Whenever we think of cancer we always have the image of a big spot somewhere visible on our body with lots of masses around it, but have you ever thought about the fact that the deadliest cancers are not visible to naked eyes?

Let’s talk about pancreatic cancer which is the deadliest cancer around the world and not easy to detect at early stages.

What is the pancreas?

The pancreas is a 6-inch long organ located behind the stomach in the back of the abdomen. It is spongy and shaped somewhat like a fish, extended horizontally across the abdomen. The head of the pancreas is on the right side of the abdomen where the stomach is attached to the first part of the small intestine (the duodenum). The tail of the pancreas - its narrowest part - extends to the left side of the abdomen next to the spleen.

The pancreas contains exocrine and endocrine glands that create pancreatic juices, hormones, and insulin. Pancreatic juices, or enzymes, made by the exocrine glands are released into the intestines by way of a series of ducts in order to help digest fat, proteins, and carbohydrates. Over 95% of the pancreas is made up of exocrine glands and ducts. The endocrine cells are arranged in small clusters called islets of Langerhans, which release insulin and glucagon into the bloodstream. These two hormones manage levels of sugar in the blood. When they are not working properly, the result is often diabetes. If we make a conclusion of above paragraph it means we cannot live without a pancreas.

Pancreatic cancer doesn't usually give rise to any symptoms or signs in the early stages. This is the main reason why it can be so difficult to detect and diagnose. As cancer grows the symptoms it causes will depend on the type of pancreatic cancer and where it is in the pancreas.

Symptoms can be quite vague and may come and go at first. An example is an abdominal pain, which may start off as occasional discomfort before becoming more painful and more common. The symptoms can also be a sign of other more common illnesses such as pancreatitis, gastritis, gallstones or hepatitis. This means that people may end up seeing their doctor several times or being sent for a number of different tests before pancreatic cancer is even considered. It is important to remember that any of the symptoms described here are common for lots of illnesses and may not be a sign of pancreatic cancer.

But if you have persistent unexplained symptoms it's important for your doctor to refer you for tests to explore what is causing them. It can help to note down the frequency of your symptoms and mention anything unusual that you are experiencing, even if it seems unrelated. If your symptoms get worse or you develop any new symptoms suddenly you should always get in touch with your doctor.

For example a patient who keeps having abdominal pain may usually have the doctor send himher to a specialist in digestive system who will access if it is something to do with the patient's digestive system or any other related issue. This process will take some time and delay the process of cancer diagnosis. This is because sending patient for many different tests such as ultrasound, blood test or other tests to rule out digestive system disease delays the process. The patient could be referred to many other specialists such as urologist for investigation.

So what are the symptoms of pancreatic cancer?

Signs and symptoms of pancreatic cancers are very common to any other disease even if we have common stomach bug or fever we could develop same signs and symptoms.

Abdominal pain

Pain is a symptom in about 70% of pancreatic cancer cases. It often starts as general discomfort or pain in the abdomen (tummy) which can spread to the back. It can be worse after eating or when you are lying down. Sitting forward can sometimes relieve the pain. At first, the pain may come and go, but over time, it may become more constant. If any of the organs (pancreas, liver or gall bladder) in your abdomen are inflamed or enlarged the area may also be tender to touch. Pain is caused by cancer affecting nerves or organs near the pancreas. It can also be a result of a tumour causing a blockage in the stomach or duodenum (top part of the small intestines).

Jaundice

Jaundice occurs in about 50% of pancreatic cancer cases. The most common signs of jaundice are that the skin and the whites of the eyes turn yellow. Other signs include dark urine, pale stools (poo) and itchy skin.

Jaundice develops when there is a build-up in the blood of a substance called bilirubin. The substance is a by-product of red blood cells breaking down and is always present in the blood. It usually gets removed from the body in the bile fluid produced by the liver which empties into the small intestines through the bile duct. Cancer growing in the pancreas can block the bile duct so that bile and bilirubin keep building up in the body. This is known as obstructive jaundice.Jaundice can be caused by other non-cancerous conditions, such as a gallstone blocking the bile duct, so it's important for all the obvious causes to be explored. 

Weight loss

Losing a lot of weight for no particular reason can be a sign that something is wrong. People may also notice a loss of appetite or changes in what they feel like eating.Pancreatic cancer can affect the ability of the pancreas to produce digestive enzymes that help to digest food, especially high-fat food. This means that the body can't digest food properly or get the nutrients it needs, leading to weight loss.

There are few treatment options for pancreatic cancer such as surgery, chemotherapy, radiography.

Pancreatic Cancer Survival Rates

Stage	5-Year Survival Rate
Stage 1A	14%
Stage 1B	12%
Stage 2A	7%
Stage 2B	5%
Stage 3	3%
Stage 4	1%

*Neuroendocrine tumour pancreatic cancer is a rare type of pancreatic cancer that develops in the cells responsible for creating insulin and glucagon. Survival rates for this type of pancreatic cancer are different than the more common type of pancreatic cancer, exocrine pancreatic cancer

As mentioned above, treatment is not very effective at the moment due to late detection of cancer but there are a lot of research going on around the world to help with early detection and finding effective medicine.  For now it is a silent killer.