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Beware ‘The Silent Killer’

Throughout World Pancreatic Cancer Awareness Month, NIPANC is raising awareness of this deadly disease in its #TimeMatters campaign to encourage the public to become more aware of the signs and symptoms of the disease and the need for early diagnosis, treatment and research.

To begin week two of the campaign, we have invited one of NI’s leading surgeons, Mark A Taylor CStJ PhD FRCSI FRCS(Eng) FRCS(Gen Surg) to contribute a blog on the ‘time really does matter’ theme to radically improve survival from this ‘silent killer.’

Early diagnosis, timely surgical and chemotherapy treatments and a much greater understanding of this cancer with robust research to understand its biology and the most effective treatments, he says, is how we will change the statistics once and for all!

“There are many pathological conditions affecting the human body that have been labelled as the ‘silent killer’ such as hypertension, cardiomyopathy, carbon monoxide poisoning and even Covid-19.

The lack of specific symptoms or indeed the inability to diagnose until a major complication or even untimely death presents is a feature of such diseases. This is the situation with the most chilling of cancers to be diagnosed with – pancreatic cancer.

Each year in Northern Ireland approximately 266 people are diagnosed with this poor-prognosis cancer with nearly as many people (241) dying of it. Unfortunately, 60% of these people will present at a very late stage (stage 3 or 4) in which cure is extremely unlikely.

Even those who present at an earlier stage still have an uphill battle in which the overall survival is guarded with a 1-year survival of 25.7% and only 6% having a greater than five-year survival.

All cancers are important to detect and treat and none more so than pancreatic cancer. However, why the silent killer? Why is it difficult to diagnose until a late stage?

Firstly, it may not create any symptoms in the early stage or indeed the symptoms may be vague and similar to many common conditions of the upper GI tract. Conditions such as dyspepsia, gallstones, hiatus hernia and IBS are extremely common causes of upper abdominal pain, change in bowel habit and at times jaundice.

However, we must look for clues in terms of symptoms that can at least raise a suspicion that something else is developing. Firstly, persistent symptoms of upper abdominal pain that fail to respond to treatments such as acid tablets or changes to diet.

Such pain in association with ‘unexplained’ weight loss particularly if lasting for a number of weeks or months should prompt the need for further tests. The majority of pancreatic cancers that we see present in the head of the pancreas.

70% of such patients will present with obstructive jaundice which means the passage of very dark urine, stools which are paler in colour than usual, an itch and yellow colouring of the whites of the eyes and skin.

It is critical that if such symptoms appear together that urgent medical attention is sought. Another symptom to be aware of is the persistence of a pain in the upper back particularly in the middle which again fails to respond to simple medical treatments or persists for a prolonged period of time.

Whilst the development of type 2 diabetes is extremely common and indeed rising in our society in association with increased BMI, the development of it in association with some of the other symptoms noted above particularly in an individual who has not had significant weight gain should raise concerns. Finally, other vague symptoms such as fatigue, low mood, pain on eating or associated early fullness whilst eating may feature.

Symptoms to look out for - include:

· Obstructive jaundice (yellow eyes and skin, dark urine, pale stools and itch)

· Persistent upper abdominal pain resistant to acid treatments

· Unexplained weight loss

· Persistent upper back pain

· Diabetes (new onset not associated with weight gain

· Vague persistent symptoms (loss of appetite, low mood, fatigue, early stomach fullness)”

Mr Mark A Taylor is a Consultant HPB Surgeon at the Mater Hospital, Belfast Health and Social Care Trust. He trained in Belfast and at the Regional HPB and Transplant Unit in Edinburgh. His Doctorate of Philosophy was in the pathophysiology of obstructive jaundice. He is the President of GBI Hepato-pancreato-billary Association (GBIHPBA), President Elect of the Pancreatic Society of Great Britain and Ireland.

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