Pancreatic cancer is the fourth leading cause of cancer deaths in Hong Kong. In 2020, a total of 813 people died from this cancer, accounting for 5.5% of all cancer deaths. In the past decade, both incidence and mortality of pancreatic cancer have significantly increased. From 2010 to 2020, the number of deaths due to pancreatic cancer jumped by 72%.
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.
Pancreatic cancer is an aggressive cancer. As the malignant tumour 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 surgery to remove the tumour, his/her life span is still shorter than that of other cancer patients.
Most patients of pancreatic cancer are over the age of 65, and the other risk factors include:
Should a patient have the following symptoms, he/she may get the disease:
The general public should adopt the following healthy lifestyle and behavioural changes to prevent pancreatic cancer:
Based on the available international and local scientific evidence, the Government’s Cancer Expert Working Group on Cancer Prevention and Screening has made the following recommendations on pancreatic cancer screening for the local population:
Screening for pancreatic cancer (including screening by serum biomarker CA19-9) is not recommended in asymptomatic persons at average risk.
There is currently insufficient evidence to recommend screening of pancreatic cancer for persons at increased risk by any standardised protocol. Persons with strong family history of pancreatic cancer, specific genetic syndromes, or carrying genetic susceptibility traits that put them at significantly increased risk of pancreatic cancer may consider seeking advice from doctors for individual assessment.
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 tumour.
Using Fine Needle Aspiration (FNA) Cytology, the doctor employs a thin needle to penetrate the wall of duodenum using the guidance of endoscopic ultrasound to reach tumour site. The samples of cells will be sucked through the needle and the sample tissues will be examined under the microscope to make diagnosis.
Blood marker carbohydrate antigen 19-9 (CA 19-9) is elevated in some patients with pancreatic cancer. It may play a role in disease monitoring and prognosis, together with radiological/imaging and clinical data. However, it can be elevated in other biliary conditions such as cholangitis, biliary obstruction of other aetiologies, and some other types of cancers.
Treatments for pancreatic cancer depend on the stage of the cancer, the age of the patient, the overall health conditions and patient’s preference. In response to these factors, the goal of tumour treatment is to eliminate the tumour, or to slow down the growth of the tumour wherever possible or to avoid causing further damages. Therefore, under certain circumstances, palliative treatment may be most suitable to individual patient.
At present, removing the tumour completely through surgery is the 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 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. Depending on the tumour condition, they may need to undergo distal pancreatectomy or total pancreatectomy.
If the cancer has spread extensively, the primary objective is to mitigate the symptoms and maintain the patient’s quality of life.
The following complications may occur to patients with pancreatic cancer:
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.
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.
Such as maintain nutrition and pain killing, etc.
Pancreas and the biliary tract are important organs inside our body. The pancreas secretes digestive enzymes that are collected by the pancreatic ducts. The bile ducts transport bile synthesized in the liver to the small intestine. The common bile duct and the pancreatic duct merge with each other before entering the duodenum in one single channel.
Diseases of the pancreas and bile ducts in general cannot be diagnosed accurately by means of external examination. Using endoscopic retrograde cholangio-pancreatography, endoscopists can cannulate the pancreatic duct or the bile duct through the opening in the duodenum and perform X-ray imaging. The procedure allows accurate diagnosis of biliary obstruction (e.g. due to gallstone or tumour), acute cholangitis, acute or chronic pancreatitis and post operative biliary or pancreatic ductal leakage. The endoscopists can also perform therapeutic procedures using various accessory tools.
Patients should resume oral intake only after the effect of anaesthetic or sedative has worn off. If naso-biliary drainage is needed, the patient should carefully maintain the position of the tube as dislodgement of the tube from the bile duct will result in failure of treatment.
For further information please contact your doctor.
Percutaneous Transhepatic Cholangiogram assists in obtaining diagnostic information for suspected bile duct disease and providing temporary or permanent drainage of bile of there is biliary tree blockage.
After the procedure, patient will be observed in the ward. He / she should inform the medical staff as soon as possible in case of any problem.
This procedure has certain risk, acute major complications such as haemobilia, septicaemia and bile peritonitis occur in 4-6% of patients. The possibility of death is about 0.5-5.6%.
For further information please contact your doctor.