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Understanding Pancreatic Cancer

In this article:

Incidence and Mortality Statistics
Common Symptoms
Causes of the Disease
Risk Factors
Diagnostic Methods
Treatment Methods
Personal Care
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Pancreatic Cancer Incidence Rates

Pancreatic Cancer Incidence Statistics: Data on the Silent Killer Among Hong Kong Cancers

Pancreatic cancer is the fourth leading cause of cancer deaths in Hong Kong. In 2022, a total of 920 people died from this cancer, accounting for 6.3% of all cancer deaths. In the past decade, both incidence and mortality of pancreatic cancer have significantly increased. From 2012 to 2022, the number of deaths due to pancreatic cancer jumped by 71%.

Don't Ignore Digestive Discomfort

What is the Common Symptoms of Pancreatic Cancer?

The pancreas is located in the upper left abdomen, between the stomach and spine, near the liver, gallbladder, spleen, and small intestine. Due to its hidden position, early-stage pancreatic cancer often shows no apparent symptoms. Initially, patients may experience intermittent abdominal pain that radiates to the back, along with weight loss, diarrhoea, nausea, and other signs. However, these symptoms are easily mistaken for common digestive issues, potentially delaying timely treatment. Once cancer cells spread to surrounding blood vessels, patients may suffer from persistent abdominal and back pain, jaundice [Note 1], itchy skin, and clay-colored stools.

Digestive System Abnormalities

Analyzing Pancreatic Cancer Causes: Why is it Often Discovered at a Late Stage?

The pancreas is a gland in the digestive system, approximately 10 cm long and shaped like a cone. Its lower right end connects to the duodenum, the first segment of the small intestine. The pancreas has an uneven surface, with a long, narrow pancreatic duct and short branches that deliver pancreatic juices to the duodenum to aid digestion. This duct also transports bile from the liver to the duodenum, mixing pancreatic enzymes with bile before they enter the gallbladder. The medical community believes pancreatic cancer may arise from abnormal cell growth and mutations in the pancreas.

Diet and Environmental Influences

Pancreatic Cancer Risk Factors: Is There a Link to Smoking and Diabetes?

Generally, most pancreatic cancer patients are aged 65 or older. In addition to age, the following factors may increase the risk of developing pancreatic cancer:

  • Smoking (smokers have a 2 to 3 times higher risk than non-smokers)
  • Abnormal glucose metabolism (diabetes)
  • Long-term excessive consumption of animal fats and low intake of fruits and vegetables
  • Obesity
  • Prolonged exposure to chemicals such as pesticides, petroleum, and dyes
  • Helicobacter pylori infection (Note 2), which increases pancreatic cancer risk by about 2 times
  • Family history (though rare)

Given these risk factors, cancer prevention should focus on dietary habits—eating more fruits, vegetables, and low-fat animal products—and regular exercise to avoid obesity. Additionally, exposure to hazardous chemicals should be minimised, and proper safety measures must be taken when necessary. Smokers should quit as soon as possible to avoid inhaling carcinogens.

If pancreatic cancer is left untreated, more severe complications may arise, such as tumour growth pressing on nerves, causing intense abdominal pain. Some patients may experience severe weight loss, requiring nasogastric tube feeding or intravenous nutrition. Furthermore, tumour spread can lead to jaundice.

Abdominal Scans

Pancreatic Cancer Diagnosis Methods: CT Scan and Endoscopic Ultrasound

If symptoms suspicious of pancreatic cancer appear, seek medical attention promptly for a thorough examination. The doctor will first check for yellowing in the whites of the eyes and skin, then press on the abdomen to assess for pain. If necessary, the following tests may be conducted:

  • Blood Test
    • These evaluate blood cell count, shape, and liver/kidney function. By measuring specific protein concentrations in the blood, “tumour markers” help assess cancer risk. However, conditions like colorectal cancer, oesophageal cancer, or cirrhosis can also elevate these markers, limiting their accuracy for definitive pancreatic cancer diagnosis.
  • Ultrasound Scan
    • A scanner is moved over the upper abdomen to examine the liver, pancreas, gallbladder, and bile ducts for abnormalities. Sound waves are analysed by a computer and converted into images. An endoscopic ultrasound (with a probe) may be used for higher-resolution imaging.
  • Computed Tomography (CT) Scan
    • X-rays from multiple angles determine the tumour’s location, size, and spread, including involvement of nearby blood vessels, lymph nodes, or organs, helping decide if surgery is feasible.
  • MRI Scan
    • Magnetic fields create cross-sectional body images to detect cancerous changes in pancreatic duct walls. A contrast dye may be injected intravenously to enhance clarity.
  • Endoscopic Retrograde Cholangiopancreatography (ERCP)
    • A lighted, camera-equipped flexible tube is threaded through the mouth, throat, and stomach into the duodenum. Contrast dye is injected backwards into the pancreatic/bile ducts for X-ray imaging, revealing inflammation or blockages.
  • MR Cholangiopancreatography (MRCP)
    • An MRI-based scan images the junction of the bile and pancreatic ducts externally to detect obstructions.
  • Laparoscopy
    • A small incision near the navel allows insertion of a laparoscope. A second incision may be made to extract tissue samples for biopsy.

