Pancreas Cancer
What is Pancreas Cancer?
Pancreas cancer is a tumour originating from the pancreas. There are different types of pancreas cancer as defined by the cell of origin and the most common type starts from within the cells of the pancreatic duct. The cancer can spread to nearby blood vessels, nerves, or other parts of the abdominal cavity.
Risk Factors for Pancreas Cancer
The risk factors for development of pancreas cancer include: cigarette smoking, family history of pancreas cancer, age > 65 years old and chronic pancreatitis (chronic inflammation of the pancreas). However, the underlying mechanism or cause of pancreas cancer remain unknown.
Diagnosis of Pancreas Cancer
Pancreas cancer is often diagnosed when it is at an advanced stage as it presents with vague symptoms which can be similar to other conditions. Some of the symptoms of pancreas cancer include: Jaundice (if the bile duct is blocked by the tumour), loss of appetite, weight loss or back pain.
If pancreatic cancer is suspected, your doctor will refer you for tests. Diagnosis may require the following:
Blood tests
Routine blood tests are non-specific for diagnosing pancreas cancer. Liver enzymes and bilirubin may be abnormal if the bile duct is blocked by the pancreas cancer. Tumour markers such as CA19-9 may be elevated in some patients with pancreas cancer.
Radiology (Non-invasive)
Ultrasound
This involves placing an ultrasound probe on the skin and using sound waves, take images of the pancreas at different areas. This is painless. However, you would require further imaging with either a CT or MRI scan
CT (Computed tomography) scan
This is a specialised X-ray taken to build a 2-dimensional image of your body. It requires you to be able to lie still on a flat surface and the scanner moves up/down your body. You will be required to have an intravenous (IV) line inserted to administer contrast agent to help better image your pancreas and abdominal organs.
Magnetic Resonance Imaging (MRI)
This is another specialised imaging test similar to a CT scan. Instead of using X-Rays, MRI uses magnetic force to construct a picture of your body. You will also require an IV line for a contrast agent, similar to CT scan.
Procedures
Endoscopy
This is performed in conjunction with an ultrasound at the end of a thin telescope and is termed endoscopic ultrasound (EUS). EUS provides high resolution images of part of your digestive tract, in this case, we are interested in the pancreas, bile ducts and surrounding tissue, and if needed, biopsies can be obtained. This procedure is performed by a gastroenterologist trained in the procedure.
Laparoscopy
In rare occasions, we would recommend a laparoscopy to look at the abdominal cavity. This involves a general anaesthetic and introduction of a laparoscope (telescope) into the abdominal cavity. This operation provide options to perform a number of procedures at the same setting including taking a sample of abnormal tissues or intraoperative ultrasound. The optimal procedure will be determined at the time of the operation.
Tissue biopsy
This is most commonly obtained at EUS (See above) to obtain pancreas tissue for analysis. Rarely, this may need to be performed percutaneously (through the skin).
Treatment of Pancreas Cancer
Treatment for pancreas cancer depends on a few factors: location of cancer within the pancreas, your fitness for major surgery and whether the cancer is localised to within the pancreas. Treatment options include:
Surgery
If the cancer is localised to within the pancreas, surgery can be performed. The type of operation depends on the location of the pancreas.
Whipple's Procedure (Pancreaticoduodenectomy)
If the tumour is located closer to the head of pancreas, the operation is called a “Whipple’s procedure” where the cancer, part of the pancreas and duodenum are removed. The gallbladder, part of the bile duct and part of the stomach are also removed.
Distal Pancreatectomy
If the tumour is located closer to the tail of pancreas, the operation is called a “distal pancreatectomy” where the cancer and the tail of the pancreas are removed. The spleen is also removed with the cancer.
Radiotherapy
This is generally used in the palliative setting to alleviate symptoms or in conjunction with chemotherapy and/or surgery to treat any cancer cells remaining in the body following surgery.
Chemotherapy
This can be given prior to or following surgery, and can be in either tablet form or intravenous infusions. This will be managed by an oncologist (Cancer Specialist) in conjunction with Dr. Michael Chu