Pancreatic cancer is known as a silent killer, as cancer usually goes undetected until the advanced stage. It is one of the deadliest cancers that we know. The prevalence of pancreatic cancer is about two persons in 100,000 in Malaysia. It typically affects people in the sixties.
The pancreas is an organ located in the upper middle portion of the body, at the back portion of our abdominal cavity. Its function is to produce insulin to control our blood sugar and to produce enzymes for fat and protein digestion.
- Old age
- Heavy consumption of alcohol
- Family history of pancreatic cancer
- Excess use of tobacco products or smoking
- Chronic pancreatitis can result from heavy drinking over a long period of time
- Men are more likely to get pancreatic cancer
- Consuming a diet rich in red and processed meat, sugar, and fried food
- Long term exposure to certain chemicals that are used in pesticides and metalworking
- People between the age of 65 and 74
- People with type 1 or type 2 diabetes
- History of H. pylori infection or Hepatitis B
Most patients with pancreatic cancer have no symptoms until the tumour is fairly large or advanced. However, some symptoms of pancreatic cancer include:
- Abdominal pain
- Painless jaundice
- Early signs of diabetes
- Itchy skin
- Light coloured faeces
- Unexplained loss of weight
- Loss of appetite
- Constant tiredness
- Worsening of diabetes
- Dark coloured skin
- Dark coloured urine
Currently, there is no real surveillance for pancreatic cancer. Most pancreatic cancers are diagnosed during performing tests that are unrelated to the pancreas itself, such as during health screening or ultrasound of the abdomen.
The doctor may also perform an ultrasound-based biopsy to check for any presence of cancer.
Additionally, blood tests can also be done to check for high levels of carbohydrate antigen, a specific protein released by the pancreas indicating the presence of the tumour.
Staging is required to determine the extent to which cancer has spread. Pancreatic cancer is divided into four key stages. Understanding these helps doctors and oncologists to determine an appropriate treatment methodology.
Stage 0: Cancer is limited to the upper layer of the cells in the pancreatic ducts. At this stage, the cancerous growth is almost impossible to identify, even on imaging tests.
Stage I: In this stage, the tumorous growth is localised and can:
- Grow less than 2 cm (stage IA) or
- More than 4 cm (stage IB)
Stage II: In this stage, cancer has grown over 4 cm. However, the growth is still limited within the pancreas and has not spread to nearby lymph nodes or out of the pancreas.
Stage III: Cancer has spread to distant areas such as lymph nodes, nerves, and major blood vessels. But it has not metastasis in distant areas.
Stage IV: In this stage, cancer has spread to distant areas and organs.
Determining the pancreatic cancer stage is often tricky. Imaging tests like CT scans and ultrasound provide some information but knowing exactly how far pancreatic cancer has spread usually requires surgery.
Following are some common treatment lines adopted by doctors for pancreatic cancer:
- Surgery - Pancreatectomy is done to remove cancerous tissues in the organ along with the affected lymph nodes
- Chemoradiation therapy
- Targeted therapy
The Whipple procedure, or pancreaticoduodenectomy, is a major surgical operation that is usually done for patients with pancreatic head cancer, trauma, or chronic pancreatitis.
The surgery involves the removal of the pancreatic head, duodenum, jejunum, gallbladder, and occasionally a portion of the stomach. The operation usually takes 4 to 8 hours. The Whipple procedure offers the best chance of survival and cure for patients with pancreatic cancer.
The treatment method largely depends on the stage. If cancer has spread to regional/distant organs, more aggressive forms of treatment are necessary.
Other than the aforementioned treatment options, supportive and palliative care is given for:
- Emotional support
- Pain management
- Jaundice management
- Diabetes control
- Treatment of intestinal blockages
The long-term prognosis of this disease depends on
- Type of tumour &
- Size of tumour
The earlier the detection, the easier is the diagnosis and the better is the prognosis.
Unfortunately, in most cases, as there are no initial symptoms, pancreatic cancer is detected in advanced stages.
- The five-year overall survival rate of pancreatic cancer is 7.2%
- For cancer that has spread to nearby regions, the survival rate is 27.1%
- The survival rate of distant cancer is 2.4%
Cancer cannot be completely prevented. However, some healthy lifestyle options are recommended by medical practitioners to reduce the risk. These include:
- Quit smoking
- Avoid excessive use of alcohol
- Maintaining a healthy weight
- Keeping the sugar level under control
- Avoid consuming red meat excessively
Make an appointment with an Oncologist / Hepatobiliary Surgeon at Gleneagles Hospitals for an early and accurate diagnosis and an appropriate, personalised, and effective treatment plan.