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Pancreatic cancer is the No. 6 cancer killer in Hong Kong with nearly 400 deaths every year. Onset of the cancer occurs at around the age of 70, and males and females share almost the same rate of getting it.

(Special thanks to Dr. F.Y. CHEUNG, Associate Consultant, Clinical Oncology, Queen Elizabeth Hospital for reviewing the information of this page.)

1. What is Pancreatic Cancer?
2. What are the risk factors of Pancreatic Cancer?
3. How to prevent pancreatic cancer?
4. What are the causes of pancreatic cancer?
5. Can symptoms of Pancreatic Cancer be recognized easily?
6. How to investigate and make diagnose for Pancreatic Cancer?
7. What are the treatments for Pancreatic Cancer?
8. What are the complications of Pancreatic Cancer?
9. How do patients with Pancreatic Cancer take care of themselves?
10. Local and overseas supporting organisations
11. Related document(s)

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What is Pancreatic Cancer?

The pancreas is a gland located deep in the abdomen between the stomach and the spine, connecting the duodenum. It is a digestive organ, mainly for the secretion of digestive enzymes to help digestion, and the manufacturing of insulin to monitor the blood sugar level.

The pancreas lies deep in the abdomen, behind the stomach and the large and small intestines. Pancreatic cancer is an aggressive cancer. As the malignant tumor within the pancreas grows slowly, and hides itself deep, it is not easy to detect at its early stage. Even though for a person who has regular checks annually, it is difficult to find out if the person has got the pancreatic cancer through general tests. Therefore, pancreatic cancer is usually diagnosed at advanced stage and so delays the necessary treatments and has poor survival rate. Even the patient is able to undergo a surgery to remove the tumor, his/her life span is shorter than that of other cancer patients.

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What are the risk factors of Pancreatic Cancer?

Most patients of pancreatic cancer are over the age of 65, and the other risk factors include:

  • Race: The black people have a higher risk.
  • Sex: men have higher risk than women
  • Smoking: Smokers’ chance of getting the disease is 2 to 3 times higher than that of non-smokers.
  • Abnormal sugar metabolism: Those suffering from diabetes mellitus have a higher risk.
  • Overweight: Obese people have higher risk.
  • Diet: People with a prolonged over intake of animal fat and poor vegetable and fruit consumption are more likely to get the disease.
  • Chemicals: Prolonged contacts with pesticides, petroleum or dyes are more vulnerable to the disease.
  • Infection with Helicobacter pylori: The risk for people infected with the bacteria is 2 times higher.
  • Hereditary pancreatitis: Hereditary chronic pancreatitis will add the risk of getting pancreatic cancer, but it seldom occurs.
  • Chronic pancreatitis: Chronic pancreatitis is usually discovered together with pancreatic cancer, but the former may not be the cause of the latter.
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How to prevent pancreatic cancer?

Although pancreatic cancer cannot be completely prevented, modification of life style can help reduce the risk of getting the disease:

  • Quite smoking: cigarette smoke contains cancer-causing substances that can destroy the DNA which monitors the cell growth.
  • Maintain a healthy weight: Excessive weight increases the risk of getting pancreatic cancer. Body weight reduction should be gradually and in healthy way.
  • Have regular exercise: Suitable amount of exercise may reduce the risk of getting the cancer.
  • Have a healthy & balanced diet: To eat more vegetables, fruit and foods with low animal fat.
  • Avoid contacting dangerous chemicals or adopt suitable safety measures.
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What are the causes of pancreatic cancer?
The causes of pancreatic cancer are not known, but mutation and hyperplasia of pancreas cells may be the cause. Most of the pancreatic cancers are adenocarcinoma arising from the pancreatic ductal epithelium.
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Can symptoms of Pancreatic Cancer be recognized easily?

Should a patient have the following symptoms, he/she may get the disease:

  • Sustained pain in the upper abdomen, which is not related to eating or drinking, and the pain may extend to the back.
  • Loss of appetite, nausea, vomiting, indigestion, physogastry, and other intestine and stomach problems
  • Jaundice, itching skin and clay coloured stools
  • Drastic loss of weight in a short time
  • Fixed, hard lumps in upper abdomen
  • Ascites
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How to investigate and make diagnose for Pancreatic Cancer?

 

After taking patient's history and suspected he/she has pancreatic cancer, the doctor will arrange the following tests to explore the size and location of the tumor:

Biopsy: Using Fine Needle Aspiration (FNA) Cytology, the doctor employs a thin needle to penetrate the skin, with ultrasound or computer tomography guide to reach tumor site., The samples of cells. will be sucked through the needle and the sample tissues will be examined under the microscope to make diagnosis.

If pancreatic cancer is diagnosed, other tests will be arranged to check if dissemination has occurred. The tests include laparoscope, lung X-ray, bone scan, positron emission tomography scan and blood test for CA19-9, etc.

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What are the treatments for Pancreatic Cancer?

Treatments for pancreatic cancer depend on the stage of the cancer, the age of the patient, the overall health conditions and patient’s preference. The major goal of tumor treatment is to eliminate the tumor. But when this turns out to be impossible, the focus will be to slow down the growth of the tumor wherever possible or to avoid causing further damages. Therefore, under certain circumstances, palliative treatment may be most suitable to individual patient.

