The pancreas is an organ located in the abdomen which helps digest food and regulate blood sugar. It is surrounded by other organs including the small intestine, liver and spleen. The pancreas is divided into four parts – the head, neck, body and tail.
Pancreatic cancers begin in the tissues of the pancreas, and are categorised according to
The pancreas is made up of two types of glands.
One type of gland tissue produces digestive enzymes that assist in the digestion of food. These glands drain into ducts, which in turn drain into the small intestine. It is the cells of these ducts which can turn into cancer. This is the most common form of pancreatic cancer known as pancreatic exocrine cancers, which accounts for 95% of all pancreatic cancers. About 95% of these are adenocarcinomas.
Another type of gland tissue produces several important hormones such as insulin. Cancers of the glands in the pancreas are known as neuroendocrine pancreatic cancers and are uncommon, accounting for about 1% of all pancreatic cancers.
In Singapore, pancreatic cancer is the 10th most common cancer in males. It is generally aggressive and ranks as the 5th most common causes of cancer death in males and 4th most common cause of cancer death in females.
There are often no or mild symptoms in the early stages of pancreatic cancer. When the cancer progresses, some symptoms may show.
Symptoms of pancreatic cancer may include:
Make an appointment with your doctor if you have any signs or symptoms that worry you.
There are several ways to lower the risk of pancreatic cancer:
While the exact cause of pancreatic cancer is unknown, several factors have been found to play a role in its development. These risk factors include:
Tests and procedures used to diagnose pancreatic cancer include:
If pancreatic cancer is diagnosed, further tests may be required to determine if the cancer has spread and to determine the stage of the cancer. Tests may include:
Treatment for pancreatic cancer depends on the following factors:
The main treatment for localised pancreatic cancer is surgery. Some patients may also require other treatments such as chemotherapy, and radiation therapy. For patients who are not suitable for curative surgery, surgery may be performed to relieve symptoms such as jaundice or nausea caused by a blockage in the bile duct.
An individual with cancer should be assessed by a specialist to determine which treatment is best suited for them.
The surgical procedure depends on the location of the tumour and whether it can be removed.
Additional procedures to clear any obstruction of the bile ducts might be done before surgery. This can be done with a tube inserted into the bile duct via endoscopic (ERCP) access, or with a tube inserted directly through the skin into the liver, known as Percutaneous Transhepatic Biliary Drainage (PTBD).
Radiotherapy also known as radiation therapy, uses powerful energy beams to kill cancer cells. It may be used when the cancer cannot be completely removed during surgery or to reduce the risk of cancer recurrence.
Chemotherapy is sometimes recommended after surgery if there is a risk that the cancer might return. It may also be used before surgery to shrink the cancer, so that it is more likely to be removed completely during surgery.
Supportive care is treatment that helps to improve the symptoms of pancreatic cancer such as problems with eating and weight loss, pain, nausea, tiredness or lethargy.
If surgery is required, your surgeon will perform comprehensive medical assessments including blood tests and scans, to see if you are suitable and advise on the risks involved. Your treatment recommendation is often based on consensus by a group of medical specialists' opinions (the tumour board), who come together to discuss the pros and cons of every treatment strategy.
The anaesthesia team will also assess your fitness for surgery and advise you on various aspects of general anaesthesia and pain control after surgery.
Specialist nurses will also provide pre-surgery counselling so that you know what to expect.
After surgery, you will be given regular outpatient appointments to see your team of doctors. During these appointments, you may have blood tests and scans to check if the cancer recurs. You will also be monitored to check that you are not deficient of digestive enzymes or blood sugar regulatory hormones that are produced by the pancreas.
It is important to follow your doctor's advice, keep to your clinic visits and do the recommended scans, so that timely treatment can be administered if the cancer or other problems occur.