Presenting treatments for stomach cancer in adults
Pancreatic cancer may be treated with surgery, radiation therapy, chemotherapy, targeted therapy and immunotherapy.
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Often, a combination of treatments is used to treat pancreatic cancer. When detected at an early stage, pancreatic cancer has a much higher chance of being successfully treated. However, there are also treatments that can help control the disease for patients with later stage pancreatic cancer to help them live longer and more comfortably.
Descriptions of the common types of treatments used for pancreatic cancer are listed below.
Depending on the location and size of the tumour in the pancreas, surgery for pancreatic cancer includes removing all or part of the pancreas. An area of healthy tissue around the tumour is also often removed. This is called a margin. The goal of surgery is to have clear margins or negative margins. This means that there are no cancer cells in the edges of the healthy tissue removed.
There are different types of surgery performed for pancreatic cancer surgery.
Total Pancreatectomy: If the cancer has spread throughout the pancreas or is located in many areas in the pancreas, a total pancreatectomy may be needed. A total pancreatectomy is the removal of the entire pancreas, part of the small intestine, a portion of the stomach, the common bile duct, the gallbladder, and the spleen.
Radiation therapy is the use of high-energy x-rays to destroy cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body.
External-beam radiation therapy is the type of radiation therapy used most often for pancreatic cancer. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. There are different ways that radiation therapy can be given:
Proton beam therapy: This is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells. It also lessens the amount of healthy tissue that receives radiation. Proton beam therapy may be given for a standard amount of time or for a shorter time like SBRT.
Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.
A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time, or a combination of different drugs given at the same time.
The goal of chemotherapy is to destroy cancer remaining before or after surgery, slow the tumour’s growth, or reduce cancer-related symptoms. It also may be combined with radiation therapy. Most chemotherapy treatments for pancreatic cancer are based on the following drugs:
Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.
To find the most effective treatment, the doctor may run tests to identify the genes, proteins, and other factors in a patient’s tumour. Targeted therapy for pancreatic cancer includes:
Larotrectinib (Vitrakvi) and Entrectinib (Rozlytrek): These are tumour-agnostic treatments that can be used for any type of cancer that harbours a specific genetic change called an NTRK fusion. This type of genetic change is found in a range of cancers, including pancreatic cancer, though it is rare. It is used as a treatment for pancreatic cancer that is metastatic or locally advanced and has not responded to chemotherapy. This drug is taken as a pill orally by mouth, usually once or twice a day.
Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.
Immune checkpoint inhibitors, which include anti-PD-1 antibodies such as pembrolizumab (Keytruda) and dostarlimab (Jemperli), are an option for treating pancreatic cancers that have high microsatellite instability (MSI-H) or mismatch repair deficiency (dMMR). Approximately 1% to 1.5% of pancreatic cancers are associated with high MSI-H.
Like all cancer treatments, surgery has benefits, risks, and side effects. After surgery, it is common to have some pain from the surgery’s effect on the body. Most patients will have at least some pain after the operation, which can usually be helped with pain medication, if needed.
The amount and location of the pain varies depending on the surgery. Factors that can affect the pain you experience include:
Side effects of surgery include weakness, tiredness, and pain for the first few weeks after the procedure. Other side effects caused by the removal of the pancreas sometimes include difficulty digesting food and diabetes from the loss of insulin produced by the pancreas. Fatigue usually goes away gradually two to four weeks after surgery.
The possible side effects of radiation therapy depend on where the radiation is targeted. The common side effects include:
The side effects of chemotherapy commonly include the following:
Depending on the targeted drugs used, the common side effects may include:
The side effects of immunotherapy may include:
The pancreas is a pear-shaped gland located in the center of the abdomen between the stomach and the spine. Doctors often say that pancreatic cancer is a “silent disease” because there are not many noticeable symptoms early on. Also, there are currently no specific tests that can reliably find the cancer for patients who do not have symptoms. When patients do have symptoms, they are often similar to the symptoms of other medical conditions, such as an ulcer or pancreatitis.
If you suspect that you or your loved one have Pancreatic Cancer, it is advisable to get the support you need. Early detection and diagnosis of Pancreatic Cancer is key to treating the disease.
Regardless of what stage your Pancreatic Cancer may be, you should schedule an appointment to see an oncologist specialising in Pancreatic Cancer as soon as possible. With the speed of developments in Pancreatic Cancer diagnosis and treatment, novel emerging treatment options could be explored by your medical oncologist.
Our cancer specialists at OncoCare specialise in treating late stage and advanced stages of Pancreatic Cancer, as well as earlier stages of the disease.
