Pancreatic cancer is the fifth leading cause of cancer deaths in Hong Kong. In 2019, a total of 740 people died from this cancer. The incidence and mortality of pancreatic cancer have both increased over the past decade. Pancreatic cancer is difficult to detect at its early stage, therefore treatment is usually delayed. Healthy Matters is here to provide you with information about the causes, symptoms, diagnosis and treatment of pancreatic cancer.
Pancreatic Cancer: What is it?
Pancreatic cancer is a disease in which malignant (cancerous) cells form in the tissue of pancreas. The pancreas is an organ located deep behind the stomach and intestines. It is a digestive organ, connecting to the duodenum. Its main function is to secrete digestive enzymes to help digest food and produce hormones, such as insulin to monitor blood sugar levels. Pancreatic cancer can occur in the head, body or tail of the pancreas. The wide end of the pancreas is called the head, the thin end is called the tail and the middle bit is called the body. Mutation and growth of cancerous cells typically occur at the head of the pancreas, resulting in pancreatic cancer.
Pancreatic Cancer Causes
Pancreatic cancer is a disease of mutation and growth of cancerous pancreatic cells. The exact cause of the genetic mutation in the disease is unknown, but most of the genetic mutations that occur in pancreatic cancer are not hereditary but acquired during life, such as long-term inhalation of cancer-causing chemicals including smoking cigarettes.
Pancreatic Cancer risk factors
Factors that may increase the risk of getting pancreatic cancer include:
- Increasing age – most pancreatic cancer patients are over the age of 65
- Gender – men have a higher risk than women
- Smoking – smokers are 2 to 3 times more likely than that of non-smokers
- Family history of pancreatic cancer
- Inherited genetic syndromes (such as BRCA2 mutations, Lynch syndrome)
- Infection with Helicobacter pylori (H. pylori) – the risk of getting pancreatic cancer is twice as high compared to those without H. pylori
- Chronic pancreatitis
- Prolonged contacts with chemicals such as petroleum, pesticides or dye
With a physical examination. By the time they do cause symptoms, they have often grown very large or even spread outside the pancreas at an advanced stage.
Pancreatic Cancer symptoms and signs
Pancreatic cancer usually does not display any signs or symptoms in the early stage. The small size and deep location of the pancreas mean that tumour can be hard to discover.
Nevertheless, should the following symptoms persist, it is important that you seek medical advice:
- Unintentional weight loss in a short period of time
- Yellowing of the eyes and skin (jaundice)
- Itching skin
- Clay colored stools
- Loss of appetite, nausea and vomiting
- Fixed, hard lumps in the upper abdomen
- Sustained upper abdominal pain, which may radiate to the back, leading to atypical back pain
- Build up of fluid in the abdomen (Ascites)
Pancreatic Cancer diagnosis
After taking a thorough medical history and clinical examination, if a diagnosis of pancreatic cancer is suspected or needed to be ruled out, the doctor may arrange the following tests, such as:
- Abdominal computerized tomography (CT) scan
- Abdominal magnetic resonance imaging (MRI)
- Endoscopic retrograde cholangiopancreatography (ERCP) and removal of a small tissue sample (biopsy) for analysis
- Percutaneous transhepatic cholangiogram (PTCA)
- Biopsy using Fine Needle Aspiration (FNA) cytology
If the diagnosis of pancreatic cancer is confirmed, other tests will be arranged to check if the cancer has spread elsewhere (metastasis). Which include:
Pancreatic Cancer staging
Pancreatic cancer staging can be categorised into two different ways: the TNM system and the number system.
TNM stands for Tumour, Node and Metastasis. It describes the size of the cancer (T), whether there are any involvement of the lymph nodes (N) and if the cancer has spread to other parts of the body (M).
- Stage 0 – Carcinoma in situ (Tis, N0, M0)
- Stage I – The pancreatic cancer is less than 4 cm in size and hasn’t spread outside the pancreas (T1, N0, M0) or (T2, N0, M0)
- Stage IIA – The pancreatic cancer is larger than 4 cm in size, but is still within the pancreas with no lymph nodes involved, nor spread to other areas of the body (T3, N0, M0)
- Stage IIB – The pancreatic cancer is any size within the pancreas and has spread to no more than 3 nearby lymph nodes. It has not spread to other areas in the body (T1/2/3, N1, M0)
- Stage III – The pancreatic cancer is any size within the pancreas and has spread to 4 or more nearby lymph nodes (T1/2/3, N2, M0)
- Stage IV – The pancreatic cancer has spread to other area of the body (such as liver or lungs) (Any T, Any N, M1)
Pancreatic Cancer treatment
Treatment for pancreatic cancer depends on the stage of the cancer, the patient’s overall health condition as well as the patient’s preference.
