Pancreas, gallbladder and bile duct cancers
Cancers of the pancreas and the bile drainage system. Jaundice is often the first sign.
Which cancers are included?
- Pancreatic cancer
- Gallbladder cancer
- Bile duct cancer (cholangiocarcinoma)
- Periampullary cancers, where the bile duct and pancreas open into the intestine
Warning signs
- Yellow eyes or skin (jaundice), often with itching
- Dark urine and pale stools
- Pain in the upper abdomen or back
- Losing weight without trying, or loss of appetite
- Diabetes appearing for the first time in later life, along with any of the signs above
How it is diagnosed
- Blood tests, including liver function and the CA 19-9 tumour marker
- Contrast CT scan designed to look at the pancreas, and MRI/MRCP to look at the bile ducts
- Endoscopic ultrasound, which can also take a biopsy
- ERCP, an endoscopic procedure to place a stent if jaundice needs to be relieved
Treatment
When the cancer can be removed, surgery offers the best chance of cure. Common operations are:
- Whipple operation for tumours in the head of the pancreas or around the ampulla
- Distal pancreatectomy for tumours in the body or tail of the pancreas
- Radical cholecystectomy for gallbladder cancer, which removes the gallbladder with a small part of the liver and the nearby lymph nodes
Chemotherapy is often given before or after surgery. Some of these operations can be done with robotic or keyhole techniques in selected patients.
Recovery
- These are major operations, and the hospital stay is longer than for most cancer surgery.
- Some people need digestive enzyme capsules with meals, and blood sugar checks after pancreatic surgery.
Common questions
Do gallstones cause gallbladder cancer?
Most people with gallstones never get cancer. Long-standing gallstones are a known risk factor, though, and sometimes cancer is found unexpectedly after the gallbladder is removed for stones. If this happens to you, see a cancer surgeon promptly, because further surgery may be needed.
What is a Whipple operation?
A Whipple operation (pancreaticoduodenectomy) removes the head of the pancreas, part of the small intestine, the gallbladder and the end of the bile duct, then reconnects the digestive system. It is a major operation, best done in a centre that performs it regularly.
Why do I need a stent before surgery?
If jaundice is severe, a small tube (stent) may be placed in the bile duct during an endoscopy to let bile drain. This helps the liver recover and makes later treatment safer.