Pancreas Cancer

Overview

The pancreas is an organ located at the upper abdomen, and it lies behind the stomach. Within the pancreas is a system of small tubes, also known as pancreatic ducts, which transports enzymes produced by the pancreas into the small intestine to help digestion. The pancreas also produces a number of hormones to regulate body functions. One of these hormones is insulin, which regulates our blood sugar level.

Although there are a few types of tumours that can grow in the pancreas, when doctors talk about pancreas cancer, we usually refer to a cancer of the cells lining the ducts within the pancreas. Therefore, the scientific medical term for this type of cancer is known as pancreatic ductal adenocarcinoma. This is a very aggressive cancer. Only 1 out of 10 patients who have this disease can be treated by surgery. This is because most patients, upon diagnosis, are already at an advanced stage.

Symptoms

  • Upper abdominal pain, which may radiate to the back
  • Developing jaundice which is yellowing of the skin and the white of the eyes. This person would usually also notice that the urine has turned quite dark. This person may also complain of generalized itch of the skin
  • Loss of appetite
  • Loss of weight
  • Oily stools
  • New-onset diabetes in adulthood

When to Seek Treatment

Generally there are 2 groups of people whom we see for pancreas cancer.

The first group are those who complained of one or more of the symptoms listed above.

The second group are those who have gone for some form of medical check-up and were found by chance to have some abnormalities.

This may include elevation of cancer markers, in particular CA 19-9.

Or they may have gone for some scans, like an ultrasound scan or CT scan, and were discovered to have a growth in the pancreas.

Diagnosis

The doctor would usually get a specialized scan, such as the CT scan or MRI scan. Sometimes a biopsy may be needed. The doctor would also need to check if the cancer has spread, and hence, he may also get a PET scan.

Treatment

Depending on what the stage of the cancer is, the doctor will then decide on the appropriate treatment. If the cancer is advanced and has spread beyond the pancreas, the doctor will recommend chemotherapy or radiotherapy or both. If the cancer is still confined to the pancreas, surgery is possible. Surgery offers the best hope. The type of surgery depends on the location of the cancer in the pancreas. If the cancer is in the head of the pancreas, the name of the surgery is called Whipple operation (or pancreaticoduodenectomy).

Whipple operation

The Whipple operation is an operation to remove the head of the pancreas, along with the duodenum, a portion of the bile duct, the gallbladder, and a portion of the stomach. After removal of these structures the remaining pancreas, bile duct and the stomach are then stitched back into the intestine to reconstitute the continuity of the digestive tract.

Pylorus-preserving pancreatico-duodenectomy (PPPD) Operation

Pylorus-preserving pancreatico-duodenectomy surgery is similar to Whipple Operation and the difference is the entire stomach is preserved and not removed. PPPD is said to allow better long-term digestive function and better quality of life. Whipple operation is a major operation that requires around 6-8 hours to complete. Because this is a major operation, there is usually a need to monitor the patient in the High Dependency Unit or Intensive Care Unit immediately after the operation, usually for 1 to 3 days. The patient will have a nasogastric tube and a urine catheter. In addition, there will be one to two surgical tubes placed into the abdomen to remove any residual fluid or blood. The patient would not be allowed to eat for a couple of days. Intravenous fluid will be given for hydration as well as nutrition. The average length of stay is 10-14 days. If there are any complications, the length of stay will be prolonged. If the cancer is in the body or the tail of the pancreas, then the surgery that would be done is called a distal pancreatectomy. The spleen may be removed at the same time. If a person is told that there is a “tumour” in the pancreas and would like to know if an operation is needed, and what type of technique is suitable for the condition, please do not hesitate to contact us. Due to the complexity of the operation, do consider seeking advice from a Hepatobiliary and Pancreatic surgeon.

Causes

Cancers, including cancer of the pancreas, are due to genetic mutations of the cells.

As a result of these gene mutations, the pancreas cells start to multiply uncontrollably. These cells also have the ability to detach from the pancreas and invade into the bloodstream and spread to other parts of the body, or invade into the adjacent organs around the pancreas.

Risk Factors

What are the risk factors of developing pancreas cancer?

  • Family history of pancreatic cancer
  • Smoking
  • Obesity
  • Diabetes
  • People who have a cystic tumour of the pancreas (such as intra-ductal papillary mucinous tumours)
  • Chronic inflammation of the pancreas (chronic pancreatitis)
  • Older age, as most patients tend to be older than 65 years of age
  • Family history of genetic syndromes which predispose to cancer, such as a BRCA2 gene mutation, Lynch syndrome, etc

Consult Our Doctor

Dr Ho Choon Kiat
Senior Consultant HepatoBiliary, Pancreas & General Surgeon

MBBS (Singapore), FRCS (Edin), FRCS (Glasg), M.Med (Surgery), FRCSEd (Gen), FAMS (Surgery) Adjunct Assistant Professor, NUS Yong Loo Lin School of Medicine

FAQs

The answer is yes. These may be less aggressive, and therefore cure is quite possible. Examples are:

  • Neuroendocrine Tumours
    These tumours arise from the hormone producing cells in the pancreas. Examples of such pancreatic neuroendocrine tumours (or pNET for short) include insulinoma, gastrinoma, etc.
  • Cystic Tumours of the Pancreas
    These are fluid containing tumours. If they are small, and do not have any high-risk features, they may be left alone and just observed. If they become larger than 3cm, or have high-risk features, then surgery becomes necessary.

These are some alternative surgical techniques to remove such tumours, and it include laparoscopic or keyhole operations. Other options include:

  • Segmental Pancreatectomy
    This removes a middle portion of the pancreas
  • Enucleation
    This removes a small portion of the pancreas

Have a question or need a second opinion?

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