Pancreatic cancer is often spoken of as a deadly disease. To add to that, several famous personalities such as Apple’s founder Steve Jobs and TV host of Jeopardy Alex Trebek, passed prematurely from pancreatic cancer in recent years, sparking a lot of discussion around the disease. How can we understand the disease better, look out for signs and symptoms and be aware of treatment options?
Image of the purple awareness ribbon representing pancreatic cancer awareness (Credit: iStock)
What is pancreatic cancer?
Pancreatic cancer refers to a cancerous growth that starts in the pancreas, which is an organ in the abdomen behind the stomach. The pancreas is an important regulator of blood sugar and produces digestive enzymes to break down food and nutrients for easy absorption. There are several types of pancreatic cancers; ductal adenocarcinoma, which is the most common and most aggressive, pancreatic neuroendocrine tumour (PNET) and cystic cancers of the pancreas.
Pancreatic cancer is considered to be severe because symptoms may not be felt until the cancer is advanced, which means medical treatment is not sought until treatment options are limited. The close proximity of the pancreas to major blood vessels and other important organs also makes treatment challenging. Furthermore, pancreatic cancer is one of the few cancers where we have not yet uncovered useful predictive biomarkers that can help doctors select the best systemic therapy for individual patients. In addition, only one out of five pancreatic cancers are diagnosed at an early stage when it can be surgically removed. Even for those eligible for surgery, the five-year survival rate post-surgery is about 20 per cent because of the absence of predictive biomarkers to guide adjuvant therapy after surgery.
Pancreatic cancer is most often diagnosed between the ages of 60 to 80. In Singapore, pancreatic cancer only accounts 2% of all cancer cases, yet it is the fourth leading cause of cancer death. This points to the fact that early detection and screening are key to combating this disease. Encouragingly the proportion of early-stage diagnosis for pancreatic cancer nearly doubled from 16.5% in 2003-2007 to 30.7% in 2013-2017, indicating improvement in this area of detecting the disease early.
Symptoms of pancreatic cancer
While early stage pancreatic cancer often doesn’t have obvious symptoms, a cancerous growth that blocks the pancreatic duct would prevent digestive enzymes from being released into the intestine. This could lead to symptoms such as indigestion, bloating and oily bowel movements. If a growth blocks the bile duct, a person could present with jaundice (yellowing of the skin and whites of the eyes).
Other potential symptoms that should be checked out are unexplained weight loss, abdominal pain, nausea, itching and a loss of appetite. If any of these symptoms are experienced, it is best to seek medical help early and undergo checks and blood tests if advised by your doctor.
Can you do anything to prevent pancreatic cancer?
In the United States, 40% of pancreatic cancer patients smoke, indicating the link between smoking and the disease. As with most other cancers not smoking or quitting smoking may reduce the risk of pancreatic cancer. Another way to decrease the risk of getting pancreatic cancer may be limiting sugar consumption. A 14-year study on 60,000 people showed that Chinese men and women living in Singapore, who drank two or more soft drinks a week were 87% more likely to develop pancreatic cancer.
Other research studies have indicated that obesity, early onset diabetes, a high-fat and low-fibre diet, heavy alcohol consumption and working in a chemical-laden environment that is toxic, increases the risk of pancreatic cancer. A family history of cancer may also increase an individual’s risk.
Treatment and looking ahead to improved survival rates
Currently, 20% of pancreatic cancer cases can be removed by surgery at time of diagnosis. For the rest of the cases, care is palliative in nature with pain control, improving quality of life and prolonging life, where possible, being the primary care goals. For advanced pancreatic cancer the median survival rate is around three to six months from diagnosis.
However, a lot of research is underway to look at news and improved ways of early diagnosis for the disease. New guidelines were just published by the American Society for Gastrointestinal Endoscopy to screen all patients with genetic susceptibility to pancreatic cancer. With ongoing research to refine treatment and increased vigilance in screening, we are hopeful for better clinical outcomes in the near future.
For now, the primary prevention against pancreatic cancer is to lead a healthy lifestyle, be vigilant about your health, have regular check-ups and seek medical help early if you experience unusual symptoms.
References:
1. Huang, H., Wang, Z., Zhang, Y., Pradhan, R. N., Ganguly, D., Chandra, R., Murimwa, G., Wright, S., Gu, X., Maddipati, R., Müller, S., Turley, S. J., & Brekken, R. A. (2022). Mesothelial cell-derived antigen-presenting cancer-associated fibroblasts induce expansion of regulatory T cells in pancreatic cancer. Cancer Cell. https://doi.org/10.1016/j.ccell.2022.04.011
2. Ilic, M., & Ilic, I. (2016, November 28). Epidemiology of pancreatic cancer. World Journal of Gastroenterology. Retrieved May 12, 2022, from http://dx.doi.org/10.3748/wjg.v22.i44.9694
3. Mueller, N. T., Odegaard, A., Anderson, K., Yuan, J. M., Gross, M., Koh, W. P., & Pereira, M. A. (2010). Soft drink and juice consumption and risk of pancreatic cancer: the Singapore Chinese Health Study. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 19(2), 447–455. https://doi.org/10.1158/1055-9965.EPI-09-0862
4. National Registry of Diseases Office. (2022, January). Singapore Cancer Registry Annual Report 2019. https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/scr-2019_annual-report_final.pdf?sfvrsn=fa847590_0
5. Sawhney, M.S., et al. (2022) ASGE guideline on screening for pancreatic cancer in individuals with genetic susceptibility: summary and recommendations. Gastrointestinal Endoscopy. doi.org/10.1016/j.gie.2021.12.001
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