Pancreatic cancer is known as a silent but deadly illness because symptoms are rarely noticed until it has reached an incurable stage. At an estimated 2% incidence rate in Singapore, pancreatic cancer itself is not a common cancer. However, there is a high mortality rate for those diagnosed with the disease, making it one of the top cancers to take lives in Singapore.
Symptoms of pancreatic cancer
The key to battling pancreatic cancer is to spot it early and have it treated as soon as possible. However, early-stage pancreatic cancer is known to have unnoticeable or vague symptoms. The safest way to go about it is to know your own body. If any of these symptoms arise unusually and cannot be traced to other known conditions, it is always best to go to a doctor for a thorough checkup.
As a guide, here are the common symptoms of pancreatic cancer:
- Poor appetite and weight loss: As the pancreas is an integral part of the digestive system, the impaired function of the pancreas often results in poor digestion. This manifests as malnutrition, declining weight, and lack of appetite.
- Abdominal bloating: Digestive problems also cause gas build-up from undigested food in the digestive tract. Pancreatic cancer may also cause ascites, which is a build-up of fluid in the abdomen, making the tummy area appear swollen.
- Nausea and vomiting: As the tumour grows larger, it can block part of the digestive tract and impede digestive functions. This causes fluids to back up in the digestive system and leads to nausea and vomiting symptoms.
- Pale/greasy stools: When the pancreas’ function is compromised, it has problems digesting nutrients. Undigested fats are excreted in the stools, causing the appearance of pale and oily stools. Malabsorption can also contribute to diarrhoea and/or constipation.
- Back pain and abdominal pain: If the tumour grows in a location that presses against nerves or other surrounding organs, patients may feel pain at the back or abdomen area.
- Jaundice: The natural breakdown of aged red blood cells turns them into bilirubin. When bilirubin pigment builds up, it causes skin and whites of the eyes to yellow. Normally, bilirubin is broken down by bile, but when the tumour obstructs the flow of the bile duct, the digestion of bilirubin can be hindered, thus causing jaundice.
Diagnosis methods for pancreatic cancer
While it is difficult to pinpoint pancreatic cancer from its symptoms, some people are fortunate to have the tumour detected early from other health examinations and diagnostic tests. Several scanning methods are able to visually identify growths on the pancreas. If you or your doctor suspect any abnormalities in your pancreas, here are some examinations your doctor may recommend:
- CT scan: Computer tomography is a method of X-ray that compiles multiple scans of the body at varying depths to give a ‘3-D’ perspective of the body tissues. Suitable for almost any part of the body, it can be used to visually check for abnormal growths on the pancreas.
- MRI: Magnetic resonance imaging uses magnetic waves to produce detailed images of organs and structures inside the body. It gives more high-definition images than CT scans but is also more expensive.
- PET scan: Positron Emission Tomography involves the injection of radioactive fluid into the body. As the fluid travels in the bloodstream to different organs, it shows up more prominently on the X-ray scan. This method can be combined with a CT scan to better visualise the tumour growth and affected areas.
These images are helpful for detecting growths on the pancreas, but cannot determine if the tumour is cancerous. To confirm the nature of the tumour, the doctor needs to obtain a small sample of tissue from the tumour for analysis. This procedure is called a biopsy. Your doctor may conduct a biopsy of one of the following types:
- FNA: Fine needle aspiration involves the insertion of a fine needle with an attached syringe into the body. The method is performed with the assistance of an imaging scan (MRI, CT scan, or ultrasound), and is used to obtain tissue samples from the target organ – in this case, the pancreas.
- ERCP: Endoscopic retrograde cholangiopancreatography is a form of endoscopy where a long flexible tube is inserted through the oral cavity to the small intestine, near the pancreas. Medical instruments can pass through the endoscope to take images and tissue samples.
- EUS: Endoscopic ultrasound is similar to ERCP in that it utilises an endoscope to reach the intestines. In EUS, a small ultrasound device is attached at the tip of the endoscope, allowing for a better view of the digestive tract and pancreas. A small needle on the endoscope may be used to retrieve tissue, or the EUS can be used in conjunction with FNA.
These diagnostic tests can typically be carried out on an outpatient basis at hospitals or specialist clinics. As performing these procedures require specialised training, you will need to find doctors who are certified and well-reputed in these techniques. For example, ERCP and EUS should only be performed by a doctor trained in advanced endoscopy in Singapore.
Recent advancements in pancreatic cancer diagnosis
In more recent advancements, medical researchers have found success in using blood tests as a diagnosis method for pancreatic cancer. While the existing blood test for Ca 19-9 is not a reliable test for pancreatic cancer, new blood tests for other markers in the blood have been shown to have better accuracy rates in diagnosing pancreatic cancer. Although it may take some time for this new method to become better established and available in the market, it offers hope for a reliable, non-invasive diagnostic test for pancreatic cancer in the near future.
An awareness of the symptoms of pancreatic cancer is crucial for defending oneself against the illness. If you observe any abnormalities in your digestive health, or are a high-risk individual for pancreatic cancer, you may want to consult a gastroenterologist for a thorough examination. Your doctor can provide you with further information about pancreatic cancer and its costs.