The London Clinic Latest on Pancreatic Cancer

As Pancreatic Cancer Awareness month draws to a close, Mr Satya Bhattacharya, Consultant Surgeon and specialist in pancreatic disease at The London Clinic explains about the disease, symptoms, diagnosis and future treatments.

According to the charity Pancreatic Cancer Action, it is the fifth biggest cancer killer in the UK and has the worst survival rate of the 22 most common cancers. Nearly half of people are diagnosed as an emergency in our A&E system and at late diagnosis, the average life expectancy is four to six months.

What should people look out for and when should they seek help?

Individuals who are suffering from persistent, upper abdominal discomfort, back pain, a sudden loss of weight, should see their GP promptly. Of course there are many other (more common and less sinister) conditions that can cause these same symptoms, and it will be up to their GP to decide what tests to ask for. But an early CT scan may help.

Is there anything positive an individual can do to limit the risk of getting pancreatic cancer?

It is always best to avoid smoking, drinking to excess and becoming overweight, if you wish to reduce your risk of developing a cancer. Certain individuals have a higher than average risk of getting pancreatic cancer, such as those with a very strong family history, those with certain genetic cancer syndromes, those with hereditary pancreatitis or even chronic pancreatitis from any cause. Such individuals may benefit from regular surveillance, but what form this surveillance should take is not always clear, and often depends on the doctor and the patient’s preferences.

What are the biggest changes with regards to pancreatic cancer and its treatment that have occurred in your time?

1) We have got a lot better at doing operations on the pancreas. Surgical outcomes have improved significantly and the numbers of complications and post-operative deaths have plummeted, especially in big centres that do these operations often. Patients can expect to return to a reasonably normal quality of life afterwards.

2) The other very encouraging development over the past decade has been new chemotherapy regimens for pancreatic cancer. We now have several new regimens such that seem to have much better response rates. I feel we are seeing a chink in the beast’s armour.

3) A large proportion of patients who undergo surgery may still see the cancer coming back over the following months or years so we need to improve the outcomes from surgery. The use of chemotherapy after surgery has been a step in the right direction.

Does technology play an important part in the field?

Yes. The diagnosis of pancreatic cancer involves complex scans (CT, MR) and the quality of these have improved dramatically over the past two decades. We are able to pick up lesions the size of a pea. In the operating room, we use various pieces of complex equipment, even a robot, so operations have become safer and quicker, and the incisions have got smaller.

Why is so little known about pancreatic cancer?

Pancreatic cancer has a much lower public profile that cancer of the breast, lung or colon. We need to work at raising its profile, and ensure greater research funding for this particular cancer.

If you had a magic wand and could solve one mystery surrounding the disease, what would it be?

I would want to see a test to identify a substance released by the tumour into blood, urine or stool that is sensitive and specific enough to become a widely used screening test, like PSA for prostate cancer. In other words, I would like to see a bio-marker.

Are there different types of pancreatic cancer?

Pancreatic cancer largely refers to pancreatic ductal adenocarcinoma (PDAC). But there are other tumours that fall within the bundle of “pancreatic cancer” and these may include bile duct cancer, ampullary cancer, or neuroendocrine tumours. Most of these – especially if surgically resected – carry a better prognosis than PDAC.

With regard to your specialty, what kind of conditions or diseases do you treat and why did you choose to specialise in this area?

My subspecialty is Hepato-Pancreato-Biliary (HPB) Surgery and I do my NHS work at Barts. I look after patients with cancers of the liver, pancreas and bile ducts. I also look after people suffering from gallstones and from pancreatitis. I was a registrar at the Royal Free, rotating through the various subspecialties within General Surgery, and when I worked in the HPB unit, I realised this was what I really wanted to do.

What are the skills that a surgeon working in your field needs?

All surgeons need technical ability, clinical judgement, empathy towards the patient and the ability to communicate clearly. In HPB surgery, a surgeon needs the stamina to cope with long, complex operations that often go on for 5-6 hours. Beyond that, one needs to manage one’s time, work within a team, stay abreast of the field, teach and train.

What satisfies you most about what you do?

When I take my gloves off after doing a long and complex operation that has gone well, I probably feel the same kind of satisfaction that a painter feels when he steps back and looks at a large painting that he has just finished. That is a good feeling.