Pancreatic Cancer Diagnosis and Referral to a Specialist

NICE (The National Institute for Health and Clinical Excellence) produced updated guidelines on referral for suspected cancer in June 2005. In these guidelines pancreatic cancer isn't covered as a separate cancer but it is included in guidelines for all upper gastrointestinal(GI) cancers which includes oesophageal, gastric (stomach) and pancreatic cancers. Within the upper GI section the statement on symptoms are general so that no one with any kind of suspected upper GI cancers is missed out. This is not a section on the diagnosis of specific upper GI cancers, this would have to be made by a specialist in secondary care and not the GP. Unfortunately in the leaflet provided for patients/public the pancreas isn't mentioned in the section on upper gastrointestinal cancers. This is a mistake as the guidelines themselves do include pancreatic cancer as can be seen by reading the full guidelines document and the evidence on which the guidelines are based. Here we separate out the guidelines that obviously relate to pancreatic cancer, although some symptoms of pancreatic cancer, such as nausea and vomitting, are covered by other parts of the upper GI guidelines.

From review of all literature and evidence they summarised the evidence as:

• Smoking is a risk factor for pancreatic cancer

• The most common presenting symptom of pancreatic cancer is abdominal pain occuring in approximately 70% of cases

• Janudice is the next most common feature occuring in approximately 50% of cases

• Non-specific symptoms and signs are common in pancreatic cancer, and include nausea and vomiting, weight loss, change in bowel habit and onset of diabetes

Out of the general guidelines for upper gastorintestinal cancers those most appropriate for pancreatic cancer are:

• A patient who presents with symptoms suggestive of upper gastrointestinal cancer should be referred to a team specialising in the management of gastrointestinal cancer, depending on local arrangements.

• An urgent referral should be made for patients presenting with either:
  • unexplained upper abdominal pain and weight loss, with or without back pain, or
  • an upper abdominal mass without dyspepsia

• In patients with obstructive jaundice an urgent referral should be made, depending on the patient's clinical state. An urgent ultrasound investigation may be considered if available.

• In patients where the decision to refer has been made, a full blood count may assist specialist assessment in the outpatient clinic. This should be carried out in accordance with local arrangements.

CancerHelp UK have produced a good summary for patients of the guidelines and the problems of diagnosis under the heading Should I see a pancreatic cancer specialist?

NICE 2005 guidelines on Referral for suspected cancer