Pancreatic Cancer

What is Pancreatic Cancer?

The pancreas is an organ in the upper abdomen and is located behind the stomach. It is situated near many vital structures like the small intestine, blood vessels and nerves.

The pancreas performs two key functions: an endocrine function (makes insulin to regulate blood sugar levels) an exocrine function (produces digestive enzymes to help break down foods). 

In pancreatic cancers or cancer of the pancreas, cancer cells can develop from both types of cells with endocrine (hormonal) and exocrine (digestive) functions.

The incidence of cancer of the pancreas in Singapore has increased over the years and is one of the common causes of cancer related deaths for both males and females.


Symptoms of pancreatic cancer may not appear until it has grown and developed further. Early first signs can be absent or quite subtle. As such, pancreas cancer symptoms are more frequently diagnosed in advanced stages after cancer has grown or progressed, and it is highly lethal as it grows and spreads rapidly.

In advanced stages, pancreas cancer symptoms can occur such as:

  • Nausea and vomiting
  • Poor appetite and weight loss
  • Abdominal bloating
  • Back pain and abdominal pain
  • Pale/Greasy stools
  • Dark urine
  • Enlarged lymph nodes in the neck
  • Jaundice

A high index of suspicion is needed to diagnose the condition early as pancreatic cancer is asymptomatic.

Do consult your pancreas cancer doctor if you have recurrent upper abdominal pain, nausea, unexplained weight loss, jaundice or dark coloured urine.


The cause of pancreatic cancer is unknown.

Pancreatic cancer occurs when abnormal cells begin to grow within the pancreas and form tumours, but it’s unclear why this happens.


People with certain risk factors may have an increased likelihood of developing pancreatic cancer. These include:

  • Diabetes
  • Smoking
  • Family history (first-degree relatives with the disease or history of genetic syndromes associated with pancreatic cancer)
  • Obesity
  • Long term pancreatitis (inflammation of the pancreas)


Pancreatic cancer specialists can suggest steps for you to take to lower your risk of pancreatic cancer by making healthy lifestyle choices such as:

  • Reducing dietary fat intake
  • Eating more fruits and vegetables
  • Reduce and stop smoking
  • Regular exercising and avoiding too much weight gain
  • Limit alcohol use

Detection of pancreatic cancer is performed by a pancreatic cancer specialist using a CT scan or MRI. Ultrasound is not optimal to detect pancreatic cancer. Patients with suspected pancreatic cancer need to undergo at least a CT scan or MRI. In some cases, an endoscopic ultrasound examination may be necessary.

Pancreatic cancer should be confirmed histologically when possible. A small piece of the cancer tissue is removed with a biopsy and put under the microscope for further examination. Special treatment of the tissue is often needed (staining).

Ca 19-9, a blood test, can be markedly raised in some pancreatic cancer but not all. It helps in diagnosis when it is elevated significantly.

If someone without risk factors and symptoms were to have a raised Ca19-9, more likely than not, this individual does not have pancreatic cancer. Doing Ca 19-9 to screen for pancreatic cancer creates a lot of anxiety for most people without actually improving the outcome.


Treatment of pancreatic cancer depends on the subtype of the cancer and its stage – how far it has spread in the body. 

Pancreatic cancer in the early stage can be treated and is also curable with surgery. Further treatment after the surgery is often recommended and it involves chemotherapy or radiotherapy.

For patients diagnosed with advanced pancreatic cancer, surgery may not often be possible thus treatment with chemotherapy and/or radiotherapy are opted to shrink the cancer, reduce symptoms, and extend lifespan. Palliative treatment primarily focuses on reducing the pain in the patient’s remaining days.