NHSGGC Community Palliative Resource Nurse Network

Sophie Heriot
Clinical Nurse Specialist
West of Scotland Pancreatic Unit
Glasgow Royal infirmary
 Objectives

What is pancreatic cancer?

What causes it?

How do we diagnose it?

What are the treatments?

What does the future look like?
 Pancreatic Cancer

5th most common cause of Cancer death in Scotland

90% of patients are diagnosed too late for curative surgery

Average life expectancy following diagnosis is 4-6 months

4% 5 year survival rate following potentially curative

surgery (No significant change in the last 40 years)
 Types of Pancreatic Tumours

Exocrine (95%)- PDAC is most common (80%)

Endocrine (5%)- eg. pNETs

IPMNs (pre-malignant)

Tumours arising from tissues close to the pancreas,

such as bile duct (Cholangiocarcinoma), Ampulla of
Vater (Ampullary Adenocarcinoma) may cause similar
symptoms to pancreatic cancer but have different
treatments and a different prognosis.
 Aetiology

Exact cause is unknown

Tobacco smoking (approx 29% of cases)

Genetics

Age

CP

Diabetes

Obesity
Alarming/Presenting symptoms

New onset diabetes

Nausea and vomiting

Abdominal pain/back pain

Indigestion/heartburn/bloating

Steatorrhoea, diarrhoea

Unexplained weight loss

Jaundice

Symptoms can be vague and some patients may have none at all.
On average patients attend their GP 3-5 times prior to
referral.
 Longer term symptoms

Exocrine insufficiency

Poorly controlled diabetes

Weight loss

Pain

Nausea/vomitting

Medication
Creon, nutritional supplements, analgesia, anti-
emetics
HPB Anatomy
 Diagnosis

Attend GP or local A&E

CT

Referral to a specialist team

EUS and FNA

ERCP, stent and brushings

Combined EUS and ERCP
 Pathway/Staging
Complex and lengthy pathway
Recovery from jaundice impacts staging

Cancer waiting times: 31 day target

62 day target

Additional investigations: MRI liver, CPET, occasionally PETCT

and possibly further fitness evaluation

Clasifications: ABCDE
Impact of Blood Vessels
 Treatment
Curative, Downstaging and Palliative Intent

Biliary stenting

Neo-adjuvant chemotherapy

Concurrent chemotherapy and radiotherapy

Surgery (Pancreaticoduodenectomy)

Palliative chemo

Clinical trials

Palliative care
Pre and Post Surgery Anatomy
 CNS Role
Clinical nurse specialists improve efficiency, reduce
emergency admissions and improve the quality of
cancer care (CNO Bulletin 2010)

Support patients, families and carers throughout cancer

journey

Manage treatment side effects and/or symptom control

Provide nurse-led services that free up consultant resource

Manage individual patients cancer pathways

Facilitate rapid re-entry into acute services if appropriate
 Research/Trials

BOC- Clinical trials

Understanding mechanisms that lead to tumour growth in

pancreatic cancer – University of Oxford

Identifying sub-types of pancreatic cancer and tailoring

effective treatments- Institute of Cancer Research

Finding the right treatment for the right patient in

pancreatic cancer – University of Glasgow
 Thank you
Discussion and questions
 Useful Websites

http://www.pancreaticcancer.org.uk/

https://pancreaticcanceraction.org/

http://www.isdscotland.org/Health-Topics/Waiting-
Times/Cancer/

https://www.pancanscot.org/

http://www.woscan.scot.nhs.uk/

http://elearning.rcgp.org.uk/course/info.php?id=103

http://www.nhsinform.co.uk/health-
library/articles/c/cancer-of-the-pancreas/introduction/