Often dubbed “the silent killer”, pancreatic cancer has one of the least successful outcomes of all types of the disease. With roughly 600 cases diagnosed in Ireland each year, it is not as common as other forms of cancer.
But while incidence rates may be at the lower end of the scale – the rate of skin cancer is roughly 13,000 annually – it has a poor survival rate, with five out of six people with pancreatic cancer dying from the disease. However, although the signs can be very difficult to spot, as in the early stages they can be similar to other less serious conditions, the sooner the patient is diagnosed the better chances they have of survival.
Susan McSweeney can attest to this as she was diagnosed with the disease in early 2024. Thankfully, she was very vigilant about her health and went to see her GP as soon as she began to feel unwell.
“I went to my doctor with a cough, which was initially diagnosed as reflux,” she says. “But when my GP felt around my back she thought that it seemed tender around the lower left area,” says Susan. “Because I am quite fit and went to the gym three times a week, and also love walking and mountain biking, I had brushed it [the tenderness] off as muscle strain, but my doctor said it might be a good idea to get a ultrasound as there would be ‘no harm’ in doing one.
“There is a clinic in Blackrock village [in Dublin] where you can have a walk-in ultrasound, so, although I had a referral, I didn’t need it to go there – so I went off and had it done and the results showed up a blockage in my pancreatic duct. After that, the doctor referred me to a gastroenterologist – even though she thought I was in good health because I was not jaundiced. But although she seemed in no rush to push things forward, I decided to change to St Vincent’s hospital [with the initial referral] where there was definitely a much greater sense of urgency.”
Although the now 54-year-old, who lives in Dublin with her husband James and two grown-up sons, was sent for further tests, the results were a complete shock. “I underwent an endoscopic ultrasound and was told that a biopsy was to be taken, but afterwards they said that no biopsy was retrieved. I received a call a few days after the scan to say that an MRI that I was booked in for was being brought forward.
“Hearing this set off alarm bells and then, when we met my consultant, I was told that I had a tumour. James and I were completely shell-shocked – I just can’t explain what it felt like hearing those words. Apparently, the biopsy could not be taken because the tumour – which was a PT1C N0 grade – was too near the gastroduodenal artery. They mentioned the word ‘Whipple’, which was almost too much to take in at the time, but I was told that I had been booked in for Whipple surgery – which involves removing the affected part of pancreas, bile duct, duodenum and part of the stomach – on April 19th, 2024.
“I had no doubt that it would be a very tough surgery and afterwards I was in hospital for three weeks because my stomach was not emptying. I was fed by TPN [total parenteral nutrition] for the whole time, which meant that I could not have any water or food by mouth – and I would say that, without a doubt, that was the toughest part.
“Then, about six weeks after the operation, I saw my oncologist and was told that I would be given six months [12 rounds] of Folfirinox – and I started chemotherapy on July 3rd. It involved one day each week in hospital getting chemotherapy through a port [on a Wednesday], then bringing the chemo home with me in a pump for 46 hours and going back to St Vincent’s hospital on a Friday afternoon to be disconnected.
“The first few months were not too bad and I was still swimming and walking and only felt sick for a couple of days after having my chemo. But that all changed from September when the cumulative effect of the treatment started to kick in. I know that everybody is different, but it is a very rough regime.”
The mother of two, who runs a family law firm in Dublin, underwent her last session of chemotherapy in December and says she is doing well and is positive about her recovery. She is grateful for all the support she received during her gruelling ordeal and says she is so fortunate to be here today and would encourage everyone, including GPs, to know the vital signs which could save someone’s life.
“The care that I have received from St Vincent’s oncology has been amazing. In spite of all the hardship involved in going on in the ward, everyone seems upbeat and that is down to the phenomenal nursing staff who have been there with me every step of the way. I have had two admissions to A&E throughout my treatment, for viruses, but never felt nervous or afraid, as I have been so well looked after. So, I would advise anyone who is going through something similar to hand over control to those in the know and don’t Google too much.
“As for my family and friends, they have all been just fantastic and so supportive – from phone calls to dropping in dinners – because this treatment does not just affect me, it also affects my family too.
“Thankfully, I was very lucky with my GP, but I would like for all GPs to be aware of the symptoms of pancreatic cancer and to know that jaundice is not the only sign. For me, the signs that I had pancreatic cancer were pain in lower left back, a cough that would not go away and light-coloured, floating stools. Also, as well as making people aware of what to look out for, I would like to get out there that St Vincent’s hospital is the centre of excellence for all things pancreatic. This would save time with regard to consultant referrals.
“My advice to others is that if something does not feel quite right, always go to your GP and get it checked out. Something as simple as an ultrasound could save your life, like it did mine. Although I do not yet know what the future holds until I get the full low down at my next appointment, I am determined to raise awareness and raise up the success stories.”
Pancreatic cancer is one of the leading causes of cancer-related death worldwide – because so many cases are at an advanced stage when diagnosed, 50 per cent die within the first year.
Some of the early signs of pancreatic cancer are similar to other health conditions and Prof Grainne O’Kane, consultant oncologist specialising in pancreatic cancer malignancies, said the disease is so lethal that clinical trials should be considered part of the first line of treatment. “Early intervention is critical and aligned to clinical trials will lead to better outcomes,” she says. “People should be aware of the link between the six leading symptoms and pancreatic cancer, particularly if there is a family history of the disease.
“Depending on the stage of the cancer at diagnosis, the treatment for pancreatic cancer includes surgery, chemotherapy and radiotherapy but over 80 per cent of people are diagnosed too late for potentially curative surgery [Whipple] because symptoms do not develop until the advanced stage of the disease.”
Pancreatic cancer
- In Ireland, about 600 people are diagnosed with pancreatic cancer every year.
- It has one of the poorest prognoses of all cancers with fewer than 15 per cent of Irish patients surviving beyond five years.
- Risk factors include: smoking, being overweight and diabetes. However, most people with diabetes do not get pancreatic cancer, chronic pancreatitis and a family history of pancreatic cancer
- While people may have few symptoms in the early stages, some can occur within time – these include:
- Tummy or back pain.
- Poor appetite, indigestion, nausea.
- Noticeable change in bowel habits (light-coloured or floating stools).
- New diagnosis of diabetes or diabetes which is harder to control.
- Unexplained weight loss.
- Jaundice (yellowing of the skin and whites of the eyes) and/or itchiness – if this occurs, seek urgent medical attention.
- There is no national screening programme for pancreatic cancer in Ireland.
- Early diagnosis is critical to better outcomes and anyone with any concerns should seek medical advice. See pancreaticcancerireland.ie and cancer.ie.
