Pancreatic cancer.
A plain-language guide to what pancreatic cancer is, the symptoms worth acting on, how it is diagnosed, and what treatment looks like in Australia. For patients, families and anyone trying to make sense of a referral.
What pancreatic cancer is.
The pancreas is a gland about the length of your hand, sitting deep behind the stomach and in front of the spine. It does two jobs. It makes enzymes that break down fat, protein and carbohydrate, and it makes hormones including insulin, which controls the sugar in your blood.
Most pancreatic cancers start in the cells lining the ducts that carry those enzymes out of the gland. This is called pancreatic ductal adenocarcinoma, or PDAC, and it is the large majority of cases. Less common types begin in the cells that produce hormones, or in other cells of the gland, and they behave and are treated differently.
In Australia, pancreatic cancer is one of the least survivable cancers. The reason is not that it is untreatable. It is that it is usually found late.
Also called: pancreatic adenocarcinoma, PDAC, cancer of the pancreas.
Why it is so often found late.
A small tumour in the pancreas cannot be felt on examination, and it does not show up on a routine blood test. Early symptoms are vague: indigestion, tiredness, a change in appetite, a change in bowel habit. None of those points clearly at the pancreas, so they are easily explained away, by you and by your doctor.
The cancer also tends to spread early, through lymph nodes and along nerves, before it causes obvious trouble. By the time it produces the symptom people most often remember, jaundice or pain, it has usually been growing for some time.
This is the reason the research we fund concentrates on finding pancreatic cancer earlier and on treating it better when it is found. It is also the reason we would rather you asked a question too many than one too few.
If you are worried, say so directly. Ask your GP for a longer appointment, describe what has changed and when it started, and ask whether a scan is warranted. Bringing someone with you helps, and so does a written list.
Symptoms worth taking to a GP.
None of these means you have pancreatic cancer, and most people who have them do not. The reason to act is persistence, or several of them arriving together, particularly if you are over 50 or have a family history.
Jaundice
Yellowing of the skin or the whites of the eyes, often with pale stools, dark urine and itchy skin. In pancreatic cancer, this usually means a tumour is pressing on the bile duct.
Upper abdominal or back pain
A dull ache in the upper abdomen that may spread to the middle of the back. It is sometimes worse after eating, or when lying flat.
Weight loss you did not plan
Losing weight without changing your diet or activity, or clothes feeling loose before anything else has changed.
Feeling full, nausea, fatty stools
Feeling full after a few mouthfuls, ongoing indigestion, nausea, or stools that are pale, greasy, float and are hard to flush.
New or worsening diabetes
Diabetes diagnosed for the first time after 50, or diabetes that suddenly becomes harder to control, is worth investigating.
Tiredness and blood clots
Unusual fatigue, or a clot in the leg or lung without an obvious cause. Both are recognised signs of pancreatic disease.
Two to three weeks is a reasonable threshold for vague symptoms such as indigestion, tiredness or a change in appetite. If something has lasted that long, is getting worse, or has arrived with company, book a longer appointment and tell your GP what has changed. Some symptoms do not wait: jaundice, vomiting blood, black stools or severe pain need to be seen now, not in two weeks. You do not need to be certain anything is wrong to ask the question.
How it is diagnosed.
The weeks after a referral follow a sequence that nearly everyone moves through. Knowing the order makes each appointment less frightening.
Seven steps, usually over two to four weeks.
Timing varies. The timeframes above are typical, not guaranteed, and a biopsy that comes back inconclusive may need repeating. If a result is taking longer than you were told, it is always reasonable to call your clinical nurse consultant and ask.
What treatment looks like.
Surgery
Surgery is the only treatment that can cure pancreatic cancer, and only a minority of people are able to have it when the cancer is first found. Where the cancer sits decides the operation. Cancer in the head of the pancreas is usually removed with a Whipple procedure, also called a pancreaticoduodenectomy. Cancer in the body or tail may need a distal pancreatectomy, and occasionally the whole gland is removed.
These are major operations, done in specialist centres, and recovery takes weeks rather than days. Most people need pancreatic enzyme replacement and dietitian support afterwards, and some develop diabetes.
Chemotherapy and radiotherapy
Chemotherapy may be given before surgery to shrink the cancer, after surgery to reduce the chance of it returning, or as the main treatment when surgery is not possible. Radiotherapy is used in selected situations, often to control pain or treat a local recurrence. Your team will explain which combination is being recommended and why.
