Pancreatic Cancer

doctor img
Dr Thng Yongxian

MBBS

MMed

MRCS (IRE)

FRCSED

FAMS

image

What Is Pancreatic Cancer?

Pancreatic cancer arises from the tissues of the pancreas, an essential organ involved in digestion and glucose regulation. It is characterized by its late diagnosis and poor prognosis, making it a significant challenge in oncology. The disease often progresses silently, with symptoms appearing in more advanced stages.

Types of Pancreatic Cancer

Pancreatic cancer represents a group of diseases arising from different types of cells within the pancreas, each with its own unique pathology, clinical presentation, and prognosis.

Adenocarcinoma

Adenocarcinoma, the most common type of pancreatic cancer, originates in the exocrine cells responsible for producing digestive enzymes. It accounts for about 95% of cases and typically arises in the ducts of the pancreas.

Pancreatic Neuroendocrine Tumors (PNETs)

PNETs are less common, forming in the hormone-producing endocrine cells of the pancreas. These tumours may be benign or malignant and can produce hormones, leading to various symptoms.

Acinar Cell Carcinomas

Acinar cell carcinomas arise from the pancreatic acinar cells that secrete digestive enzymes. This type is rare and tends to have a slightly better prognosis than adenocarcinoma.

Causes and Risk Factors

The exact cause of pancreatic cancer remains unclear, but several risk factors have been identified that increase the likelihood of developing this disease.

  • Age: The risk of pancreatic cancer increases with age, most commonly affecting individuals over 55.
  • Smoking: Tobacco use significantly increases the risk, with smokers being about twice as likely to develop pancreatic cancer compared to non-smokers.
  • Obesity and Diet: Obesity and a diet high in red and processed meats can elevate the risk, while a diet rich in fruits and vegetables may lower it.
  • Chronic Pancreatitis: Long-standing inflammation of the pancreas, known as chronic pancreatitis, is linked to a higher risk of developing pancreatic cancer.
  • Diabetes: Both long-standing type 2 diabetes and new-onset diabetes may be associated with pancreatic cancer.
  • Family History and Genetic Factors: A family history of pancreatic cancer or inherited genetic syndromes can increase risk. Specific genes, such as BRCA2, may also elevate the risk when mutated.
  • Environmental Exposure: Exposure to certain chemicals, such as those used in the dry cleaning and metal industries, may increase the risk of pancreatic cancer.

Symptoms of Pancreatic Cancer

Symptoms of pancreatic cancer often do not appear until the disease is in its advanced stages, contributing to its low survival rate. The following are common symptoms associated with pancreatic cancer.

Jaundice

Yellowing of the skin and eyes is often one of the first and most noticeable signs, caused by the buildup of bilirubin.

Abdominal and Back Pain

Pain in the abdomen or back, resulting from the tumour pressing against surrounding organs or nerves.

Weight Loss and Loss of Appetite

Unintended weight loss and a decrease in appetite are common as the cancer progresses.

Nausea and Vomiting

Digestive issues, including nausea and vomiting, may occur if the tumour blocks part of the digestive tract.

New-onset Diabetes

Sudden development of diabetes in individuals without a history of the condition can be a sign of pancreatic cancer.

Changes in Stool

Pale, oily, or smelly stools that float in the toilet can indicate a problem with digestive enzyme production.

Fatigue

A general feeling of being unwell and fatigued is common among those with pancreatic cancer.

Diagnosis of Pancreatic Cancer

The diagnosis of pancreatic cancer typically involves a combination of steps, and it includes:

Medical History and Physical Examination

An initial review of the patient’s medical history and a physical exam to check for signs such as jaundice.

Imaging Tests

Key imaging tests include:

  • Computed Tomography (CT) Scan and Magnetic Resonance Imaging (MRI): These provide detailed images of the pancreas, helping to identify the tumour’s size and location.
  • Endoscopic Ultrasound (EUS): Involves using an ultrasound device to get close-up images of the pancreas, and can also be used to perform a biopsy.
  • Biopsy: A definitive diagnosis is made by examining a small tissue sample under a microscope, usually obtained via fine-needle aspiration during an EUS.
  • Blood Tests: Blood tests can check for markers that might indicate cancer, such as CA 19-9, although they are not specific for diagnosing pancreatic cancer.

Get an Accurate Diagnosis & Specialised Treatment For Your Condition Today

Consult our dual fellowship-trained surgeon for a personalised treatment plan today.

