Overview

What is Pancreas Cancer?

The pancreas is an organ lying between the stomach, liver and intestine. It is made of 2 types of glands. One type of gland tissue produces insulin and other hormones. Cancers of the glands in the pancreas are uncommon cancers. They are called by various names, depending on the specific type of cancer cell or by the hormone produced by the cancer. Names include carcinoid tumour, islet cell carcinoma, insulinoma, glucagonoma, and so forth. These are not covered in this website because of rarity. The other type of gland tissue produces enzymes which help in digestion of food. These glands drain into ducts which in turn drain into the small intestine. It is the cells of the ducts which can turn into cancer. These are more common pancreas cancers, usually of the type called adenocarcinoma.

How common is Pancreas Cancer?

Although pancreatic cancer is common in the United States and accounts for the 4th most common cause of cancer death there, pancreatic cancer is not as common here in Singapore.

Age of Onset

The incidence of pancreatic cancer increases with age. The vast majority of patients are aged between 50 and 80 years of age.

Causes and Risks

The only known risk factor is smoking. Diabetes is not known to increase the risk of pancreatic cancer. Dietary factors such as alcohol and fat have been implicated but not proven as yet to cause pancreatic cancer.

Symptoms

Symptoms and Signs of Pancreas Cancer

The symptoms of pancreatic cancer are generally vague and non-specific. Weight loss is one of the earliest symptoms. However, there are many other medical and non-medical causes of weight loss. Abdominal pain is not uncommon late in the disease. Another late symptom is jaundice, or yellowness of the whites of the eyes.

Diagnosis

Diagnostic Tests

The signs and symptoms of the disease are non-specific. If pancreatic cancer is suspected, the initial diagnostic test would be a CT or computerised scan of the abdomen. The CT scan is able to detect any pancreatic mass greater than 2cm 95% of the time. Smaller cancers are more difficult to detect. Magnetic resonance imaging (MRI) scans can visualise the pancreas and the ducts in the pancreas. This can be particularly useful when planning surgery.

Another procedure that is often done is an endoscopic retrograde cholangiopancreaticography (ERCP) which involves using a fiberoptic scope to look into the stomach and small intestine where the ducts of the pancreas drain into. X-ray dye is then injected into the ducts of the pancreas and x-rays taken of the pancreas.

Irregularities of the pancreatic ducts can then be visualised. Small pieces of tissue can also be biopsied during this procedure. If a blockage of the ducts is seen, a small plastic tube, called a stent, can be placed during this same procedure to try and bypass the block. Potential complications of this procedure include infection of the pancreas and perforation of the small intestine. A stent which is placed will need to be changed 3 to 4 monthly because the stent can be blocked by normal secretions from the pancreas.

Sometimes, when a biopsy cannot be obtained via ERCP, a percutaneous biopsy of the pancreatic lesion is performed to obtain tumour tissue for diagnosis. This involves inserting a needle through the abdominal wall to the pancreas under CT or ultrasound imaging guidance.

Treatment Options

Treatment of Pancreas Cancer

Surgery continues to be the treatment of choice for pancreatic cancer. Unfortunately, most patients are not candidates for curative surgery because of the advanced stage of disease when diagnosed. Even if curative surgery is not possible, bypass procedures performed during the time of surgery to relieve the jaundice and itching associated with pancreatic cancer can do much to improve the patient's quality of life. Radiotherapy may be considered as primary treatment if surgery is not possible. In this situation, radiotherapy can relieve pain and occasionally jaundice.

Radiotherapy may be considered as primary treatment if surgery is not possible. In this situation, radiotherapy can relieve pain and occasionally jaundice. Radiotherapy may also be considered as an additional treatment after curative surgery to try and prevent cancer recurrence.

Chemotherapy is used either to make radiotherapy more effective, i.e. as a radiosensitiser or when pancreatic cancer is very advanced i.e. surgery and radiotherapy are not being considered at all. Chemotherapy may prolong a patient's life by a few months. More important, chemotherapy has been shown to relieve pain in some patients with advanced pancreatic cancer.

Prognosis of Pancreas Cancer

Even with curative surgery, about half of patients with pancreatic adenocarcinoma survive between 2 to 3 years. The chance of surviving to 5 years after curative surgery is about 20%. For patients with advanced inoperable pancreatic cancer, most patients do not live beyond a year.