MBBS (Delhi) – American Board Certified (Int Med) – American Board Certified (Hematology) –
American Board Certified (Med Oncology)
Before joining OncoCare Cancer Centre at Mount Elizabeth Hospital, Singapore, Dr Akhil Chopra was a Senior Consultant in Medical Oncology at Johns Hopkins Singapore, Tan Tock Seng Hospital and Adjunct Associate Professor at Lee Kong Chian School of Medicine.
Dr Chopra has experience treating multiple cancer types including breast cancer, lung cancer, cancers of stomach, colon, rectum, liver, prostate, kidney, testicular and bladder, gynaecological cancers such as ovarian and uterine/cervical cancers; as well as Stomach Cancers and chronic leukaemia’s/multiple myeloma. Besides his clinical and research work, he has been involved in teaching medical students from the Lee Kong Chian School of Medicine as well as medical residents and students from Johns Hopkins University, Baltimore in USA.
Cancer Specialities: breast cancer, lung cancer, cancers of stomach, colon, rectum, liver, prostate, kidney, testicular and bladder, gynaecological cancers such as ovarian and uterine/cervical cancers
Senior Consultant, Medical Oncologist
MBBCH, BAO (Ireland) – MRCP (United Kingdom) – FRCP (Edinburgh) – FRCP (Medical Oncology)
Dr Benjamin Chuah, Senior Consultant Medical Oncologist at OncoCare Cancer Centre, was previously Consultant in the Department of Haematology-Oncology, National Cancer Institute Singapore, National University Hospital.
Graduating in medicine from Trinity College Dublin in 1998 where he was awarded the Professor Prize in Physic (Surgery) and the Arthur Ball Prize (2nd Place), Dr Chuah returned to Singapore and obtained his Membership of the Royal College of Physicians of the United Kingdom in 2002.
Prior to entering private practice, Dr Benjamin Chuah (patients often address him as Dr Ben Chuah) was actively involved in both post-graduate teaching and research. He was the Director for Postgraduate Medical Education (Medical Oncology) and was a Core Faculty for the Residency Program (Internal Medicine). For his efforts, he was awarded the National University Hospital Postgraduate Teaching Excellence Award in 2011. He was also involved in clinical and translational research for many years and was the principal or co-investigator in international trials involving the use of novel and targeted therapy drugs for colorectal and pancreatic cancer. He was awarded the NUH Innovative Grant for research in warfarin pharmacogenomics and was also honoured with the inaugural Kobayashi Foundation Award for work done on serial changes in the expression of breast cancer-related proteins in response to neoadjuvant chemotherapy. His research work has lead to several 1st author publications in high impact medical and oncology journals including Gastroenterology, GUT and Annals of Oncology.
Dr Ben Chuah’s subspecialty interest is in Gastrointestinal Cancers including oesophageal, gastric, biliary tract, pancreatic, liver (hepatocellular carcinoma), neuroendocrine cancers and colorectal cancers. As a clinical cancer specialist and researcher, his research work includes small cell gallbladder cancer with paraneoplastic hyponatremia, exploring the lack of somatic mutations in VEGFR-2 tyrosine kinase domain in hepatocellular carcinoma, renal cell carcinoma (kidney cancer) with bony metastases and use of the chemotherapy drug, docetaxel (Taxotere) with or without ketoconazole in breast cancer. He has published on screening in colorectal cancer and was involved in a randomized, phase 2 study of ganitumab or conatumumab in combination with FOLFIRI (5-FU, leucovorin, irinotecan) for second-line treatment of mutant KRAS metastatic colorectal cancer.
MBBS (Singapore) – MRCP (United Kingdom)
Dr Thomas Soh is a Senior Consultant Medical Oncologist at OncoCare Cancer Centre. He is also an accredited medical practitioner by the Office of the Public Guardian, to assist patients with making a Lasting Power of Attorney (LPA).
He was previously Consultant at the Department of Haematology Oncology at National University Hospital(NUH) and Visiting Consultant at Ng Teng Fong General Hospital.
He graduated from National University of Singapore in 2003 and received his Membership of the Royal College of Physician (United Kingdom) in 2007. He later completed his advance specialist training in Medical Oncology in 2012.
He was heavily involved in both undergraduate and postgraduate education, and was core faculty for the both the Internal Medicine Residency program and the Oncology Senior Residency program in the National University Hospital from 2012 to 2016. He was recognised for his mentorship and a good teacher to junior doctors and medical students, with the Teaching Excellence Award in 2014, from National University Cancer Institute (NCIS), as well as the Best Tutor Award in 2015 for undergraduate teaching by the University Medical Cluster, NUH.
Dr Soh believes in the delivery of quality healthcare, and was the lead and co-lead in several healthcare improvement projects. He had received multiple awards for his involvement in the Clinical Practice Improvement Programmes that he had implemented in NUH. From 2013-2015, he contributed a leading role being the Honorary Secretary of the Executive Committee, Singapore Society of Oncology.
