• 4/F., Champion Tower, 3 Garden Road, Central, Hong Kong
  • Unit. 1908-09, 19/F, Mira Place Tower A, 132 Nathan Road, Tsim Sha Tsui

Pancreatic cancer is the sixth leading cause of cancer death in Hong Kong, accounting for approximately 500 cancer deaths every year and occurs at around the age of 70[1]. Known as the deadliest type of cancer, pancreatic cancer has the highest mortality rate of all the major cancers, far exceeding that of lung and colorectal cancer.

 

It has drawn a substantial amount of attention around the world as a global medical challenge. According to the latest statistics published by the Cancer Council of Australia, the five-year survival rate for pancreatic cancer is only 7%, and approximately 30% of deaths occur just two months following diagnosis. Over 80% of pancreatic cancer patients are diagnosed with cases of advanced pancreatic cancer that are inoperable[2].

 

In the past ten years[3], a number of international medical studies have recognized the therapeutic potential of a new pancreatic cancer treatment option called stereotactic body radiation therapy (SBRT) that improves the overall effectiveness of pancreatic cancer treatment. According to pancreatic cancer research from The University of Texas MD Anderson Cancer Center, SBRT has proven effective in shrinking pancreatic cancer tumours, with close to 90% of patients seeing their cancer tumours completely removed following surgery[4]. This research is bringing new hope to pancreatic cancer treatments.

 

What follows below is the latest information about pancreatic cancer treatments and an overview of the treatment options, including FAQs regarding pancreatic cancer symptoms and treatment options from their diagnosis to their treatment.

How does pancreatic cancer occur?

The pancreas is an organ located in the digestive system. It secretes enzymes critical to proper digestion, converting the food we eat into fuel for the body’s cells. By producing insulin, the pancreas allows our body to use sugar (glucose) from carbohydrates in the food that we eat for energy or to store it for future use.

 

When pancreatic cells begin to grow out of control, these cells accumulate and form a cancerous tumour which can then spread to the surrounding organs and blood vessels. Pancreatic cancer is quite difficult to detect in the early stages and due to it being located deep inside the abdomen. The development of pancreatic cancer is often characterized by early and rapid spread from the pancreas to other organs, making traditional chemotherapy and electrotherapy treatments rather ineffective. This is why a pancreatic cancer prognosis tends to be grim.

Symptoms of pancreatic cancer

Pancreatic cancer at advanced stages could lead to severe weight loss, jaundice and related symptoms. When the following pancreatic cancer symptoms present, the disease tends to be much more difficult to treat:

 

  • Weight loss – Pancreatic cancer prevents the pancreas from producing enough digestive fluids to convert food into fuel and nutrients, causing unintended weight loss.
  • Jaundice and related symptoms– Jaundice is caused by the buildup of bilirubin that blocks the bile duct, leading to the yellowing of the eyes and skin and dark urine
  • Abdominal pain – Pain occurs when a pancreatic cancer tumor grows large enough to put pressure on surrounding abdominal organs or invades surrounding nerves.
  • Back pain – The pain from the abdomen spreads to the back, becoming more intense after meals.
  • Bloating and constipation – A pancreatic cancer tumor that grows or presses against the duodenum obstructs the passage of food from stomach to intestines, leading to bowel obstruction.

You should consult your doctor should the above pancreatic cancer symptoms persist.

Pancreatic Cancer Causes and Risk Factors

The cause of pancreatic cancer remains unclear, but there have been some research studies pointing to smoking, obesity and unhealthy diet habits as some of the factors that may increase the risk of developing pancreatic cancer. Statistically speaking, most of the genetic mutations that occur in pancreatic cancer are not hereditary but have been acquired during life, such as long-term inhalation exposure to carcinogens (cancer-causing chemicals) including cigarette smoke, insecticide, petroleum and dyes. And there still many cases where the cause of the gene mutations remain largely unknown.
Factors that may increase the risk of getting pancreatic cancer include:

 

  • Chronic pancreatitis (pancreatitis)
  • Helicobacter pylori (H. pylori)[5]– The risk of getting pancreatic cancer is twice as high compared to those without H. pylori.
  • Diabetes
  • A family history of pancreatic cancer
  • Inherited genetic syndromes (including BRCA2 mutations, Lynch syndrome, Melanoma)
  • Tobacco use
  • Obesity
  • Unhealthy diet (including diets that are high in red meats)
  • Aging – Most pancreatic cancer patients are at least 65 years old.

For those with an unhealthy lifestyle such as tobacco use, the risk of getting pancreatic cancer tends to be at least twice as high as those leading a healthy lifestyle. About 20% to 30% of pancreatic cancer cases are believed to have been caused by smoking. In addition, alcohol use can also lead to conditions such as chronic pancreatitis which is known to increase the risk of developing pancreatic cancer, with about 70% of chronic pancreatitis as caused by heavy alcohol use. Other high-risk factors include eating too much processed meats and obesity. In the United Kingdom alone, about 10% of pancreatic cancer cases are closely related to problems with obesity[6].