Surgery
At present, removing the tumor completely through surgery is only mean of eliminating pancreatic cancer thoroughly, but this is not applicable to all the patients, especially when the cancer cells have spread beyond the pancreas to other organs and affected the lymph nodes and major blood vessels extensively.
 
Whipple’s Operation: This is the most commonly used surgery technique which includes the removal of the pancreas, duodenum, gall bladder and even part of the stomach, etc. The death rate caused by surgery is lower than 5%.

Around 25% of the patients have pancreatic cancer located in the body and tail of the pancreas and discovered only at advanced stage. They may need to undergo distal pancreatectomy or total pancreatectomy.
 
Radiotherapy
It is to use high-energy radiation to destroy the cancer cells and this process can be employed after surgery. Should a patient be found out not suitable to undergo surgery, he/she may be recommended to have both radiotherapy and chemotherapy.

Chemotherapy
This is to kill cancer cells by using drugs, and this is usually done through intravenous injection or oral admission. Although cancer cells cannot be completely destroyed simply using chemotherapy, the signs and symptoms of the disease can be relieved and the patient’s quality of life be improved. Meanwhile, chemotherapy may also be used as adjuvant treatment after the surgical removal of pancreas tumor.

Target Therapy
This is done by using specific biological molecules to stop the growth and recovery abilities of cancer cells, just like missiles hitting targets directly. It is mostly used together with chemotherapy in treatments for pancreatic cancers.
    
Palliative Treatment
If the cancer has spread extensively, the primary objective is to mitigate the symptoms and maintain the patient’s quality of life.
 
Palliative shunt: If the tumor blocks the bile duct, a stainless steel or plastic stent is inserted in the bile duct, so as to maintain free flowing in the duct. If the intestine is blocked, by-pass surgery may be deemed necessary.

Pain treatment: This may be the case in the advanced stage when the tumor presses against surrounding nerves, which results in severe pain. Morphine is particularly useful in this stage. When the drug fails to function efficiently, the patient may be consulted on other choices, such as using drugs to stop the pain signals from being transmitted or injecting alcohol into the nerves to destroy the pain reception nerves.

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What are the complications of Pancreatic Cancer?

The following complications may occur to patients with pancreatic cancer:

  • Jaundice
  • Pain: Abdominal pain will intensify as the tumor enlarges and presses the nerves
  • Sever loss of weight: Patients having difficulties in eating may need to be fed with an nasogastric tube or through intravenous injection to insert nutrition supplements

Surgical complications: Pancreatic cancer operations are very difficult to perform, but the survival rate has improved a lot. Complications include bleeding, infection and unstable blood sugar level.

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How do patients with Pancreatic Cancer take care of themselves?

Before and after surgery, and during recovery, there are quite a number of things that the patient needs to attend to. The more the patient knows about the disease, the more positive the patient may become.

Regular follow-ups: Regular follow-ups are arranged for a patient to monitor his /her conditions and symptoms of recurrence. Should there be any new symptom, the doctor must be notified as soon as possible.
Palliative treatment and caring for other symptoms, such as maintain nutrition and pain killing, etc.

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Local and overseas supporting organisations
Hong Kong Cancer Registry
Health Zone - Central Health Education Unit, Department of Health
Hong Kong Cancer Fund - CancerLink (Central)
Hong Kong Cancer Fund - CancerLink (Wong Tai Sin)
The Hong Kong Anti-cancer Society
The Hong Kong Society for Rehabilitation
Hong Kong Cancer Fund
Hong Kong Cancer Fund - CancerLink Hotline
The Hong Kong Anti-cancer Society - Cancer Hotline
Better Health Channel
NHS Direct
Palliative Care Patient & Family Support Group
The Hong Kong Pioneers Mutual Support Association
Regeneration Society Ltd
Taishan Charitable Association Ltd
Health Support Group (Surgical Unit)
Mayo Clinic
Hong Kong Cancer Fund - CancerLink (Tin Shui Wai)
Hong Kong Cancer Registry
Health Zone - Central Health Education Unit, Department of Health
Hong Kong Cancer Fund - CancerLink (Central)
Hong Kong Cancer Fund - CancerLink (Wong Tai Sin)
The Hong Kong Anti-cancer Society
The Hong Kong Society for Rehabilitation
Hong Kong Cancer Fund
Hong Kong Cancer Fund - CancerLink Hotline
The Hong Kong Anti-cancer Society - Cancer Hotline
Better Health Channel
NHS Direct
Palliative Care Patient & Family Support Group
The Hong Kong Pioneers Mutual Support Association
Regeneration Society Ltd
Taishan Charitable Association Ltd
Health Support Group (Surgical Unit)
Mayo Clinic
Hong Kong Cancer Fund - CancerLink (Tin Shui Wai)
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Related document(s)
Endoscopic Retrograde Cholangiopancreatography, ERCP
Computed Tomography
Magnetic Resonance Imaging
Ultrasound
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