What is pancreatic cancer?
Pancreatic cancer accounts for approximately 1% of all gastrointestinal cancers in Thailand. It occurs four times more frequently in men than in women, with an average age of onset of 40-70 years. Although it is a relatively uncommon cancer, since the pancreas is an organ located behind the peritoneal cavity, diagnosis is difficult, and symptoms usually appear only after the cancer has advanced. (National Cancer Institute, Department of Medical Services, Ministry of Public Health)
There are several types of pancreatic cancer. The most common is ductal adenocarcinoma, which arises from cells in the pancreatic ducts. A small number arise from hormone-producing cells, and some are cyst-like.
What causes pancreatic cancer?
The exact cause of this cancer is unknown, but some pancreatic tumors can become malignant. Some factors believed to contribute to pancreatic cancer include smoking and diabetes.
Pancreatic cancer is more common in patients over 45 years of age, with a prevalence rate of 14.8 per 100,000 (2) in the population. This is a very low rate. Therefore, when patients experience jaundice (yellowing of the eyes, body), fatigue, or weight loss, they should always consider other more common conditions, such as cirrhosis, hepatitis of various causes, liver cancer, or other bile duct obstruction conditions, such as bile duct stones and bile duct cancer.
However, pancreatic cancer is more likely in breast cancer patients with the BRCA gene, those with a family history of pancreatic cancer, smoking, and a high intake of meat and fatty foods.
Pancreatic Cancer Symptoms
In the early stages, there may be no symptoms. Symptoms often develop as the tumor progresses, such as:
- Pain in the lower abdomen, which feels like a stabbing pain radiating to the back.
- Jaundice.
- Yellow eyes.
- Loss of appetite and weight loss.
- Enlarged liver.
Symptoms of pancreatic cancer are therefore categorized according to the location of the tumor.
1. Masses located in the head of the pancreas. Since the pancreas serves as a passageway for the bile duct, patients experience symptoms of impaired bile drainage and bile pooling in the bloodstream. This can cause jaundice, yellow eyes, dark urine, fatigue, decreased appetite, weight loss, and greasy stools due to the inability to digest fat. Initially, there may be no abdominal pain. Later, abdominal pain may develop due to the tumor spreading to the nerves. Some patients may experience severe vomiting due to the large mass pressing on the proximal small intestine, preventing food from passing through.
2. Masses located in the body and tail of the pancreas. Since these areas are not near the bile duct, patients often have no symptoms initially. However, symptoms begin to appear as the tumor grows larger or the disease spreads. Patients will experience symptoms such as fatigue, poor appetite, weight loss, abdominal pain from the mass pressing on the nerves, and ascites from the cancer spreading to the peritoneal lining.
How many stages are there of pancreatic cancer?
Based on the 2002 American Joint Committee on Cancer (AJCC) classification method, pancreatic cancer is divided into three groups:
- Surgically viable
- More advanced but locally advanced
- Metastatic
Surgically viable cases include:
- No cancer spread
- The tumor does not encircle the celiac or superior mesenteric artery
- The tumor does not encircle the superior mesenteric or portal vein
How long does pancreatic cancer last?
Analysis of treatment results revealed a median survival time of 9 months, with a 1.5-year survival rate of 9%.
(CHULA CANCER, Radiation Therapy and Oncology)
Pancreatic Cancer Screening/Diagnosis
Pancreatic Cancer Diagnosis Using Blood Tests
1. Helical CT (Computerized Tomography Scan) and contrast injection can detect small tumors because the CT machine rotates continuously around the patient. As the X-rays pass through the patient, multiple images are obtained. This scan takes less time than standard CT scans and provides higher accuracy.
2. Radiation injection and CT scan can also determine whether the tumor is attached to or has spread into blood vessels.
3. CT – Guided Fine Needle Aspiration (FNA) can help identify cancer cells, but this method requires the expertise of an interventional radiologist.
4. An effective biopsy is performed through an endoscope (Endoscopic Retrograde Cholangiopancreaticography (ERCP). This method can also provide radiographic images showing obstruction of the bile duct and pancreatic duct.
Pancreatic Cancer Treatment
Surgical removal of the tumor is the best treatment option, and can be performed if the cancer is detected early and has not spread. Often, by the time the cancer is detected, it is already advanced, irreversible, and the survival rate is low.
Therefore, doctors recommend that those in high-risk groups undergo regular health checkups, perhaps every six months or a year. In the later stages of the illness, the cause may remain unknown and there may be no specific symptoms. Don’t be complacent if you are in a high-risk group, as health cannot be taken lightly.
Preparing for pancreatic cancer screening:
Fasting for 4 hours before a CT scan.
Fasting for 8 hours after an ERCP biopsy.
