What the Surgeon Says About Pancreatic Cancer
Dr. Tan Yu‑Meng, a general surgeon at Mount Elizabeth Hospital, breaks down the hard facts and treatment options for anyone dealing with this tough diagnosis.
The Reality Check
- Only about 5 % of patients survive five years or more after a pancreatic cancer diagnosis.
- Even rarer, just 1 % make it past ten years.
When the Evil Shows Up
Most people discover the disease only after it has already slipped past to the local area or spread to other parts of the body—no symptoms, no warning signs.
Hope on the Horizon: Surgery
For those that can make it into the surgery window, the 5‑year survival rate jumps to roughly 20‑25 %. But sadly, most folks only have that option about 20‑25 % of the time they’re diagnosed.
Takeaway
Pancreatic cancer is brutal, but staying informed and exploring surgical paths early can shift the odds slightly. Keep your hopes realistic and your support network solid—your instinct and doctors deserve every reason to encourage you.
Who is at risk of developing pancreatic cancer?
Catch Pancreatic Cancer Before It’s Too Late
Think of pancreatic cancer as the stealthy ninja of the body—usually you only notice its attacks once it’s already doing serious damage. But there’s a silver lining: we can actually outsmart it if we spot the red flags early.
Who Should Be on the Watchlist?
- People with a family history of pancreatic cancer (so-called inherited or familial genes) – less than 10% of cases.
- Everyone else, because the other 90% of tumors show up from random mutations.
That means everyone could benefit from a little check‑up, especially if you tick any of the boxes below.
What Makes Pancreatic Cancer Tick?
- Smoking – the more smoke you inhale, the higher the risk. Quit now; your pancreas will thank you.
- H. pylori infection – the nasty stomach bug that can indirectly push cancer down the line.
- New‑onset diabetes – if your pancreas stops producing insulin right out of the blue, it might be fighting back.
- Dietary habits that look bad on paper:
- Body Mass Index (BMI) over 30 ‑ weight matters.
- Heavy red meat intake ‑ those grill sessions can be a fire hazard.
- Low fruit & vegetable consumption ‑ your body’s own vitamin factory is underfed.
Why This Is a Golden Chance
We can turn the tables—by telling folks that lifestyle tweaks do matter. If more people adopt healthier habits, we can genuinely slow down or even stop the spread of this brutal disease.
So, exchange that extra can of soda for a fresh salad, light up the grill bay instead of the cigarette light, keep that diabetes check routine in the spotlight—your pancreas will be a little less dramatic!
How is pancreatic cancer diagnosed?
Pancreatic Cancer: A Whisper That Becomes a Howl
1⃣ The Early Signs That Won’t Stay Quiet
- Obstructive jaundice – Think of your skin and eyes turning a yellowish shade, like a sun‑baked cereal toast.
- Weight loss that’s unexplained – It’s not your gym routine or your love for pizza.
- A vague feeling of expansion in your belly – not a snack aneurysm, but more like an “oops, I swallowed a balloon” vibe.
- Help! A painful wheeze that might sound like a burp from a broken drum.
- Steatorrhea – greasy, smelly poop that doesn’t belong in a hat.
- Early diarrhea – a sudden urge to race to the restroom before the next coffee break.
Most cancers (two‑thirds) hang out in the pancreas’s head, which is notorious for block‑ing the bile duct or pancreatic duct and thus shows up early. If it’s in the body or tail, the symptoms wait until it’s nursing a covert operation. So, if you notice any of those clues, set up a quick check‑up.
2⃣ The Detective Work: Imaging
When the pancreas plays hide‑and‑seek, the triphasic fine‑cut CT scan is your best buddy. It does more than just glance—it dives deep:
- Looks at the mass wall‑to‑wall.
- Checks whether you can surgically remove it or if you’ll need a medical roadmap.
- Identifies the portal vein and mesenteric artery to gauge blood flow.
- Spotlights any lymph node or peritoneal stir‑ups.
Honestly, when the tumor is a fluid‑filled cyst, switching to MRI might bring extra clarity. In the rest, the CT scan stays in the front line.
3⃣ Bottom Line: Quick, Clear, and Friendly
Remember, the pancreas doesn’t mind a late‑night check‑in. If you’re in doubt, a quick scan is always better than a long wait. Keep your wallet close and steer clear of tummy tantrums—trust the science, and let the images tell it all, in plain English, and with a wink of humor.
What is the role of biopsy in pancreatic cancer?
Pancreatic Cancer: Where the Gold‑Standard Lives
When it comes to catching pancreatic cancer, a definitive biopsy is your go‑to “gold treasure.” Think of it as the courtroom evidence that leaves no room for doubt. Yet, in the real world, the procedure isn’t always feasible or even required.
When Do We Need a Biopsy?
- Borderline cases: Things look uncertain—tumor size or location isn’t crystal clear.
- Doubts fly high: Imaging vibes clash with clinical suspicion.
- Pre‑surgery check‑in: We want to be 100 % sure before pulling out the knife or firing up chemotherapy.
