Pancreatic Cancer

Pancreatic cancer begins in the pancreas when mutations in the pancreas cells cause these cells to divide uncontrollably.

The Global Cancer Observatory 2020 report by World Health Organization provided statistics for Malaysia: 2 out of 100 newly diagnosed cancer cases were due to pancreatic cancer, and only around 3 patients diagnosed in the past five years for every 100,000 people remain alive. Despite a grim outlook, it is possible to cure pancreatic cancer if detected and treated early.

There are two types of tumours that grow in the pancreas:

• Exocrine tumours are found in almost all pancreatic tumours. The most common type is adenocarcinoma, attributing to 95% of exocrine cancer, while the less common types are adenosquamous carcinomas, squamous cell carcinomas, signet ring cell carcinomas, undifferentiated carcinomas, and undifferentiated carcinomas with giant cells.
• Neuroendocrine tumours (NETs) make up of less than 2% of pancreatic cancers. This type of cancer tends to have a better outlook than exocrine tumours.

• Male gender
• Older than 45 (average age of diagnosis is 70)
• Heavy smoking or drinking
• Overweight
• Family history of pancreatic cancer
• Chronic pancreatitis (long-term inflammation of the pancreas)
• People with type 1 or type 2 diabetes
• Hereditary chronic pancreatitis or certain inherited genetic syndromes
• Long-term exposure to certain chemicals that are used in dry cleaning and metalworking

In most cases, pancreatic cancer does not show any symptoms until the disease is advanced.

Some symptoms of pancreatic cancer include:

• Unexplained loss of weight
• Loss of appetite
• Constant tiredness
• Nausea and vomiting
• Abdominal pain that may radiate to the back
• Signs of jaundice, observed as yellowing of the skin and the whites of the eyes
• Itchy skin
• Dark urine
• Light-coloured or greasy stools
• New or worsening diabetes
• Gallbladder or liver enlargement, felt as a lump during physical exam

It remains challenging to find pancreatic cancer in the early stages, as doctors cannot feel the pancreas in a routine exam.

If pancreatic cancer is suspected:

• Imaging tests will be ordered:
• Computed tomography (CT) scan
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Ultrasound
• Other diagnostic tests include:
• Blood tests assess liver function in case of jaundice, as well as tumour markers (CA 19-9).
• Biopsy involves the removal of a small sample of the tumour and examination under the microscope to confirm the diagnosis for pancreatic cancer.

Learn more about the different types of screening and diagnostic procedures performed to diagnose pancreatic cancer.

Following are some common treatments for pancreatic cancer:

• Surgery of pancreatic cancer involves two general types:
• Potentially curative surgery aims to remove all cancer cells.
• Palliative surgery is conducted to relieve symptoms and prevent complications in cases where complete surgical removal is not possible.
• Ablation destroys tumours without surgical removal with extreme heat or cold and it is best for tumours of less than 2 cm in diameter.
• Embolisation destroys tumour without surgery by injecting substances to block blood flow to the cancer cells. This is usually meant for larger tumours of up to 5 cm in diameter.
• Chemotherapy is an anti-cancer drug that shrinks tumour before surgery, kills remaining cancer cells after a surgery, and relieve symptoms in advanced cancer.
• Radiotherapy uses high-energy x-rays to kill cancer cells. It is sometimes given along with chemotherapy to shrink tumour, kill cancer cells and provide symptoms relief.
• Immunotherapy stimulates immune system to recognise and destroy cancer cells.
• Targeted therapy targets changes in the pancreatic cancer cells that grows the tumour.

Learn more about the different types of treatment technologies to treat pancreatic cancer.

Pancreatic cancer cannot be completely prevented. However, some options for healthy lifestyle are recommended to reduce the risk of getting this disease. These include:

• Quit smoking
• Avoid excessive use of alcohol
• Maintain a healthy weight
• Keep the sugar level under control
• Limit exposure to certain chemicals in the workplace

Currently, routine screening for pancreatic cancer among those at average risk is not recommended.

However, people at high risk of pancreatic cancer may be able to detect the disease early through endoscopic ultrasound or MRI. This group of individuals includes someone with a strong family history of pancreatic cancer or with a known genetic syndrome that increases their risk.