Understanding Pancreatic Cancer

Pancreatic cancer is a type of cancer that develops in the pancreas, an organ located deep within the abdomen that plays an essential role in digestion and blood sugar regulation. The pancreas produces digestive enzymes and hormones such as insulin, which help the body process food and maintain energy balance.

Statistics from the latest Singapore Cancer Registry Annual Report 2023, show that pancreatic cancer was the ninth most common cancer in males and females, with close to 3,000 new cases diagnosed in Singapore between 2019 and 2023.

While outcomes for pancreatic cancer have improved due to advances in surgical techniques, chemotherapy and radiation therapy, pancreatic cancer is often diagnosed at an advanced stage when the disease is harder to treat because symptoms are often vague or absent in early stages of the disease.

At the National Cancer Centre Singapore (NCCS), pancreatic cancer care is delivered by multidisciplinary teams included medical oncologists, surgeons, radiation oncologists, radiologists, and supportive care specialists. This page explains how pancreatic cancer is diagnosed and treated, and the support available throughout care.

What Is Pancreatic Cancer

Pancreatic cancer develops when cells in the pancreas undergo genetic changes that cause them to grow and divide uncontrollably. Over time, these abnormal cells can form a pancreatic tumour that interferes with normal pancreatic function and may spread to nearby structures or distant organs.

Pancreatic Cancer Symptoms

Pancreatic cancer symptoms vary depending on the size and location of the tumour, as well as whether the disease has spread. Early symptoms are often subtle and may be mistaken for other conditions.

Common symptoms include: 

• Jaundice (yellowing of the skin or eyes), particularly when the tumour blocks the bile duct 
• Persistent upper abdominal pain or discomfort, which may radiate to the back 
• Unexplained weight loss or loss of appetite 
• Dark urine or pale-coloured stools 
• Fatigue 
• New-onset diabetes or worsening blood sugar control 
• Digestive difficulties, such as nausea, indigestion or bloating or

These symptoms can also be caused by non-cancerous conditions. If symptoms persist, worsen, or occur together, it is important to be medically assessed for further evaluation.

Pancreatic Cancer Causes and Risk Factors

The exact causes of cancer of the pancreas are not fully understood, but research has identified several risk factors.

Non-modifiable Risk Factors 

• Increasing age 
• Family history of pancreatic cancer 
• Long-standing diabetes 
• Chronic pancreatitis 
• Certain inherited genetic conditions 
• Gender – pancreatic cancer is more common in men than women

Environmental and Lifestyle Factors 

• Cigarette smoking 
• Obesity

Having one or more risk factors does not mean a person will develop pancreatic cancer, and some individuals are diagnosed without any known risk factors.

How Pancreatic Cancer Is Diagnosed

Diagnosis aims to confirm the presence of pancreatic cancer, determine how far it has spread and identify which treatment would be most effective. Diagnosis often requires a combination of clinical assessment , blood tests, imaging scans and tissue sampling (biopsy).

Clinical Assessment

Doctors review the patient’s symptoms, medical history and risk factors, and perform a physical examination which may uncover symptoms such as jaundice or abdominal tenderness which requires further investigation.

Imaging Scans

Imaging scans play a central role in diagnosing pancreatic cancer and assessing the spread of the disease. Scans may include: 

• CT scans to evaluate the pancreas, surrounding blood vessels and nearby organs 
• MRI scans to provide detailed views of soft tissues and bile ducts 
• Endoscopic ultrasound (EUS) to closely examine the pancreas and guide the biopsy

These scans help to determine whether the tumour can be surgically removed and whether the cancer has spread beyond the pancreas to other parts of the body.

Biopsy and Pathology

A biopsy or tissue sample is usually required to confirm pancreatic cancer. Tissue samples may be obtained through endoscopic ultrasound-guided procedures or other image-guided techniques. Pathologists examine the samples to confirm the diagnosis of cancer and characterise the tumour.

Blood Tests

Blood tests assess overall health and organ function. Some patients may have elevated tumour markers, such as CA 19-9, which can help to support the diagnosis and monitor the body’s response to treatment.

Staging and Classification

Staging describes how far pancreatic cancer has spread at the time of diagnosis and helps to guide treatment decisions.

