“Diseases of the pancreas are fairly rare, with pancreatic cancer the 12th most common cancer worldwide,” says Professor Jose Ramos, Head of HPB Surgery at Wits Donald Gordon Medical Centre. “However, it is the third or fourth most common cause of cancer deaths as most patients with this cancer cannot be cured. Like chronic pancreatitis, pancreatic cancer has devastating effects.” 

Prof Ramos notes that the global incidence of pancreatic cancer is between 5 and 15 per 100 000 patients. “In South Africa we do not have up to date statistics. The most recent figures from the South African National Cancer Registry date back to 2014 and report a much lower figure than the global statistics. However, these figures are almost certainly incomplete, and the local incidence is likely to be in line with international statistics.” 

In South Africa, diseases of the pancreas often affect the poor and the working class, according to Professor Martin Smith, Head of the Department of Surgery at Wits, and Chief Surgeon and Head of General Surgery at the Chris Hani Baragwaneth Academic Hospital. “Chronic pancreatitis, a long-term inflammation of the pancreas, is linked with an increased risk of pancreatic cancer. Pancreatic cancer is a major problem in the public healthcare sector because we have a large, indigent population and a public health system that cannot meet the needs of the population, so many patients die from pancreatic diseases without ever having been diagnosed.” 

Prof Smith points to the lack of diagnostic methods and other resources in the health sector as a critical problem. “Blood tests are helpful in determining whether the pancreas is involved in a specific symptom but may be misleading. The best radiographic tests to evaluate the structure of the pancreas include CT (computed tomography) scan, and MRI (magnetic resonance imaging). Tests to evaluate the pancreatic ducts include ERCP (endoscopic retrograde cholangiopancreatography) and MRCP (magnetic resonance cholangiopancreatography). There are also instances in which surgical exploration is the only way to confirm the diagnosis of pancreatic disease. Patients in the public health system are unlikely to have access to these types of tests, so many simply remain undiagnosed.” 

Prof Ramos explains that the pancreas has two main functions: “It makes enzymes, which help digest proteins, fats, and carbohydrates before they can be absorbed in the intestine, and it makes hormones, the most important of which is insulin, which control how the body uses and stores sugar (glucose), its main source of energy.” 

For these reasons, Prof Ramos advises people to look out for certain warning signs that may point to either chronic pancreatitis or pancreatic cancer:

“Both chronic pancreatitis and pancreatic cancer lead to permanent damage of the pancreas, eventually impairing the person’s ability to digest food and make pancreatic hormones,” says Prof Smith. “Malnutrition can be avoided with pancreatic enzyme replacement therapy (PERT), which involves taking the digestive enzymes you need in the form of a capsule to assist the digestion of fat, carbohydrates and proteins. PERT can also help to stop diarrhoea, which contributes significantly to poor quality of life for patients.” 

Prof Smith says patients have the best outcomes when they have access to multi-disciplinary teams that are able to support them in all aspects of disease management and treatment, from the emotional to the physical components. “It’s about putting the patient first and applying a holistic treatment programme.” 

If you notice any unusual symptoms or suspect you might have chronic pancreatitis or pancreatic cancer, consult your healthcare provider immediately. It is essential to seek help as soon as possible.