and Tests
- Ultrasound: Initial investigation for jaundice
- CT Scan: Best for tumour staging
- EUS with FNA: Allows direct tumour sampling
- MRCP/ERCP: Visualize and relieve bile duct obstruction
- CA 19-9: Useful tumour marker (not diagnostic alone)
Management Strategies
Curative Options
Whipple’s Procedure (Pancreaticoduodenectomy):- Indicated for localized head tumours (T1/T2, no node involvement)
- Only 10–20% of patients qualify
Palliative Treatment
- Biliary stenting (via ERCP): Relieves jaundice
- Gastrojejunostomy: For duodenal obstruction
- Coeliac plexus block: For intractable pain
- Enzyme/Insulin supplements: To manage malabsorption and diabetes
Prognosis and Survival
- Median survival: ~6–11 months for advanced adenocarcinoma
- 5-year survival overall: <5%
- With Whipple resection: ~10%
- Periampullary carcinoma: ~50% post-surgery
- Neuroendocrine tumours: Better outcomes if localized
Case-Based Presentations
Case 1: 65-year-old male with progressive jaundice, dark urine, and weight loss. Imaging reveals head mass. Undergoes Whipple’s surgery. Diagnosis: Periampullary carcinoma.
Case 2: 58-year-old female with back pain and new-onset diabetes. CT shows mass in pancreatic tail with liver metastasis. Managed with palliative care.
Case 3: 42-year-old male with MEN1 syndrome presents with peptic ulcers and hypoglycaemia. Diagnosis: Functioning neuroendocrine tumour (gastrinoma).
Red Flag Symptoms and Referral Criteria
- New-onset dysphagia or jaundice
- Unexplained weight loss or upper abdominal mass
- New dyspepsia >55 years old
- Family history of upper GI malignancy
FAQs About Pancreatic Tumours
Q1. Is pancreatic cancer always fatal?
No, early-stage tumours like periampullary cancers can be curable. However, late detection often leads to poor outcomes.
Q2. What is the Whipple procedure?
A major surgery that removes the pancreatic head, duodenum, part of the bile duct, and gallbladder. It's the only curative option for some cases.
Q3. Are neuroendocrine tumours less dangerous?
Generally, yes. They grow slower and have better outcomes, especially if detected early.
Q4. What is CA 19-9 used for?
A tumour marker to monitor treatment response; not reliable for screening.
Q5. Can pancreatic cancer cause diabetes?
Yes. Loss of insulin-producing islet cells can lead to new-onset diabetes, especially in body/tail tumours.
