Pancreatic Cancer – “The King of Carcinoma”

Q1. How bad is pancreatic cancer?
Pancreatic cancer is a very serious type of cancer.  Annually there are around 800 new cases in Hong Kong.  About 700 patients die of pancreatic cancer each year, which means only 100 out of 800 cases survive the condition. Though not among the top 10 cancer types, pancreatic cancer is the fifth deadliest cancer. While only 50% of patients can be cured if diagnosed at the early stage, the percentage decreases to less than 10% when it reaches intermediate or advanced stage. Pancreatic cancer has one distinct characteristic: it is almost asymptomatic at the early stage. Most patients may not beware of it until they feel pain and discomfort at the intermediate or advanced stage, which delays diagnosis and makes treatment difficult.  

Q2. Who are more prone to pancreatic cancer?
Some people are at higher risk of developing pancreatic cancer, e.g. smokers and heavy drinkers. They are also more prone to pancreatic inflammation, which is also one of the risk factors of pancreatic cancer. Diabetic or overweight patients are also more likely to have pancreatic cancer. Due to mutation, those who are genetically disposed to breast and ovarian cancers also belong to the high-risk group. 

Q3. How to detect the cancer early?
Nowadays body checkups are common. Health screening can facilitate early detection of pancreatic cancer. What are the assessments?  Some tumour markers, such as CEA (carcinoembryonic antigen) or CA19.9 (carbohydrate antigen 19-9) are measured in blood tests. These indexes tend to increase in patients with pancreatic cancer. Liver function can also be tested with blood tests, as bilirubin is elevated when the tumour presses on the bile duct. Follow-up is required. CT or MRI scan is also important for diagnosis. Some patients may opt for ultrasound examination of liver and pancreas. As the pancreas sits deep in the abdomen, the images may not be clear. Further assessment is thus required if suspected, e.g. to confirm the presence of tumour with CT or MRI scan. Symptoms may be present in intermediate or advanced pancreatic cancer, e.g. yellowing of skin or the eyes, dark urine. Stools may also turn lighter in colour as the bile cannot reach the intestines. Patients may feel pain in the upper abdomen, even back pain when the nerves in the abdomen are invaded. Detailed assessments and diagnosis are necessary as soon as these symptoms arise.

Q4. Can surgery remove pancreatic cancer?
Pancreatic cancer can be removed surgically, especially when it is confined to the pancreas or has only spread to the nearby lymph nodes in early stage. Complete excision is required: all tumour cells must be removed with the nearby lymphatic glands and nerves. Tumour location is also considered. If the tumour grows near the head of the pancreas, pancreaticoduodenectomy (also known as the “Whipple Operation”) is recommended. It involves the removal of the head of the pancreas, the first part of the duodenum and the end of the stomach, followed by reconstruction to connect the bile duct, pancreatic duct and stomach.  If the tumour is found at the end of the pancreas, the tail of the pancreas as well as the spleen will be excised. If the tumour is big or is located at the centre of the pancreas, the entire pancreas may have to be removed.

Q5. Can surgery cure pancreatic cancer?
Surgery is the most effective treatment for early pancreatic cancer. It involves complete removal of the tumour with the nearby lymphatic glands and nerves. For intermediate pancreatic cancer, chemotherapy, targeted therapy or immunotherapy are considered after surgery to boost protection and control the disease. Regular check-up is of utmost importance, as early detection can greatly increase the chance of recovery from pancreatic cancer. A healthy lifestyle can eliminate other risk factors such as smoking, drinking or obesity, reducing the risk of developing pancreatic cancer.

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