Pancreatic cancer in Singapore

PANCREATIC Cancer SINGAPORE

The pancreas is a gland located behind the stomach and next to the intestines. It is made of two types of glands. One type of gland tissue produces insulin and other hormones. Although pancreatic cancer is common in the United States and accounts for the third most common cause of cancer death there, pancreatic cancer in Singapore is not as common.

 

They are called by various names, depending on the specific type of cancer cell or by the hormone produced by the cancer. Names include carcinoid tumour, islet cell carcinoma, insulinoma, glucagonoma, and so forth. These are not covered here because of their rarity. The other type of gland tissue produces enzymes which help in digestion of food. These glands drain into ducts which in turn drain into the small intestine. It is the cells of the ducts which can turn into cancer. These are more common pancreas cancers, usually of the type called adenocarcinoma.

Risk factors

Pancreatic cancer is mainly a genetic disease, a cancer caused by damage to the DNA. These mutations can be inherited or acquired as we age.

  • Smoking

increases the risk of pancreatic cancer and is associated with cancer at an early age. It is the leading preventable cause of pancreatic cancer.

  • Age

Risk of developing pancreatic cancer increases with age. Over 80% of pancreatic cancers develop between the ages of 60 and 80 years.

  • Gender

Cancer of the pancreas is more common in men.

  • Chronic pancreatitis

Long-term inflammation of the pancreas (pancreatitis) has been linked to pancreatic cancer.

  • Alcohol

Excessive alcohol intake can cause inflammation of the pancreas (pancreatitis) and also linked to increase the risk of pancreatic cancer.

  • Diabetes

Diabetes mellitus can be a symptom of pancreatic cancer, and long-standing adult-onset diabetes also increases the risk of pancreatic cancer.

  • Obesity

Obesity increases the risk of pancreatic cancer. Studies suggests that a body mass index ≥ 30 have a higher risk.

  • Diet

Diets rich in red meats, cholesterol, fried foods and nitrosamines may increase risk, while diets high in fruits and vegetables reduce risk.

  • Genes

One is at a higher risk if you have a family history of pancreatic cancer (≥ 2 first-degree relatives with pancreatic cancer. o  Inherited cancer syndromes increase the risk of pancreatic cancer e.g. breast cancer syndrome (BRCA2), Lynch syndrome, Peutz-Jeghers syndrome.

  • Environment

Exposure to cancer-causing substances (called carcinogens) such as asbestos, pesticides, dyes, and petrochemicals may be linked to pancreatic cancer.

Signs and symptoms

Signs and symptoms of pancreatic cancer often don't occur until the disease is advanced.

Jaundice

  • Jaundice is yellowing of the eyes and skin; this is often one of the first signs, it is caused by the build-up of bilirubin which the liver excretes as bile.

  • When the bile duct becomes blocked by the cancer, bile can’t reach the intestines and the level of bilirubin in the body builds up.

Dark coloured urine​​

  • Dark urine may be noticed as the first sign.  As bilirubin levels in the blood increase, the urine becomes brown in color

Light coloured stools​​

  • Bile gives stools their brown color. If the bile duct is blocked, stools might be pale or gray.

  • When bile and pancreatic enzymes can’t get to the intestines to digest fats, the stools can become greasy and might float in the toilet.

Itchy skin​​

  • When bilirubin builds up in the skin, it can start to itch as well as turning yellow.

Abdominal or Back pain

  • Pain in the abdomen that radiates to the back is common in pancreatic cancer. It can grow and press on other nearby organs or affect nerves, causing pain.

Loss of Weight and appetite

  • Unintended weight loss and poor appetite is very common in people with pancreatic cancer.

Nausea and vomiting

  • If the cancer presses on the stomach it can block the outlet and this can cause nausea, vomiting, and pain that tend to be worse after eating.

Gallbladder or Liver swelling

  • If the cancer blocks the bile duct, the gallbladder can be enlarged and felt as a lump under the right ribcage. o    The liver also can be enlarged if the cancer has spread to the liver.

Diabetes

  • Sudden Adult-onset Diabetes can be a sign- pancreatic cancers cause diabetes (high blood sugar) because they destroy the insulin-making cells.

Diagnosing pancreatic cancer

The signs and symptoms of the disease are non-specific. If pancreatic cancer is suspected, the initial diagnostic test would be a CT or computerised scan of the abdomen. The CT scan is able to detect any pancreatic mass greater than two centimetres, 95 percent of the time. Smaller cancers are more difficult to detect. Magnetic resonance imaging (MRI) scans can visualise the pancreas and the ducts in the pancreas. This can be particularly useful when planning surgery.

 

Another procedure that is often done is an endoscopic retrograde cholangiopancreaticography (ERCP) which involves using a fibre-optic scope to look into the stomach and small intestine where the ducts of the pancreas drain into. X-ray dye is then injected into the ducts of the pancreas and X-rays taken of the pancreas.

 

Irregularities of the pancreatic ducts can then be visualised. Small pieces of tissue can also be biopsied during this procedure. If a blockage of the ducts is seen, a small plastic tube, called a stent, can be placed during this same procedure to try and bypass the block. Potential complications of this procedure include infection of the pancreas and perforation of the small intestine. A stent which is placed will need to be changed three to four times monthly, because the stent can be blocked by normal secretions from the pancreas.

 

Sometimes, when a biopsy cannot be obtained via ERCP, a percutaneous biopsy of the pancreatic lesion is performed to obtain tumour tissue for diagnosis. This involves inserting a needle through the abdominal wall to the pancreas under CT or ultrasound imaging guidance.

pancreatic cancer illustration.jpg

Treatment

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision making.” Shared decision making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision making is particularly important for pancreatic cancer because there are different treatment options. Learn more about making treatment decisions.

 

When detected at an early stage, pancreatic cancer has a much higher chance of being successfully treated. However, there are also treatments that can help control the disease for patients with later stage pancreatic cancer to help them live longer.