Staging of Pancreatic Cancer

Staging determines the extent of pancreatic cancer and guides treatment decisions. Staging not only influences the treatment approach but also helps in predicting the prognosis of the disease.

The TNM system, developed by the American Joint Committee on Cancer (AJCC), is commonly used.

Tumor (T)

Indicates the size of the primary tumour and whether it has invaded nearby tissues. T1 to T4 categories exist, with higher numbers indicating larger or more invasive tumours.

Node (N)

Describes whether cancer has spread to nearby lymph nodes. N0 indicates no lymph node involvement, while N1 and N2 show increasing involvement of lymph nodes.

Metastasis (M)

Reflects whether the cancer has spread to distant parts of the body. M0 means no distant spread, and M1 indicates metastasis to distant organs.

Based on the TNM classification, pancreatic cancer is then staged:

  • Stage 0: Also known as carcinoma in situ, indicates abnormal cells are present but have not spread to nearby tissues.
  • Stage I: The cancer is limited to the pancreas and is relatively small.
  • Stage II: Cancer may be larger and might have spread to nearby lymph nodes but not to distant sites.
  • Stage III: Cancer has spread to major blood vessels or nearby lymph nodes but not to distant sites.
  • Stage IV: Indicates cancer has metastasized to distant organs, such as the liver, lungs, or peritoneum.

Treatment Options for Pancreatic Cancer

Treatment for pancreatic cancer depends on the stage of the disease, the patient’s overall health, and personal preferences.

Surgery

Surgery may be an option for those with localized cancer and involves removing the tumour and some surrounding tissue. Types of surgery include:

  • Whipple Procedure: Removes the head of the pancreas, part of the small intestine, the gallbladder, and a portion of the bile duct.
  • Distal Pancreatectomy: Involves removing the tail and possibly a portion of the body of the pancreas.
  • Total Pancreatectomy: The entire pancreas, part of the stomach, small intestine, spleen, gallbladder, and lymph nodes are removed.
Radiation Therapy

Uses high-energy rays to target and kill cancer cells. It may be used before surgery to shrink tumours or after surgery to eliminate remaining cancer cells.

Chemotherapy

Involves the use of drugs to kill cancer cells, often used in advanced pancreatic cancer or as an adjuvant therapy to surgery.

Targeted Therapy

Targets specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This approach is typically used for tumours that have specific genetic mutations.

Immunotherapy

A treatment that uses the body’s immune system to fight cancer, though its effectiveness in pancreatic cancer is still under investigation.

Palliative Care

Aims to improve the quality of life by managing symptoms and side effects of the disease and treatment. It is an essential component of care for all stages of pancreatic cancer.

Challenges in Treating Pancreatic Cancer

Treating pancreatic cancer presents several challenges that significantly impact the effectiveness of treatments and the overall prognosis for patients. These challenges include:

  • Late Diagnosis
    Pancreatic cancer is often diagnosed at an advanced stage when the tumour has already grown large or metastasized, limiting treatment options.
  • Resistance to Treatment
    Pancreatic tumours tend to be resistant to chemotherapy and radiation therapy, making them difficult to treat effectively.
  • Location of the Pancreas
    The pancreas’ location deep within the abdomen complicates surgical approaches and increases the risk of complications.
  • Genetic Diversity of Tumors
    The genetic makeup of pancreatic cancer can vary significantly between patients, requiring personalised treatment approaches that are still under development.
  • Limited Early Detection Methods
    There are currently no widely recommended screening tests for early detection of pancreatic cancer in people at average risk, making it harder to catch the disease in its early, more treatable stages. However CT or MRI imaging might pick up early disease.
image

Dr Thng Yongxian

MBBS (SG)

MMed (Surg)

MRCS (Ire)

FRCSEd (Gen)

FAMS (Surg)

Dr Thng Yongxian is a dual fellowship-trained Hepatopancreatobiliary & General Surgeon who has performed over 6000 surgical procedures.

  • Bachelor of Medicine & Bachelor of Surgery,
    National University of Singapore
  • Membership of the Royal College of Surgeons, Ireland
  • Master of Medicine, General Surgery, Singapore
  • Fellow of the Royal College of Surgeons, Edinburgh
  • Fellow of the Academy of Medicine, Singapore

He pursued his subspecialty training in Hepatopancreatobiliary surgery first in the Department of Hepatopancreatobiliary Surgery, Singapore General Hospital. Following this, he completed a clinical fellowship in Minimally Invasive Hepatopancreatobiliary Surgery at Seoul National University Hospital in Bundang, South Korea.

