Pancreatic Cancer

Conditions & Treatments

Pancreatic Cancer
Introduction	Diagnosis
Causes	Treatment
Symptoms	FAQs



Introduction
The pancreas lies between the stomach, liver and the intestine. It is made of 2 types of glands - one produces insulin and the other hormones, the other produces enzymes that help in digestion of food. The glands that produce enzymes drain into ducts, which in turn, drain into the small intestine. The cells of the enzyme producing glands can become cancerous. *How common is Pancreatic Cancer?* Although pancreatic cancer is common in the United States and accounts for the fourth most common cause of cancer death there, pancreatic cancer is not as common here in Singapore. The incidence of pancreatic cancer increases with age. The vast majority of patients are aged between 50 and 80 years.

Risks and Causes
The only known risk factor is smoking. Alcohol and fat in diet have been implicated but not proven to cause pancreatic cancer.

Symptoms
The symptoms of pancreatic cancer are generally vague and non-specific. Weight loss is one of the earliest symptoms. Abdominal pain or jaundice (yellowness of the whites of the eyes) is not uncommon late in the disease.


Diagnosis
If pancreatic cancer was suspected, the initial diagnostic test would be a CT or computerised scan of the abdomen. It is able to detect any pancreatic mass greater than 2cm, 95% of the time. Smaller tumours are more difficult to detect. When a fibreoptic scope is used to look into the stomach and small intestine where the ducts of the pancreas drain, the procedure is called an endoscopic retrograde cholangiopancreaticography (ERCP). X-ray dye is injected into the ducts of the pancreas and x-rays taken of the pancreas. Irregularities of the pancreatic ducts can then be seen. Small pieces of tissue can also be biopsied during this procedure. If the ducts are blocked, a small plastic tube, called a stent, can be placed during this same procedure to bypass the block. Potential complications of this procedure include infection of the pancreas and perforation of the small intestine. A stent that is placed will need to be changed every 3 to 4 months because the stent can be blocked by normal secretions from the pancreas. Clinical examinations, x-rays and pathology reports all help the medical team decide what the progress of an individual case of pancreatic cancer may be. Then, the appropriate course of treatment will be put into action. The treatment strategy will vary from person to person. With prompt and appropriate treatment, the outlook for a person with pancreatic cancer is fair. Even with surgery, about half of patients survive between 2 to 3 years. The chance of surviving to 5 years after curative surgery is about 20%. Patients with advanced inoperable pancreatic cancer do not normally survive beyond a year.

Treatment
Surgery is recommended for pancreatic cancer. Unfortunately, most patients are not candidates for surgery because of the advanced stage of disease when diagnosed. If surgery to remove the entire cancer is not possible, bypass procedures will relieve the jaundice and itching associated with pancreatic cancer and do much to improve the patient's quality of life. Radiotherapy may be considered if surgery is not possible, to relieve pain and occasionally jaundice. Radiotherapy may also be given after surgery to try and prevent cancer recurrence. Radiotherapy focuses high energy rays onto the cancer in the pancreas. Daily treatments over 2 to 5 weeks are associated with nausea and vomiting, and redness of the skin. Chemotherapy is used either to make radiotherapy more effective, i.e. as a radiosensitiser, or when the 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 importantly, chemotherapy has been shown to relieve pain in some patients with advanced pancreatic cancer.

Frequently Asked Questions
*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 given, i.e. nerve block. Other measures include radiotherapy and chemotherapy. *My mother is extremely jaundiced from her pancreatic cancer. Is it dangerous?* The jaundice in itself is not life threatening. The jaundice is a result of the pancreatic ducts being blocked by the cancer. With the blockage, infection of the pancreas is more common and may require antibiotics. The jaundice is also associated with moderate to severe itching of the skin. Oral medications or bypass of the blockage, either with surgery or during ERCP may relieve problematic itching.