Screening for Pancreatic Cancer

Tests for pancreatic cancer include:

 

Blood tests – to assess the severity of pancreatic cancer

Imaging tests – such as CT scans and ultrasound which can identify the type and location of the suspicious mass

Endoscopy – such as endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance cholangiopancreatography (MRCP) and percutaneous transhepatic cholangiography (PTC)

Biopsy – removal of a small sample of the suspicious mass which is then examined by a pathologist

Common Pancreatic Cancer Treatment Approaches

Surgery is relatively effective in treating pancreatic cancer but not all pancreatic cancer cases are operable. The best treatment for pancreatic cancer depends on its stage and the location of the tumour. Common pancreatic cancer treatments include:

  • Stereotactic Body Radiation Therapy (SBRT)

Pancreatic cancer tends to be diagnosed when already within the advanced stages and is often untreatable with traditional surgery. Cancer patients in the advanced stages may consider receiving stereotactic body radiation therapy (SBRT) to slow down the development of the cancerous tumour[7]. This treatment method is a targeted radiation therapy through ERCP and is an advanced radiation therapy that uses a narrower beam of radiation to allow doctors to more precisely target the tumour with better results.

 

SBRT requires one to five days to complete. The biggest advantage is that patients do not always experience as many side effects as they do with other radiation therapies. Patients do not experience hair loss, and their daily lives is largely remain unaffected.

  • Surgery

If pancreatic cancer is detected early enough and the tumour is located in the head of the pancreas, surgery can be performed on the patients to remove the tumour. Before surgery, patients are screened through imaging tests or laparoscopy. In laparoscopy, a small, thin tube with a lens will be inserted in the abdomen to locate the cancer cells and make sure they have yet to spread to other parts of the body. The surgery normally requires the doctor remove a small portion of the pancreas and spleen.

 

After the surgery, the patients are required to receive further treatments including chemotherapy and radiation therapy, or both, known as chemoradiotherapy. The objective of post-operative treatment is to destroy all the remaining cancer cells and prolong the lives of the patients whilst reducing the risk of recurrence.

 

Whipple’s procedure – also known as a pancreaticoduodenectomy – is the most common type of surgery for pancreatic cancer. It involves the removal of any parts to which cancer cells have spread such as pancreas, duodenum, gallbladder and sometimes a portion of the stomach. The death rate for patients undergoing the surgery is less than 5%[8].

  • Pre-operative chemotherapy

For patients diagnosed with a stage III pancreatic cancer, relying on surgery alone will not be able to remove the tumour because the cancer cells have spread beyond the pancreas to its surrounding areas. Chemotherapy or radiation therapy may be used to reduce the size of the tumour. The doctor will continue to monitor the development of the disease through imaging tests and procedural review to assess the feasibility of a surgical treatment on the patients.

  • Targeted Therapy

Targeted therapy tends to be used alongside chemotherapy in pancreatic cancer treatment. It targets the changes in cancer cells that help them grow, through molecular biotechnological means cuts off the tumour cell’s ability to grow and repair themselves.

  • Palliative Treatment

Palliative treatment is normally recommended to patients diagnosed with a stage IV pancreatic cancer. It focuses on providing the patients with relief from their symptoms, along with the pain and stress induced by the disease so as to slow down the growth of the cancer cells, in turn prolonging the patient’s lives and improving their quality of life. The medication choices and treatment times will depend on how the patients react to the treatment and how they cope with the side effects from this treatment.

Pancreatic Cancer: Frequently Asked Questions

  • Q1. How can I prevent pancreatic cancer?

    Given that the cause of most pancreatic cancer remains largely unknown, there are no established means to preventing pancreatic cancer. However, some commonly known risk factors for pancreatic cancer should and can be avoided such as smoking, unhealthy diets and chronic pancreatitis.

  • Q2. What are the treatments for advanced-stage pancreatic cancer?

    If pancreatic cancer has spread to other parts of the body, the treatment priority is to focus on alleviating symptoms and maintain the patient’s quality of life. Palliative pancreatic cancer treatment approaches include maintaining adequate levels of nutrition and relieving the pain. If the tumour causes a blockage in the common bile duct, the physician will insert a stent into the bile duct to allow the bile or food to flow into the bowel again. If obstructions occur in the intestines, bypass surgery is usually done to palliate the obstructive symptoms. Patients should have follow-up consultations as requested for better monitoring and control of the disease.

     

    At the later stages of pancreatic cancer, the tumour may press against surrounding nerves and cause severe pain. The doctor may prescribe pain medications to prevent the pressured nerves from transmitting the pain messages to the brain or adopt injections of alcohol as a nerve block in the pain affected area for patient pain relief.

References:

 

  1. http://www21.ha.org.hk/smartpatient/SPW/zh-hk/Disease-Information/Disease/?guid=074209a8-91f7-4223-8b41-d46d43b4e28c
  2. http://languages.cancercouncil.com.au/zh-hant/%E6%8C%89%E7%99%8C%E7%97%87%E7%A8%AE%E9%A1%9E/%E8%83%B0%E8%85%BA%E7%99%8C/#
  3. https://www.ncbi.nlm.nih.gov/pubmed/28708929
  4. https://www.mdanderson.org/publications/cancerwise/stereotactic-body-radiation-therapy–a-new-treatment-option-for-pancreatic-cancer-patients.h00-159228090.html
  5. http://www21.ha.org.hk/smartpatient/SPW/zh-hk/Disease-Information/Disease/?guid=074209a8-91f7-4223-8b41-d46d43b4e28c
  6. https://www.news-medical.net/health/Pancreatic-Cancer-Causes.aspx
  7. https://www.hkioc.com.hk/zh/treatment-2/radiation-therapy/
  8. http://www21.ha.org.hk/smartpatient/SPW/zh-hk/Disease-Information/Disease/?guid=074209a8-91f7-4223-8b41-d46d43b4e28c