Enter Endoscopic Ultrasound (EUS)
Picture a tiny camera that sneaks right in, offering high‑definition views of those pesky pancreatic lumps and even grabbing a tissue sample in one go. EUS is the crowd‑pleaser for resectable tumors. It’s like a superhero that keeps the tumour in check while giving us the cells we need.
Worries? Not so Much!
For a while, folks fretted that the needle might stir up tumour cells, potentially leaving them spattered around. But newer evidence says: chill out. The data shows no drop in postoperative survival when EUS is used.
One Size Doesn’t Fit All: Why Percutaneous Biopsy Steers Clear
When a tumour is potentially resectable—meaning you might be able to take it out surgically—thrusting a percutaneous needle through the skin isn’t the smart move. It’s a risky call that could hamper careful surgical planning.
Bottom line: Stick with EUS for the best of both worlds—clear imaging and honest biopsy—while steering clear of percutaneous approaches.
What are the current treatment options?
Rounding Up the Dream Team for Pancreatic Cancer Care
When the pancreas turns against you, it’s not a solo act. The ideal treatment lineup is a multidisciplinary squad featuring:
- Pancreatic Surgeon – the hands-on hammer for surgical options.
- Medical Oncologist – the wizard behind chemo, radiation, and newer drug combos.
- Gastroenterologist – the gut guru who keeps the digestive system in check.
What’s the Game Plan?
Goal #1: Shoot the Stomach. If the tumor’s accessible, the team aims for a complete removal or clearance.
Goal #2: Halt the Hype. When total elimination is off the table, the focus shifts to stopping the cancer from expanding. Think of it as putting a slow‑moving obstacle in the path.
When the Gate’s Closed: Quality of Life Takes Center Stage
In the advanced stages, where medical advances struggle to tip the odds, the primary mission enters a gentle territory: delivering the best possible comfort, dignity, and joy for the patient.
Everything—from pain control to emotional support—gets fine‑tuned, so the journey can feel as smooth as a well‑plucked guitar string.
Bottom Line: A Team, A Plan, and a Touch of Humanity
With the right specialists in play, every patient gets the most tailored strategy: elimination if possible, growth prevention next, and a compassionate care plan when survival chances dim. It’s not just about fighting cancer; it’s about living the best life before, during, and after treatment.
Surgery
Surging Through the Pancreatic Landscape
Only 1 In 4 Tumours? (No, Not That Easy)
At the moment, roughly 25% of pancreatic tumours can be scooped out in surgery. It’s like finding a smooth spot in a minefield. The surgeon’s job is not just squeezing out the tumour, but also raking out a safety margin to make sure no rogue cells are left behind.
The ‘Surgical Sweet Spot’: Whipple vs. Tail or Body Ops
Whipple Procedure – The Headliner
When the tumour lives in the pancreatic head, the surgeon pulls out the crop of a Whipple procedure (aka pancreaticoduodenectomy). Think of it as a surgical swap party: the head of the pancreas, the duodenum, the gall bladder, and a slice of the bile duct get a stunning makeover.
Distal or Subtotal Pancreatectomy – The Back‑End Action
For tumours residing in the body or tail, a different textbook playbook is required. The operation either removes the farthest sections (distal) or takes out a middle chunk (subtotal). These are no easy feats – only seasoned pancreatic pros should take the helm, because experience equals lower death risk and a better chance of living well after the surgery.
New Tricks: Minimally Invasive Surgery
Good news – both Whipple and pancreatectomy’re now available in minimally invasive flavors (think slimmer incisions, less pain, faster recovery). These modern tricks reduce the risk of complications without sacrificing the win on cancer outcomes.
- Less blood loss
- Shorter hospital stay
- Equal oncologic success
Right now, they’re still a bit of a niche party trick. But we’re watching a rapid shift– soon these could become the brand‑new, standard way of doing things.
Chemotherapy and radiation therapy
Why C‑Cancer Gets a Two‑Step Treatment Plan
When it comes to battling pancreatic cancer, doctors usually give you a two‑tiered playbook: chemo and radiation at the front line, and a special post‑surgery routine that keeps the cancer at bay afterward.
1⃣ Shrink‑Then‑Cut Strategy
For patients whose tumours are stuck in that gray zone where surgery is a possibility but not guaranteed, the first move is to send a chemo‑radiation “squeeze‑squeeze” routine. Think of it like a spa retreat for the tumour: it uses the dual burn‑and‑chemo combo to make the mass smaller, before the surgeons step in for a clean cut.
Good news? It’s a team sport. Surgeons and oncologists have to stay in sync—imagine them as a dance duo—so they pick the right timing, dosages, and how to keep the patient in top shape throughout the whole journey.
2⃣ The Post‑Surgery “Arm‑Band” (Adjuvant Therapy)
Once the surgeons finish their meal‑time (or, technically, after a successful hepatectomy), chemo and radiation often hop back on the stage. This adjuvant phase is all about keeping microscopic cancer teens from crashing the party.
It’s akin to pest control after a wild party: you want to seal any cracks and make sure there’s no lingering residue left behind.
