Pancreatic Cancer - Symptoms & Causes

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What is pancreatic cancer?

Pancreatic cancer is a type of cancer that begins in the pancreas, an organ in the abdomen that releases digestive enzymes and hormones.

Abnormal growths or tumours can develop in the pancreas, and these may either be cancerous (malignant) or non-cancerous (benign).

Cancerous tumours, if left untreated, can spread to nearby organs and blood vessels, and the disease, if advanced, can spread to the liver or lungs. The most common form of pancreatic cancer is pancreatic ductal adenocarcinoma.

In Singapore, the incidence of pancreatic cancer has increased over the last 40 years. Between 2003 and 2007, approximately 1,000 cases were diagnosed, making it the 6th and 7th most common cause of cancer death among men and women respectively.

What are the symptoms of pancreatic cancer?

Symptoms of pancreatic cancer are usually non-specific, and may begin gradually and worsen over time. These include:

Jaundice – Pancreatic cancer can cause blockage of the bile duct, which can lead to jaundice. Jaundice is caused by the build-up of bilirubin, a substance produced by the liver. High levels of bilirubin in the blood can lead to a yellowish tint on the skin or in the whites of the eyes. It can also lead to dark urine, light-coloured stools, or itchy skin.
Abdominal pain – Sometimes called mid-epigastric pain, it is felt below the ribs, in the upper abdomen, and may radiate to the lower back. This may be caused by the tumour pressing on nearby organs or the spread of cancer to the nerves.
Diabetes – Pancreatic cancer can affect the cells responsible for creating insulin, leading to diabetes.
Fatigue – Feeling easily or constantly tired may be a sign of several conditions including pancreatic cancer.
Weight loss – People with pancreatic cancer often experience loss of appetite, which can lead to weight loss.

What are the causes of pancreatic cancer?

Pancreatic cancer forms when cells in the pancreas mutate and grow abnormally, forming a tumour. The exact causes of pancreatic cancer are unclear.

What are the risk factors for pancreatic cancer?

The risk factors for pancreatic cancer include:

Age – The risk for pancreatic cancer increases with age. In most cases, around 80% of cases are found in those 60 – 80 years of age.
Chemical exposure – People with occupations that involve the heavy use of chemicals, especially those in metal-working and dry cleaning, may be at increased risk.
Gender – Men are more likely to develop pancreatic cancer.
Genetics – Genetic syndromes such as the BRCA2 gene mutation, Lynch syndrome, and familial atypical mole-malignant melanoma (FAMM) syndrome place individuals at increased risk.
Nutrient deficiencies – Some studies have made a possible connection between pancreatic cancer and low levels of lycopene and selenium, which are found in lean meat and red or yellow vegetables.
Obesity – People with a Mass Body Index (BMI) above 30 are more likely to develop pancreatic cancer.
Diabetes – The risk for pancreatic cancer is higher in those with new onset of diabetes.
Pancreatitis – Pancreatitis refers to chronic inflammation of the pancreas, which may be caused by heavy use of alcohol.
Family history – Having a close family member with pancreatic cancer may increase your risk.
Smoking – The more a person smokes, the higher their risk for developing pancreatic cancer.
Consuming a diet high in fat or processed meat

The combined effect of smoking, long-standing diabetes, and a poor diet increases a person’s risk of pancreatic cancer beyond the risk of any one of these factors alone.

Complications of pancreatic cancer may include:

Jaundice – When the tumour is in the head of the pancreas, it often causes obstruction to the common bile duct, and the person will get jaundice. This will lead to infection of the biliary tree called cholangitis. This condition is life-threatening when untreated.
Pancreatic insufficiency – Pancreatic cancer can interfere with the normal functions of the pancreas, which is to produce digestive enzymes that help to neutralise stomach acids and break down fat, protein and carbohydrates.
Obstruction of stomach or small intestine – A tumour can block the gastric outlet (where stomach contents pass into the small intestine) or the duodenum (the early part of the small intestine). This will lead to nausea and vomiting, and the person will not tolerate much oral intake.
Cachexia – This is a syndrome characterised by loss of appetite, weight loss and muscle wasting. It is present in up to 80% of people with pancreatic cancer.
Distant metastases – Pancreatic caners can spread locally and invade adjacent organs. It can also spread to other organs such as the lungs or liver. When it has spread to distant organs, treatment can only be palliative in nature.
Blood clots – blood clots that break off in the leg (deep vein thrombosis) or lung (pulmonary embolism) is both a complication and a potential symptom of pancreatic cancer.

How to prevent pancreatic cancer?

While there is no clear way to prevent pancreatic cancer, there are steps to reduce your risk:

Avoid or quit smoking – Smoking-related risks decrease after you quit. It is estimated that after 10 years of not smoking, your risk is the same as a person who has never smoked.
Eat a healthy diet – A diet with less fat, sugar and processed meat, and more fruits and vegetables of many colours, can help to reduce the risk of many diseases and cancers including pancreatic cancer.
Exercise – Getting more exercise can help to reduce your risk. Obese individuals who get more exercise are about half as likely to get pancreatic cancer compared to those who got no exercise at all.
Limit or avoid alcohol consumption – Heavy alcohol use is linked to pancreatitis, a risk factor for pancreatic cancer.
Limit or avoid exposure to chemicals – Where possible, avoid exposure to workplace chemicals with protective gear or speak to your supervisor about your work arrangements.
Maintain a healthy body weight – A healthy diet and regular exercise can help you to keep to a healthy body weight and reduce your risk for many conditions including pancreatic cancer.