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Pancreatic Cancer

Pancreatic Cancer - What it is

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 3rd 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.

Pancreatic Cancer - Symptoms

 

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.

Pancreatic Cancer - How to prevent?

Pancreatic Cancer - Causes and Risk Factors

 

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

Pancreatic Cancer - Diagnosis

 
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.

Pancreatic Cancer - Treatments

 
Surgery continues to be the treatment of choice for  early pancreatic cancer. Unfortunately, most patients are not candidates for curative surgery because of the advanced stage of disease when diagnosed. Even when curative surgery is not possible, bypass procedures may be performed during the time of surgery to relieve the jaundice and itching to improve the patient's quality of life. 

Chemotherapy and occasionally radiotherapy may also be considered as an additional treatment after curative surgery to reduce the risk of cancer recurrence.

In patients with advancd disease, palliative chemotherapy may be offered to prolong life as well as to improve symptoms such as pain. Patients may also be invited to join a clinical trial where suitable and available.

Prognosis of Pancreas Cancer

Even with curative surgery, risk of recurrence is high and 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, even with palliative chemotherapy

Pancreatic Cancer - Preparing for surgery

Pancreatic Cancer - Post-surgery care

Pancreatic Cancer - Other Information

 
My father has pancreatic cancer. He has a lot of abdominal pain. What can be done?

Pain control is a very important part of the treatment of advanced pancreatic cancer. Besides oral painkillers, such as NSAIDs (Ponstan®, Synflex® and others from the same family of medicines) and opioids, such as codeine and morphine, injections to deaden the nerve causing the pain can be considered, i.e. nerve block. Other measures include radiotherapy and chemotherapy.

My mother is extremely jaundiced from her pancreatic cancer. Is it dangerous?

Jaundice, by itself, is not life-threatening. It is a result of the biliary ducts being blocked by the cancer. Because of the blockage, infection is more common and may require antibiotics and decompression procedures. Jaundice can also be associated with itching of the skin which can be troublesome. Oral medications may sometimes help. 

American Cancer Society http://www.cancer.org
Cancer Care, inc. http://www.cancercare.org
Cancer Information Service (National cancer Institute, USA) http://www.nci.nih.gov
CancerNet (National Cancer Institute, USA) http://www.cancernet.nci.nih.gov

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