Although pancreatic cancer is uncommon, it is the 5th most frequent cause of cancer deaths in Singapore and one of the top 10 most deadly cancers worldwide. There are several types of pancreatic cancers, with the majority affecting the area of the pancreas that produces enzymes. This is known as pancreatic ductal carcinoma. The pancreas also has hormone making cells (for example islet cells produce insulin). Cancers can arise in these cells and are known as neuroendocrine tumours (NET). This article covers the more common pancreatic ductal carcinoma.
Often, no identifiable risk factor is present, but the following have been linked to an increased risk of developing pancreatic cancer.
Increased intake of sugary drinks
Chronic pancreatitis or inflammation of the pancreas
A strong history of cancer in the family, including a history of breast cancer and ovarian cancer, colon cancer, gastric cancer, may be linked to an increased risk of pancreatic cancer through the genes.
Signs and Symptoms
Many patients with pancreatic cancers do not have any symptoms, and often present in the advanced stages.
Common signs and symptoms for cancer of the pancreas are:
Jaundice, or yellowing of the eyes and skin
Loss of weight
The diagnosis of pancreatic cancer is made by initial imaging with a CT or MRI scan. This is followed by a biopsy of the tumour by a pancreatic cancer specialist or cancer treatment team. In Singapore, this can be done by endoscopy guided by ultrasound (EUS) without have an operation for most patients. Other methods include a biopsy with a needle through the skin, if it has spread to other organs such as the liver. If the tumour is causing jaundice by obstructing the flow of bile, a stent, may also be placed to relieve the obstruction.
A raised tumour marker, usually CA 19-9, may aid in the diagnosis and treatment follow up.
Early pancreatic cancer may be cured with surgery. Expertise in managing pancreatic cancer in a pancreatic specialist team is important. Review of imaging done, often with MRI, in consultation with experienced hepatobiliary surgeon, radiologist, medical oncologist helps to plan the optimal approach.
In general, only 15% to 20% of patients are able to be operated when they are diagnosed, owing to the very silent and aggressive nature of this cancer. However, with just surgery alone, the vast majority of patients suffer a relapse. Chemotherapy given before or after surgery has been proven to reduce the relapse risk, and increases the chances of cure.
Advanced pancreatic cancer is generally treated with palliative chemotherapy. With the approval and availability of new chemotherapy agents, the average survival of patients with advanced pancreatic cancer has doubled over this decade with appropriate treatment. Chemotherapy has been also shown to reduce and provide symptom relief.
The drugs that may be used include 5-fluorouracil (5-FU), Oxaliplatin, Leucovorin (folinic acid), Irinotecan, Gemcitabine, nab-Paclitaxel (Abraxane), Cisplatin, TS-One, and Capecitabine (Xeloda).
At OncoCare Cancer Centre, Singapore, we know that arranging for investigations and the starting of treatment are important and time sensitive. Our local and international patients can expect staging scans and investigations to be done in 1 to 2 working days.
Dr Thomas Soh