Dr Thng set up and pioneered the Minimally invasive surgery program for his hospital in complex liver and pancreas cases. His surgeries were featured on live national television. His surgical videos have also been presented at international surgical conferences. He also pioneered the use of capsule colonoscopy for colorectal screening.

Dr Thng has served on various committees at hospital, cluster and ministry level. Dr Thng served as a member of the Ministry of Health (MOH) Laparoscopic cholecystectomy Clinician workgroup for value-driven care (VDC).

Patient Reviews

I cannot possibly express how grateful I am for the compassionate care received by Dr Thng during my hospitalization. I was 20 hours away from flying back to the USA after a long work trip, and homesick already when diagnosed with acute appendicitis and a UTI. To say that I was nervous to undergo surgery so far away from home, friends and family is an understatement. He was expedient, attentive and thorough. He even took the time to text and call my husband back home multiple times to update him on my status. His infectious laugh, sense of humor and kindness helped to sooth my own frazzled nerves. I am so appreciative to have had Dr Thng as my surgeon.

Ms Tina Hunter

I was diagnosed for ampullory cancer in 2021. I am very thankful to Dr. Thng Yongxian who kept me calm when revealing the report to me. I really felt like God sent his angel to speak to me.He helped me overcome the operation. Dr. Thng said 3 things that I needed to do before the operation....Stay positive, exercise n eat well, have faith in God. He even gave me his handphone number incase I need to consult him when home. Indeed the 8 hrs operation was a success n I am able to write this testimonial, living a normal life. Finally, its still God who works all things good for those who love Him... Romans 8:28.

Mdm Tang K H

I recently underwent gallbladder stone removal surgery performed by Dr. Thng, and I am impressed with the quality of care I received during this process. Dr. Thng demonstrated exceptional professionalism and expertise throughout my entire experience. From the initial consultation to the post-operative care, Dr. Thng explained the procedure in great details, answered all my questions, and alleviated my concerns and ensuring that I fully understood each step of the process. His compassionate and caring demeanor put me at ease, making me feel confident in his abilities. The outcome of the procedure was beyond my expectations. Dr. Thng successfully removed all my 3 gallstones, and I experienced a smooth recovery process. I am grateful for his expertise and the care I received under his supervision. Overall, my experience with Dr. Thng was exceptional. I highly recommend him for his professionalism, compassion, and outstanding surgical skills. Thank you, Dr. Thng for your excellent care.

Mr Low LT

Corporate & Personal Insurance Plans

Navigating the financial aspects of healthcare can be overwhelming. Allow us to assist you with your insurance claims, enabling you to concentrate on recovery & getting well. Our friendly clinic staff is here to answer any questions you have about insurance or payment options.

Visit Us

Please leave us a message and we will be in touch with you shortly.

    Full Name*

    Email Address*

    Phone Number*

    Your Message*

    For Faster Response, Call us!

    +65‎ 9838‎ 5827

    Our Clinic Locations

    Nexus Surgical @ Mt. Alvernia

    820 Thomson Road, #06-05 ,Singapore 574623

    Monday-Friday: 9.00am-5.00pm
    (Lunch: 1.00-2.00pm)
    Saturday: 9.00am-1.00pm
    Sunday & PH: Closed

    Frequently Asked Questions (FAQ)

    Can Pancreatic Cancer Be Prevented?

    While there’s no guaranteed way to prevent pancreatic cancer, reducing risk factors such as smoking cessation, maintaining a healthy weight, and a balanced diet may lower risk.

    How Long Can You Live with Pancreatic Cancer?

    Life expectancy varies significantly depending on the cancer stage at diagnosis, with early-stage cancers having a better prognosis than advanced-stage cancers. Treatment advances are improving survival rates, but pancreatic cancer remains one of the most challenging cancers to treat.

    Does Pancreatic Cancer Affect Blood Sugar Levels?

    Yes, pancreatic cancer can affect blood sugar levels. The pancreas plays a crucial role in regulating blood sugar, and cancer can interfere with this process, sometimes leading to diabetes.

    Can Lifestyle Changes Improve Outcomes for Pancreatic Cancer Patients?

    Lifestyle changes, such as improved diet, regular physical activity, and quitting smoking, can support overall health and may improve outcomes when combined with standard treatments.

    +65‎ 9838‎ 5827