Pancreatic cancer is classified into two types: exocrine tumours, which involve the uncontrolled growth of pancreatic juice-secreting gland cells usually originating from the pancreatic duct lining, and endocrine tumours, which consist of abnormal proliferation of insulin-producing gland cells.

Beyond these classifications, doctors determine the disease stage based on diagnostic results to guide appropriate treatment decisions.

Multiple Treatment Options

Pancreatic Cancer Treatment Methods: Surgical Removal and Chemoradiation Options

The treatment approach for pancreatic cancer is determined based on factors such as the patient’s age, overall health, and tumour characteristics, including size, number, and location. The primary treatment methods include:

  • Surgical Resection
    • Pancreaticoduodenectomy (Whipple procedure):
      • This is currently the only potentially curative surgery used for early-stage tumours in the pancreatic head. The procedure involves removing the affected pancreas, gallbladder, duodenum, part of the stomach (pylorus), and nearby lymph nodes, then reconnecting the remaining pancreas, bile duct, and stomach to the small intestine.

The surgery is complex and requires about 10 days of hospitalisation. Potential complications include delayed gastric emptying (requiring tube feeding) and pancreatic leakage, which may necessitate drainage or antibiotics.

    • Pylorus-preserving pancreaticoduodenectomy:
      • Like the Whipple procedure, it preserves the pylorus, allowing standard food passage. This method is less invasive, has shorter surgery times, and reduces blood loss.
    • Distal pancreatectomy:
      • The affected pancreas and spleen are removed for tumours in the pancreatic body or tail. Risks include pancreatic leakage or infection.
    • Minimally invasive pancreatectomy:
      • For early-stage tumours in the pancreatic tail, small incisions are made for laparoscopic removal. Recovery is faster, but leakage or infection may still occur.
    • Total pancreatectomy:
      • For cancer involving the entire pancreas, the pancreas, gallbladder, duodenum, pylorus, and lymph nodes are removed. Lifelong insulin and enzyme supplements are required post-surgery.
  • Chemotherapy
    • Drugs are administered intravenously to target rapidly dividing cancer cells. Side effects like fatigue, nausea, appetite loss, and hair loss may occur due to damage to healthy cells.
  • Radiation Therapy
    • High-energy beams destroy cancer cells by damaging their DNA. External beam radiation is standard for pancreatic cancer, with temporary side effects such as fatigue, nausea, vomiting, diarrhoea, and skin irritation.
  • Targeted Therapy
    • Targeted therapy uses chemical drugs to directly block tumour cells’ ability to grow and repair themselves. However, most targeted drugs for pancreatic cancer remain in clinical trial stages and are considered self-paid medications in hospitals under the Hospital Authority’s jurisdiction.

Healthy Living

Pancreatic Cancer Personal Care: How to Alleviate Pain and Improve Nutrition?

After treatment, patients should continue with regular follow-up appointments to allow doctors to monitor their condition and check for any signs of recurrence. Additionally, since the pancreas plays a crucial role in digestion, patients must pay attention to their diet. For example, they should eat small, frequent meals, consuming food every 2 to 3 hours in moderate portions. Reducing intake of gas-producing foods such as beans, cabbage, broccoli, and carbonated drinks is also advisable to minimise gastrointestinal discomfort.

Further Understanding

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Note:
1. Jaundice results from increased bilirubin levels in the blood, causing yellowing of the skin. Helicobacter pylori bacteria reside in the stomach and duodenum, potentially causing chronic gastric inflammation, ulcers, or even stomach cancer.

2. A vacuum erection device is a cone-shaped apparatus placed over the penis, equipped with a pump at the base to create a vacuum. This draws blood into the corpora cavernosa, inducing an erection.

Sources:

Hospital Authority

Cancer Foundation

Mayo Clinic

Cancer Online Resource Hub



▣ The information on this website has been reviewed by the HEAL Medical Team and is regularly updated according to the most recent clinical evidence. All content is provided for general informational purposes only and should not replace professional medical advice. Please consult your doctor or another qualified healthcare professional for personalized medical guidance.

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