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Pancreatic Cancer

Clinical OncologyGeneral SurgeryGastroenterology Hepatology

Pancreatic cancer is a malignant tumour, and its early symptoms are not obvious, often manifesting as abdominal pain, weight loss, etc. It is challenging to treat, and prevention and treatment should be emphasized.

Pancreatic cancer is the sixth leading cause of cancer-related deaths in Hong Kong, with nearly five hundred people dying from this disease each year. The average age of onset is around 70, and the chances of developing this disease are roughly equal for both men and women.

Early symptoms of pancreatic cancer may not be obvious, but in later stages, the following symptoms may occur:

Symptom	Cause
Abdominal and Back Pain	Cancer cells invade surrounding nerves, causing pain in the upper abdomen and affecting the back.
Sudden Weight Loss	Reduced secretion of pancreatic juice leads to the body's inability to absorb nutrients, resulting in a rapid decrease in body weight.
Oily Stools, Diarrhoea	Pancreatic juice aids in digesting fat in food. When the secretion of pancreatic juice decreases, undigested fat may be excreted, leading to malabsorption, oily stools, and foul-smelling diarrhoea.
Jaundice	The patient's face and eyes turn yellow; urine becomes dark yellow. It is mainly due to the tumour blocking the bile duct, preventing bile from entering the duodenum. It can also cause skin itching, and the stool may appear clay-coloured.

Factors

The medical community believes that pancreatic cancer may be related to uncontrolled cell growth in the pancreas. According to past research, pancreatic cancer is associated with the following factors:

Age
Unhealthy lifestyle habits (such as heavy alcohol consumption, smoking)
Family history

High Risks

The following individuals have a higher chance of developing pancreatic cancer:

Aged 65 or older
Smokers and heavy alcohol drinkers
Overweight or obese
Long-term consumption of excessive animal fat and insufficient intake of vegetables and fruits
Individuals with diabetes
Prolonged exposure to chemicals (such as pesticides, petroleum, or dyes)
Infection with Helicobacter pylori
Patients with chronic pancreatitis
Family history of hereditary chronic pancreatitis

Patients can be diagnosed with pancreatic cancer through the following methods:

Diagnostic Method
Blood Test	Differentiate the concentrations of CA19-9 and CEA (tumour markers) in the blood. It's important to note that tumour markers' accuracy could be much higher.
Ultrasound	Use a scanner to examine the patient's abdomen, checking organs such as the liver, pancreas, gallbladder, and bile ducts. If necessary, it may be combined with an endoscopic ultrasound examination.
CT Scan	Examine the location of the tumour.
MRI	Utilize a magnetic field to create images of tissues, allowing observation of abnormalities in the pancreatic duct wall.
Endoscopic Retrograde Cholangiopancreatography (ECRP)	A tube is passed through the mouth, throat, and oesophagus, then through the stomach and the first part of the small intestine (duodenum), using X-rays to visualize the condition of the pancreatic or bile ducts to identify tumours or other abnormalities.
Magnetic Resonance Cholangiopancreatography (MRCP)	A diagnostic method that uses magnetic resonance imaging (MRI) technology to examine the bile ducts and pancreatic ducts. This examination is typically employed to assess the structure of the bile and pancreatic ducts, aiming to detect any obstructions or other issues.
Laparoscopy	A small incision is made near the navel, and a laparoscope is inserted. A small amount of internal tissue can be extracted for examination if necessary.

Treatments

According to the different stages of pancreatic cancer, doctors will recommend corresponding treatment plans:

Treatment Methods
Surgery	Doctors may remove the affected area and, in some cases, parts of organs based on the patient's symptoms and condition. This could include removing the duodenum partial or total pancreatectomy, among other procedures.
Chemotherapy and Targeted Therapy	Chemotherapy involves using drugs to kill cancer cells. However, due to the low selectivity of these drugs for cancer cells, normal cells may also be affected, leading to side effects. Targeted therapy involves drugs specifically designed for specific characteristics of cancer cells, with fewer side effects than traditional chemotherapy.
Radiotherapy	It uses high-energy radiation to eliminate cancer cells.

Impact

If pancreatic cancer is not treated promptly, more severe complications may arise. For example, the tumour's enlargement can exert pressure on nerves, causing severe abdominal and back pain. Some patients may experience significant weight loss. Additionally, the spread of pancreatic cancer tumours can lead to jaundice.

Prevention

If you have no symptoms, individuals without symptoms do not need to undergo pancreatic cancer screening. High-risk individuals, including those with a family history of pancreatic cancer, specific genetic syndromes, or particular genetic susceptibility features that significantly increase the risk of pancreatic cancer, may consult with a doctor for advice before deciding whether to undergo screening.

FAQ

Pancreatic cancer is an aggressively invasive form of cancer. In the early stages, pancreatic cancer symptoms are not obvious, and the tumour grows slowly in a concealed location. Regular physical examinations and tests typically cannot precisely detect it. As a result, many patients only become aware of symptoms in the late stages of pancreatic cancer, leading to delays in receiving treatment during the optimal window.

Pancreatic cancer can be classified into exocrine tumours and endocrine tumours. Exocrine tumours, which account for 90%, result from uncontrolled growth of epithelial cells that secrete pancreatic juice, typically originating from the inner wall of the pancreatic duct. Endocrine tumours, on the other hand, are less common. They occur due to the uncontrolled growth of epithelial cells that produce hormones and form tumours in pancreatic islet cells, also known as pancreatic neuroendocrine tumours.

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