3⃣ The “Static” Group – Those with No Surgery Option
Large swaths of pancreatic cancer patients fall into the “locally advanced” group, where surgery is a no‑go. For these folks, chemo becomes the frontline hero that fights off the tumour’s growth and spread.
Multiple chemo combos exist—think of them as the interchangeable “garage keys” that can fit different lock types. And because we’re talking clinical trials and cutting‑edge research, the exact combo should be tailored to each person’s flavor profile, side‑effect tolerance, and overall health.
Bottom line: Talking with your oncologist is key. They’ll help you pick the best plug (chemotherapy regimen) that fits your schedule, lifestyle, and the unique quirks of your cancer.
Palliative treatment for metastatic cancer
Metastatic Cancer: A Quick Look at the Big Picture
Who’s in the Spotlight?
Every year, about 30‑40 % of cancer patients turn out to have metastatic disease—meaning the tumor’s decided to spread beyond its original spot. That’s not exactly a small number, but it’s high enough that doctors have to stay on their toes.
Getting the Bile Flowing – and the Food Into the Stomach
When the cancer bumps into the bile ducts or the duodenum (the first part of the small intestine), the food chain gets messed up. Here’s where the surgical and endoscopic stenting crew swoops in:
- Surgery: A quick fix to clear blockages and keep organs moving.
- Stenting: Tiny tubes that keep the bile ducts and duodenum open so the pipeline stays smooth.
These interventions usually go hand‑in‑hand with chemotherapy. Think of them as the “pre‑prep” phase before the chemo fire‑works launch.
Nutrition: The Unsung Hero
Patients often face malnutrition because their bodies can’t keep up with the demands of both cancer and treatment. The goal: Fuel the body, keep it sturdy, and keep the stomach happy. It’s not just about eating more; it’s about smart nutrition and sometimes even specialized supplements or feeding tubes.
Hitting the Pain Nerves: Pain Management Matters
One of the biggest pain points—literally—is controlling discomfort. A palliative pain specialist can bring a new toolkit to the table, ensuring that the patient’s quality of life isn’t left on the back burner.
Mixing It Up: Chemo + Targeted Therapy
There’s a constant push to crack the code on the perfect combo of chemotherapy drugs and targeted therapies. Scientists are tinkering like a chef trying to get the seasoning “just right.” The goal? A regimen that’s powerful enough to fight the cancer but gentle enough for the patient’s body to roll with.
Bottom Line
Metastatic cancer doesn’t just sit there; it’s a full-on operation theater. From surgery and stenting to nutrition and pain control, every layer matters. And the quest for the best chemo mix? It’s a relentless, thrilling, and sometimes messy scientific adventure—one that keeps on improving our chances of fighting cancer on all fronts.
What next in pancreatic cancer treatment?
Pancreatic Cancer: The Stubborn Drama Queen of the Cancer World
Ever imagined a cancer that loves to throw tantrums and refuses to cooperate? That’s pancreatic cancer for you – a fierce, unpredictable foe that keeps the medical community on its toes.
Why It’s Such a Tough Cookie
- It hides in plain sight – the pancreas is tucked deep inside, so tumors can grow unchecked before anyone notices.
- Its symptoms are a sly trickster: fatigue, back pain, and suddenly a belly that feels like it’s on a tight rope.
- By the time we catch it, it’s usually already playing hide-and-seek with distant organs.
The Battlefield of Genomics
Doctors and scientists have been sweating buckets searching for those “genetic bullseyes” that make the cancer vulnerable. Imagine trying to hit a moving target with a laser – that’s what researchers feel when they chase common DNA mutations. The reality? Pancreatic cancer is an extremely diverse gang of cells, each with its own wild card.
What We Can Actually Do
While a permanent cure is still playing hard to get, the tenacity of modern medicine has carved out some sweet victories:
- Longer Survival – Data shows many patients are living more months than before.
- Quality of Life – Comfort care, pain control, and nutrition planning help patients feel their best.
- Targeted therapies—although not yet a silver bullet, they’re giving the treatment a personalized edge.
Meet the Doctor Behind the Curtain
Dr. Tan Yu‑Meng, a general surgeon with a knack for turning grim statistics into hopeful stories, is at the forefront of this battle at the Mount Elizabeth Hospital. He reminds us that even in the darkest journeys, a good plan, a supportive team, and a dose of humor can keep spirits afloat.
References
- Maisonneuve P, Lowenfels AB. “Risk Factors for pancreatic cancer: a summary review of meta‑analytical studies.” Isn’t J Epidemiol 2015; 44: 186‑98.
- Poruk KE et al. “The Clinical Utility of CA19‑9 in Pancreatic Adenocarcinoma: Diagnostic and Prognostic Updates.” Curr Mol Med 2013 Mar 13(3): 340‑51.
- Ducreux M et al. “Cancer of the pancreas. ESMO clinical practice guidelines for diagnosis, treatment and follow up.” Ann of Oncology 26 (supplement 5): v56‑68, 2015.