Pancreatic Cancer

Learn more about pancreatic cancer, its symptoms and the treatments available in Singapore.

​Pancreatic Cancer — What Is It?

The pancreas is an organ lying between the stomach, liver and intestine. It is made of two 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 here because of their 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 third most common cause of cancer death there, pancreatic cancer is not as common in Singapore.

Age of Onset

The incidence of pancreatic cancer increases with age. The vast majority of patients are 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 — Causes and Risk Factors

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.

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 two centimetres, 95 percent 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 fibre-optic 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 three to four times 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 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 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 two and three years. The chance of surviving to five years after curative surgery is about 20 percent. For patients with advanced inoperable pancreatic cancer, most patients do not live beyond a year.

Pancreatic Cancer FAQs

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 arranged, i.e. nerve block. Other measures include radiotherapy and chemotherapy.

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

The jaundice, by itself, is not life-threatening. The jaundice is a result of the pancreatic ducts being blocked by the cancer. Because of the blockage, infection of the pancreas is more common and may require antibiotics when that happens. The jaundice is also associated with moderate to severe itching of the skin which can be troublesome. Oral medications may sometimes help. Some form of bypass of the blockage, either with surgery or during ERCP using stents may also be arranged to relieve problematic itching. 

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