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Pancreatic Cancer Alert: Are You Ignoring These Red Flags?

TICKING TIME BOMB: PANCREATIC CANCER

Could a ticking time bomb be hiding in your body? Pancreatic cancer, the stealthy health hijacker, could be staging a silent takeover. 

It’s the dark plot twist in your life’s story that you didn’t see coming. This article isn’t just a read—it’s your potential lifeline. Wake up to the warning signs now! We spoke with Dr Lee Lip Seng for a doctor’s insight into pancreatic cancer.

Dr Lee Lip Seng is a senior consultant of Hepatobiliary and Pancreatic Surgery. He has key expertise in minimally invasive surgery (laparoscopy and robotic surgery) to treat both the benign and malignant conditions of the pancreas, liver, gallbladder and bile duct.

For our understanding, could you describe what constitutes a pancreatic tumour and the types that are most often diagnosed?

Dr Lee: A pancreatic tumour is an abnormal growth within the pancreas. This abnormal growth can be broadly classified into cystic tumour and solid tumour. 

Pancreatic cystic tumour, which contains mucin (sticky material), has the potential to turn into cancer. 

Solid pancreatic tumours are mostly malignant. The types of pancreatic tumours are named after their cells of origin. E.g.

  • Pancreatic ductal cancer originates from the cells of the pancreatic duct. 
  • Pancreatic neuroendocrine tumour (pNET) originates from the endocrine cells within the pancreas. PNET, which actively produces hormones, is known as functional pNET. In contrast, the non-functional pNET is not producing hormones. 
  • Pancreatic acinar cell carcinoma originates from the acinar cells within the pancreas. 

Overall, pancreatic ductal cancer is the most common cancer of the pancreas. It also behaves “aggressively”. For example, it tends to have spread to distant organs at the time of diagnosis, and this cancer recurs early, even after treatment. 

What are the early warning signs or symptoms of pancreatic tumours, and why is early detection crucial for treatment outcomes?

Dr Lee:  Patients with pancreatic cancer often overlook their vague symptoms for a while before seeking medical attention at a clinic. These vague symptoms include fatigue, loss of appetite and weight and nausea. The more specific signs are painless jaundice and dark-coloured urine. Abdominal pain caused by pancreas cancer is usually due to a more advanced cancer.

Functional pNET will present with symptoms related to the excess hormone it produces. e.g. low blood sugar when there is too much insulin being produced. The patient will experience palpitation, rapid heart rate, sweating, and fainting.

The pancreas is a long organ; the signs and symptoms of the tumour also depend on the location of the tumour in the pancreas and the stage of the cancer (early vs advanced stage).

Pancreas cancer that is located at the head of the pancreas will compress on the lower part of the bile duct; therefore, the patient will present earlier for medical attention with jaundice when the bile flow is obstructed. However, the pancreas cancer located at the body and tail of the pancreas will not compress on any surrounding structures until it grows to a much bigger size or when it has already spread; therefore, it will usually present at a more advanced stage.

Finally, patients with early-stage pancreas cancer are usually identified incidentally from screening or from scans performed for other conditions unrelated to the pancreas. This group of patients has the best outcome (i.e. longest survival) after treatment since they are identified before the cancer spreads to the lymph nodes or other distant organs such as the liver and the lungs. The cancer that has already spread to the lymph nodes tends to have early cancer recurrence even after treatment.

How do specialists typically diagnose pancreatic tumours, and can you discuss the advancements in diagnostic technologies?

Dr Lee:  Diagnosis of pancreas cancer requires scans and tissue diagnosis. Pancreas tumours are usually identified on CT or MRI scans; the scans will show features of cancers. Commonly, patients with pancreas tumours undergo an endoscopy. This obtains biopsies from the pancreas tumour to diagnose the nature of the tumour.

PET-CT scan is useful to look for the presence of a distant spread of pancreas cancer and the pNET. It will guide whether a patient should go for surgical removal of the tumour (early stage) or undergo chemotherapy when it has already spread (advanced stage).

Can you outline the current treatment modalities for managing pancreatic tumours? How are decisions made based on the type or stage of the tumour?

Dr Lee:  Treatment of the pancreas tumours depends on

  1.   The type of the tumour,
  2.   The location of the tumour,
  3.   The stage of the tumour, and
  4.   The approach of surgical removal.

Premalignant cystic tumours, malignant cystic tumours, pNET and pancreas ductal cancers that have not spread distantly (early-stage tumours) can be treated with surgical resection.

The pancreas tumour located at the tail of the pancreas will require a distal pancreatectomy. The tumour located at the head of the pancreas requires the Whipples’ operation. This involves the removal of the head of the pancreas, the bile duct, the gallbladder, the duodenum and part of the stomach.

However, advanced-stage pancreatic cancer will require chemotherapy to control or slow down the spread of the cancer.

Advanced cancer (that is not suitable for complete surgical removal) that has an invasion to the bile duct and stomach can cause persistent jaundice and prevent one from eating. The process to cure this is surgery bypass to relieve the bile flow obstruction and to restore the continuity of the stomach. Subsequently, chemotherapy will follow.

The progress in surgical technology now allows patients with pancreatic cancer to undergo minimally invasive surgery with the aid of robotic systems, offering significant benefits. Additionally, robotic surgery for treating pancreatic cancer allows the surgeon to have a close-up 3D view and precise handling and suturing of the structures.

Not all pancreatic surgery is suitable with minimally invasive methods. Therefore, careful assessment to determine the best treatment approach is the key to success.

Are there any lifestyle factors that contribute to pancreatic tumours?

Dr Lee:  Most of the time, pancreatic cancer occurs sporadically and is not completely preventable. Risk factors associated with pancreatic cancer are tobacco use, alcohol drinking, chronic pancreatitis and poorly controlled diabetes.

Finally, maintaining a healthy lifestyle is essential generally.

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