Pancreatic Cancer – “The King of Carcinoma”

Presented by Dr. CHAN See Ching, Specialist in General Surgery

PancreaticCancer Awareness Month

November is Pancreatic Cancer Awareness Month. During this month, multiple international organisations work together to raise awareness and funds for pancreatic cancer research. The event symbolises the purple ribbon as a tribute to one woman's love for her mother. A woman named Rose Schneider, whose favourite colour was purple, died after battling pancreatic cancer.

Why is pancreatic cancer the most feared cancer?

#Pancreaticcancer can be a very deadly #cancer. Annually there are around 800 new cases in #HongKong. About 700 patients die of pancreatic cancer each year, which means only 1 out of 8 patients survive the condition. Pancreatic cancer is also the fifth deadliest cancer. While half the patients can be cured if diagnosed at the early stage, the percentage decreases drastically to less than 10% when it reaches the later stages. Pancreatic cancer has one distinct characteristic: it is almost asymptomatic at the early stage. Most patients may not beware of it until the pain and discomfort at the intermediate or advanced stage, which delays diagnosis and makes treatment extremely difficult. 

Who is more prone to pancreatic cancer?

Some people are at higher risk of developing pancreatic cancer, for instance, smokers and heavy drinkers. The other segment is diabetic or #overweight patients. Due to #mutation, those genetically disposed to breast and ovarian cancers also belong to the high-risk group. 

How to detect pancreatic cancer early?

#Healthscreening can facilitate early detection of pancreatic cancer. Some tumour markers, such as CEA (carcinoembryonic antigen) or CA19.9 (carbohydrate antigen 19-9) are measured in blood tests. These indexes tend to be proportional to the chances of getting pancreatic cancer.

Liver function can also be tested with blood tests, as bilirubin is elevated when the tumour presses on the bile duct. While some patients may opt for an ultrasound examination of the liver and pancreas, CT or MRI scan is then presented as a more feasible solution for the diagnosis as images may not be clear if the pancreas sits deep in the abdomen.

#Symptoms may be present in intermediate or advanced pancreatic cancer, e.g. jaundice (yellowish skin or eyes), and 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.

Can pancreatic cancer be removed surgically?

Pancreatic cancer can be removed surgically, especially when it is confined to the pancreas or has only spread to the nearby lymph nodes in the early stage. Complete excision is required: all #tumour cells must be removed with the nearby lymphatic glands and nerves.

Tumour location is also a factor in this case:

• 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 located at the end of the pancreas, the tail of the pancreas as well as the spleen will be excised.
• If the tumour is too big or is located at the centre of the pancreas, the entire pancreas may have to be removed.

What are the alternative treatments for pancreatic cancer?

Surgery is the most effective treatment for early pancreatic cancer. It involves the 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.

Liver Surgery and Transplant Centre | HKSH Cancer Centre (Island East)

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