Pancreatic Cancer

Pancreatic cancer is cancer that starts in the pancreas. The pancreas is an organ (a gland) in the digestive system that makes juices and hormones that help with digestion. It also produces insulin which controls blood sugar levels.

Pancreatic cancer is when abnormal cells start to divide and grow in the pancreas and then form a growth (a tumour). These abnormal cells can stop the pancreas from working properly.

We talked to 40 people about their experiences with pancreatic cancer. 

A consultant talks about a common type of pancreatic cancer, pancreatic adenocarcinoma, and a less common type, neuroendocrine pancreatic cancer

A consultant talks about a common type of pancreatic cancer, pancreatic adenocarcinoma, and a less common type, neuroendocrine pancreatic cancer

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And are there different types of pancreatic cancer?

 

Yes, there are two common types and the normal pancreas cells do two things. They’re involved in digestion, generating enzymes that help to break up our food. Or they’re also involved in hormone production, in particular insulin.

 

Now each of those different functions are generated by different cells of the pancreas, and if those cells go wrong they create different types of pancreatic cancer. The common one, we know as pancreatic adenocarcinoma is the one associated with the cells associated with our digestive system. And that’s a particularly aggressive type of cancer.

 

Another one which is less common we call pancreatic neuroendocrine cancer, and this tumour arises from cells that seem to have an hormonal function, sometimes generating the insulin, so you can form things like insulinomas, but sometimes actually arising from other hormonal cells, both in the pancreas and in other parts of the body, whose function we don’t fully understand. But these tumours we call neuroendocrine carcinomas and they tend to have a less aggressive pattern of behaviour. And it’s important to know which type you have because you treat them very differently. 

Types of Pancreatic Cancer

There are different types of pancreatic cancer that behave and are treated differently. Most of the people we talked to said that they had no idea which type of pancreatic cancer they had. However, some were sure they had the most common type: an adenocarcinoma, which is when the cancer starts in the cells that line the ducts of the pancreas.  

Two people, Vicky (interview 15) and Peter (interview 36), knew that they had a neuroendocrine tumour (NET) in the pancreas, which is a rare tumour that develops from abnormal neuroendocrine cells (see below).

A consultant explains what cancer is and why it may develop in any part of the body.

A consultant explains what cancer is and why it may develop in any part of the body.

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So cells in the body are continually growing and dying, and they have to be replenished normally. And so the cells normally grow and divide under a very controlled process, but sometimes that controlled process goes wrong and uncontrolled growth leads to cancer. And this can happen in any organ of the body, such as the pancreas, and generate what we know as pancreatic cancer.

Pancreas cancer is organised into 2 distinct groups: exocrine pancreatic cancers and endocrine pancreatic tumours. 

Exocrine pancreatic cancers are those that start in cells that make pancreatic digestive juices and include the following types: 

• Adenocarcinomas: cancer that starts in the cells that line the ducts of the pancreas.
• Cancer of the acinar cells: cancer that starts in the cells that are at the ends of the ducts that make pancreatic juices.
• Cystic tumours: tumours that cause a fluid filled sac (a cyst) to form in the pancreas, and may be benign (non-cancerous) or malignant (cancerous).

Endocrine pancreatic tumours (pancreatic neuroendocrine tumours (PNETS), islet cell tumours) start in the endocrine pancreas, which is the part of the pancreas that produces insulin and other hormones and then releases them into the bloodstream.  

Neuroendocrine tumours (NETs) of the pancreas are a rare type of endocrine pancreatic cancer that starts in the neuroendocrine cells of the pancreas. These are grouped into functioning and non-functioning types of cancer.

• Functioning pancreatic NETs are those that make hormones that cause symptoms.
• non-functioning pancreatic NETs either do not make hormones or make hormones that don’t cause symptoms.