Pancreas Cancer
What is Pancreas Cancer?
The pancreas is an organ lying between the stomach, liver and intestine. It is made of 2 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 in this website because of 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 4th most common cause of cancer death there, pancreatic cancer is not as common here in Singapore.
Age of Onset
The incidence of pancreatic cancer increases with age. The vast majority of patients are aged between 50 and 80 years of age.
Risks and Causes
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.
Symptoms and Signs of Pancreas Cancer
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.
Diagnostic Tests
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 2cm 95% of the time. Smaller cancers are more difficult to detect.
Magnetic resonance imaging (MRI) is a recent scanning technique that also visualises the pancreas and the ducts in the pancreas. This scan is being evaluated for specificity and sensitivity with regard to cancer of the pancreas.
Another procedure would be an endoscopic retrograde cholangiopancreaticography (ERCP) which involves using a fiberoptic 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 3 to 4 monthly because the stent can be blocked by normal secretions from the pancreas.
Treatment of Pancreas Cancer
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 and 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 pancreas adenocarcinoma survive between 2 to 3 years. The chance of surviving to 5 years after curative surgery is about 20%.
For patients with advanced inoperable pancreatic cancer, most patients do not live beyond a year.
Frequently Asked Questions about Pancreas Cancer
1. 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.
2. 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 may also be arranged to relieve problematic itching.
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