Description
Pancreatic cancer is a malignant tumour that develops in pancreatic tissue. The pancreas is located behind the stomach and produces digestive enzymes as well as hormones that regulate blood glucose. The most common type is pancreatic ductal adenocarcinoma, which begins in the duct cells that carry digestive fluid.
Because the pancreas lies deep within the abdomen, early tumours may cause no clear symptoms and are not easily found during routine examinations. As the tumour grows, it may block the bile duct and cause jaundice, dark urine, pale stools and itching. Other symptoms include upper abdominal or back pain, reduced appetite and weight loss.
Types
Pancreatic Ductal Adenocarcinoma: The most common exocrine pancreatic cancer and usually begins in the pancreatic ducts.
Acinar Cell Carcinoma and Other Exocrine Tumours: Rare tumours with different biological behaviour and treatment considerations.
Pancreatic Neuroendocrine Tumour: Begins in hormone-producing cells and is assessed and treated separately from pancreatic ductal adenocarcinoma.
Cancer Arising from Cystic Lesions: Some pancreatic cystic lesions, including IPMN and MCN, have malignant potential and may need long-term surveillance or surgical assessment.
Stages
Pancreatic cancer can be staged from 0 to IV using the TNM system. In clinical practice it is also described as resectable, borderline resectable, locally advanced or metastatic.
Risk Factors
The following factors may increase the risk, but having one or more risk factors does not mean that a person will develop cancer:
Smoking
Increasing age
Chronic pancreatitis
Long-standing diabetes or recently diagnosed diabetes
Overweight or obesity
Family history of pancreatic cancer
Inherited factors such as BRCA1, BRCA2, PALB2 or Lynch syndrome
Certain pancreatic cysts or hereditary pancreatitis
Symptoms
Early disease may not cause obvious symptoms. Medical evaluation is recommended when any of the following symptoms persist, recur, or gradually worsen:
Yellowing of the skin or eyes (jaundice)
Dark urine, pale stools or itching
Upper abdominal pain that may extend to the back
Unexplained weight loss
Loss of appetite or feeling full quickly
Nausea, indigestion or fatty stools
Persistent fatigue
New diabetes or diabetes that suddenly becomes difficult to control
Diagnosis
Diagnosis usually combines medical history, physical examination, imaging, laboratory tests, and pathology. The exact tests are selected by the doctor according to the individual case.
Blood Tests
Liver function, bilirubin and blood glucose tests
CA 19-9 may support assessment but cannot be used alone for screening or diagnosis
Imaging
Pancreas-protocol contrast-enhanced CT
MRI and MRCP
Endoscopic ultrasound (EUS)
Tissue Diagnosis
EUS-guided fine-needle aspiration or core biopsy
In some clearly resectable cases, the sampling approach is decided according to imaging and multidisciplinary assessment
Staging and Genetic Tests
CT or PET-CT to assess distant spread
Germline genetic and tumour molecular testing may be recommended for selected patients
Facts (FAQ)
Q: Why is pancreatic cancer difficult to detect early?
A: The pancreas lies deep in the abdomen, early disease often causes no obvious symptoms, and common symptoms may resemble other digestive disorders.
Q: Can CA 19-9 be used to screen for pancreatic cancer?
A: No. It is not suitable as a stand-alone screening test for the general population. It can rise with bile-duct obstruction and other conditions, and some patients do not produce it.
Q: Does newly diagnosed diabetes mean pancreatic cancer?
A: Usually not. However, older adults with new diabetes together with weight loss or abdominal and back pain should discuss further assessment with a doctor.
Q: Can pancreatic cancer be operated on?
A: Surgery depends on the tumour location, involvement of major blood vessels, presence of metastasis and the patient’s general health.
Q: Do people with a family history need screening?
A: People with strong family clustering or specific inherited variants may discuss MRI or endoscopic ultrasound surveillance at a specialist centre.
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*Disclaimer: The effect of treatment varies from person to person. The information on the website of Modern Cancer Hospital Guangzhou is for reference only, and cannot be used as the basis for medical diagnosis and treatment, nor can it replace the doctor's diagnosis and treatment. For more details, please review the Liability Clause.