The ultimate goal of tumor treatment is to eliminate the tumour. However, if the pancreatic tumour is impossible to be eliminated completely, the focus of treatment will then be to slow down the progression and growth of the tumour to avoid causing further damages. In some circumstances, if pancreatic cancer was diagnosed at an advanced stage, a palliative approach would be advised.
Pancreatic Cancer Treatment: Surgery
If pancreatic cancer is detected early and the tumour is located in the head of the pancreas, surgery can be performed to remove the tumour.
- Whipple’s procedure (pancreaticoduodenectomy) – is the most common type of surgery for pancreatic cancer. It involves the removal of the head of pancreas, duodenum, gallbladder and maybe a part of the stomach
If the pancreatic cancer is located in the body or tail of the pancreas, the patient may undergo distal or total pancreatectomy, meaning to remove the tail or the entire pancreas.
Pancreatic Cancer Treatment: Radiotherapy
Pancreatic cancer tends to be diagnosed at an advanced stage and is often untreatable with traditional surgery. Radiotherapy may be more suitable in these patients, it uses high-energy radiation to destroy the cancer cell and slow down the development of the cancerous cell.
Should a patient be found not suitable to undergo surgery, or surgery alone will not be able to remove the tumour, a combination of both radiotherapy and chemotherapy may be recommended to reduce the size of the tumour.
Pancreatic Cancer Treatment: Chemotherapy
Chemotherapy is an anti-cancer drug injected into a vein or taken orally. The drugs can then enter the bloodstream and reach different parts of the body to kill the cancerous cell. Meanwhile, chemotherapy may also be used before or after surgery as an adjuvant to reduce the size of the tumour.
Pancreatic Cancer Treatment: Targeted Therapy
Targeted therapy works by using specific biological molecules to stop the growth of cancerous cells and cut off the tumour cells’ ability to grow and repair themselves. Targeted therapy tends to be used alongside chemotherapy in treatments for pancreatic cancers.
Pancreatic Cancer Treatment: Palliative Treatment
Palliative treatment is normally recommended to patients with advanced stage The primary goal is to provide patients with relief from their symptoms, manage the pain and stress caused by the disease and thereby maintain the patient’s quality of life.
In cases where the tumour blocks the bile duct, a biliary stent can be inserted into the bile duct under ERCP, to maintain the free flow in the duct. A duodenal stent can be inserted into the first part of the small intestine to alleviate sickness.
Pancreatic Cancer prognosis
Although pancreatic cancer is the tenth most common cancer found in males, it was the fifth leading cause of cancer death in both genders with 740 deaths recorded in 2019, indicating an overall poor prognosis.
Pancreatic Cancer complications
Pancreatic cancer can lead to the following complications includes:
- Yellowing of skin and eyes (jaundice) – due to building up of bilirubin
- Worsening abdominal pain as the tumour grows and presses on the nerves
- Severe weight loss – patient having difficulty in eating may need to be fed with a nasogastric tube or parenterally through veins to provide nutritional supplements
- Diabetes – damage to the insulin-producing cells in the pancreas can affect the regulation of blood glucose and lead to diabetes
Pancreatic Cancer care and supporting organization
Regular follow-ups will be arranged for patients with pancreatic cancer to monitor the conditions and symptoms of recurrence. Other help and support such as maintaining nutrition, psychological support and managing pain will also be provided.
Seek help from the below local patient groups and supporting organizations:
The exact cause of pancreatic cancer is unknown, however, some things can be done to reduce the risk of getting pancreatic cancer such as stop smoking cigarettes, avoid prolonged contact with chemicals such as petroleum, pesticides or dye; maintain a healthy weight and diet and reduce alcohol consumption to prevent chronic pancreatitis.
This article was reviewed by Dr. Patricia Poon. Dr. Patricia Poon is a specialist in Clinical Oncology who practices in Hong Kong. She graduated from the University of Adelaide, South Australia in 1995. Dr. Poon subsequently received her Oncology training at the Queen Elizabeth Hospital in Hong Kong and became a fellow of the Royal College of Radiologists in 2002. Dr. Poon earned the Fellowship of Hong Kong College Radiologists and Fellowship of the Hong Kong Academy of Medicine (Radiology) in 2005. She also obtained a Master's degree in Palliative Medicine at the Cardiff University, U.K. in 2010. Besides training at the Queen Elizabeth Hospital in Hong Kong, she was a Consultant Oncologist at the Hong Kong Baptist Hospital until 2014. She is currently working as a private Clinical Oncologist in Virtus Medical Group Ltd. in Hong Kong.
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This article was independently written by Healthy Matters and is not sponsored. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.