Assessing Disease Extent

Doctors evaluate: 

• Tumour size and involvement of nearby blood vessels 
• Spread to nearby lymph nodes 
• Evidence of spread to distant organs, such as the liver or lungs

Why Staging Matters

Staging helps to determine whether surgery is possible, it guides the use of chemotherapy or radiationtherapy and supports discussions with the patient about treatment options .

Treatment for Pancreatic Cancer

Treatment planning at NCCS involves close collaboration among oncologists to tailor care according to the stage of the disease and the individual patient’s overall health.

Key considerations include: 

• Extent of the disease and whether it has spread to other parts of the body or organs 
• Tumour biology and imaging findings 
• General health of the patient and their ability to tolerate treatment 
• Individual patient preferences and goals of care

Surgery

Surgery offers the best chance of long-term disease control for patients whose pancreatic cancer is confined to the pancreas and nearby tissue . The type of surgery depends on the tumour location and may involve complex procedures performed by experienced surgical teams.

Chemotherapy

Chemotherapy is commonly used in pancreatic cancer treatment. It may be given: 

• Before surgery to shrink the tumour 
• After surgery to reduce the risk of recurrence 
• As the main treatment when surgery is not suitable

Radiation therapy

Radiation therapy may be used, often in combination with chemotherapy, to help control tumour growth or manage symptoms.

Targeted Therapy and Other Systemic Treatments

In some cases, additional treatment may be considered based on tumour characteristics or genetic findings.

What Treatment Aims to Achieve

Treatment goals in pancreatic cancer may include: 

• Removing or controlling the cancer, where possible 
• Slowing disease progression 
• Relieving symptoms such as pain or jaundice 
• Maintaining quality of life and daily function

Care plans are individualised, and goals may evolve over time depending on how the tumour responds to treatment.

Supportive Care and Living With Pancreatic Cancer

Supportive care is integrated throughout pancreatic cancer treatment to help a patient manage physical, emotional and practical challenges.

Support may include: 

• Pain management and symptom control 
• Psychological and emotional support for patients and caregivers 
• Rehabilitation and palliative care services when appropriate

Patients are encouraged to share any concerns so that supportive care can be adjusted as needs change.

Follow-Up and Monitoring

After treatment, structured follow-up helps the care team assess treatment response, detect recurrence early and manage long-term effects.

Follow-up care may include: 

• Clinical reviews and physical examinations 
• Imaging scans 
• Blood tests to monitor health and tumour markers, where appropriate

Regular follow-up supports each patient’s ongoing recovery and wellbeing.

Guidance and Support at NCCS

Pancreatic cancer can present complex medical and emotional challenges. At NCCS, care is delivered by coordinated, multidisciplinary teams who are focused on providing clear information, personalised care and access to supportive services throughout the treatment journey.

Patients are encouraged to speak with their care team to better understand their condition and discuss treatment options.

For further information about pancreatic cancer treatment please visit www.nccs.com.sg.

Commonly Asked Questions

1. Is pancreatic cancer always aggressive?

Pancreatic cancer can behave differently from person to person. Some tumours grow and spread more quickly, while others progress more slowly. The behaviour of the cancer depends on factors such as tumour type, staging and individual biology.

2. Can pancreatic cancer be detected through routine health screening?

There is currently no routine population screening test for pancreatic cancer. Most cases are diagnosed after symptoms develop or when medical investigations are performed.

3. Will pancreatic cancer treatment affect blood sugar control?

Yes. Because the pancreas plays a role in insulin production, pancreatic cancer or its treatment may affect blood sugar levels. Some patients may develop new or worsening diabetes and require ongoing monitoring or treatment adjustments.

4. How long does treatment for pancreatic cancer usually last?

Treatment duration varies depending on the stage of cancer, treatment approach and individual response to treatment. Some patients may undergo treatment over several months, while others may receive longer-term therapy to control disease progression.

5. Can pancreatic cancer treatment continue if side effects become difficult to manage?

Treatment plans can be adjusted if the patient experiences challenging side effects. The treating doctors may modify the medication dose, change the treatment schedule or introduce supportive care measures to help manage side effects while maintaining treatment goals.