Supportive and palliative care
Supportive care is not the same as giving up. It is the part of treatment that manages pain, nausea, nutrition, enzymes, diabetes and fatigue, and it can run alongside active treatment from the very beginning. Palliative care teams are experts in quality of life, and involving them early is associated with better outcomes, not worse ones. Advance care planning, which records what matters to you and who can speak for you, can start at any stage and is not only for the end of life.
Clinical trials
Pancreatic cancer is an area where trials matter, and there are often studies open at Australian centres. Asking your oncologist whether a trial is suitable for you is always reasonable, at any stage of treatment.
Bring your questions. Our education section includes a question list for each appointment, and a glossary of every term you are likely to hear. Read the full patient guide.
The research we fund.
Everything below is funded by donors, and each project answers a question that came out of the operating theatre or the clinic.
Australian Pancreatic Cyst Registry
Intraductal papillary mucinous neoplasms, or IPMNs, are precancerous cysts in the pancreas that can change over time into pancreatic cancer. This registry follows people diagnosed with an IPMN to identify who is at real risk, so that surveillance can be aimed at them and safely reduced for everyone else.
Finding pancreatic cancer earlier is the single biggest lever we have on survival.
HIIT Cancer
A randomised controlled trial of high intensity interval training in the days immediately after major foregut cancer surgery, including pancreatic resection. It tests whether structured exercise in hospital improves recovery compared with bed rest.
Better decisions in surgery
A program using artificial intelligence and machine learning to support surgical decision making, from pre-operative planning to predicting complications, so that the right operation is offered to the right patient.
A family who lived it.
Michael Turner played 165 games for Geelong and captained the club. When he was diagnosed with pancreatic cancer, he and his family chose to speak about it publicly, and to ask that support go to research and to the people caring for patients.
His story is one of the reasons we do this work, and it is worth reading in full.
Questions people actually ask.
What are the first signs of pancreatic cancer?
Early pancreatic cancer often causes no clear symptoms. When it does, the most common are jaundice, pain in the upper abdomen that may spread to the back, unexplained weight loss, loss of appetite, nausea, and new or worsening diabetes. These symptoms are common and usually have other causes, so the reason to see a GP is that they persist or arrive together, especially after age 50.
Is pancreatic cancer hereditary?
Most pancreatic cancers are not inherited, but roughly one in ten people with pancreatic cancer has a family history or an inherited gene change that raises their risk. Genes involved include BRCA1, BRCA2, PALB2, CDKN2A and the Lynch syndrome genes. If two or more close relatives have had pancreatic cancer, tell your GP. A family cancer clinic can assess whether surveillance is appropriate for you.
How is pancreatic cancer diagnosed?
A contrast CT scan of the abdomen is usually the first test, because it shows where the tumour is and whether it has spread. An MRI, PET scan or endoscopic ultrasound may follow, and a biopsy taken during endoscopic ultrasound confirms the diagnosis. Blood tests such as liver function and CA19-9 are used alongside imaging, but neither is a screening test.
Can pancreatic cancer be cured?
Surgery is the only treatment that can cure pancreatic cancer, and only a minority of people are able to have it when the cancer is first found. For everyone else, chemotherapy, radiotherapy and supportive care can control the cancer, relieve symptoms and extend life. Clinical trials are an option at every stage.
What is the Whipple procedure?
The Whipple procedure, or pancreaticoduodenectomy, removes the head of the pancreas along with the first part of the small bowel, part of the bile duct, the gallbladder and sometimes part of the stomach. It is the most common operation for cancer in the head of the pancreas, it is performed in specialist centres, and recovery takes several weeks.
What research into pancreatic cancer does The HOPE Fund support?
We fund the Australian Pancreatic Cyst Registry, which follows people with IPMNs to work out who is at risk of developing pancreatic cancer, the HIIT Cancer trial of exercise immediately after major foregut surgery, and a program using artificial intelligence to improve surgical decision making. See the full list of projects.
This page is general information, not medical advice. It is written for people in Australia and does not replace a conversation with your own treating team, who know your history and your scans. If you are worried about a symptom, see your GP. In an emergency, call 000.
Related guides.
Liver cancer
Primary liver cancer begins in the liver itself, most often in people with long-standing liver disease or cirrhosis. The liver can also be a site where cancers from elsewhere spread, which your team will distinguish carefully.
Read the liver cancer guideBiliary tract cancer
Begins in the bile ducts (cholangiocarcinoma) or the gallbladder. These cancers can block the flow of bile, causing jaundice, a yellowing of the skin and eyes, which is often the first noticeable sign.
Read the biliary tract cancer guideFund the work that finds it earlier.
Every dollar you give goes to a named project in pancreatic cancer research, surgical education or patient care, and every dollar is tracked.