Dr Soh is actively involved in both research and education in cancer medicine. He had received funding for his work from the National Medical Research Council, Singapore, being awarded the Clinical Investigator Salary Support Program (CISSP) award 3 times. He had researched on drug response and toxicity in treating cancer, understanding how chemotherapy and targeted medications is absorbed and cleared in the body in relation to the pharmacokinetics and pharmacodynamics. He had published on genetic variants affecting chemotherapy in Asian breast cancer patients. His research publication in colorectal cancer involves working with cell free DNA, chemotherapy drugs Regorafenib, FOLFIRI regimen (irinotecan, 5-fluorouracil and folinic acid).
He was the principal investigator in several multi-centre gastrointestinal cancer clinical trials and his research work has lead to more than 10 publications in high impact medical and oncology journals. He was the Principal Investigator for studies of circulating tumour cells, and was also doing trials in hepatocellular cancer (hepatoma) with drugs such as Sorafenib, Lenvatinib, Carbozantinib. The colorectal cancer trials involved drugs such as Cetuximab (Erbitux) with FOLFOX (Oxaliplatin, 5-fluorouracil and folinic acid), FOLFIRI regimens, Aflibercept and Y90 (Therasphere). In advanced pancreatic cancer, he was principal investigator for studies using Gemcitabine, Masitinib, and Abraxane. These experiences stand him in good stead to care for cancer patients and he is recognised for his dedication and expertise in these areas.
Dr Soh’s subspecialty interest is in Gastrointestinal (oesophageal, gastric, colon and rectal cancer) and Hepatobiliary Cancer (liver, pancreas, bile duct and gallbladder cancers). He is also a cancer specialist who looks after patients with neuroendocrine cancers. He speaks fluent English, Mandarin, Malay, Bahasa as well as Hokkien and has looked after many Indonesian and Malay patients. He has looked after many international patients, including Vietnamese, Myanmar, Banglahdeshi and Cambodian patients as well, with the help of interpreters.
MBBS (Singapore) – M.Med (Singapore) – MRCP (United Kingdom) – FAMS (Medical Oncology) – MHsc (Duke, USA)
Dr Wong Nan Soon is a Senior Consultant Medical Oncologist with more than 15 years of experience in the diagnosis and management of a wide range of cancers.
His subspecialty interests are in the field of breast cancer and gastrointestinal cancers (which include colon cancer, rectal cancer, anal cancer, biliary cancer, pancreatic cancer, liver cancer, GI stromal cancers (GIST) and neuroendocrine cancers.
In addition, he is also well versed in the treatment of a wide variety of cancers which include lung cancers kidney cancers, uterine, cervical and ovarian cancers.
He graduated from the Faculty of Medicine, National University of Singapore in 1994 and obtained the degrees of Master’s in Internal Medicine and Membership of the Royal College of Physicians of the United Kingdom in 2000.
In 2003, he completed advanced specialty training in general medical oncology.
This was followed by a 1 year clinical fellowship sub-specializing in breast medical oncology in Sunnybrook and Women’s Health Science Centre, Toronto, Canada where he trained under world renowned breast oncologists including Professor Kathleen Pritchard.
He was promoted to the position of consultant in 2006 and subsequently rose to the position of senior consultant and chief of breast team in the department of medical oncology, National Cancer Centre Singapore in 2009.
In 2009, he was awarded the prestigious Singapore National Medical Research Council overseas research fellowship to develop expertise in phase I clinical trials at Duke University, North Carolina, USA. During this year, he broadened his subspecialty interest to encompass gastrointestinal cancers, training under Professor Herbert Hurwitz. He also underwent further training in biostatistics and clinical research methodology, graduating with a master’s degree in health science research.
With this knowledge and experience in novel drug combinations, he is able to offer cutting edge medical treatment for both early stage cancers and also drug resistant difficult to treat advanced cancers.
Faculty and lecturer at numerous national and international oncology conferences
Senior Medical Oncologist
MBBS (S’pore), Grad Dip (GRM), MRCP (UK), M Med (Internal Med)
Dr Angela Pang is a Senior Medical Oncologist at OncoCare Cancer Centre and also a visiting consultant at the National University Cancer Institute of Singapore (NCIS).
Prior to this, she was a Consultant with the Haematology-Oncology Department of National University Cancer Institute of Singapore (NCIS), National University Hospital (NUH) and Visiting Consultant at Ng Teng Fong General Hospital (NTFGH).
She had obtained her undergraduate degree from the School of Medicine, National University of Singapore (NUS). Thereafter, she obtained her postgraduate qualifications – Masters in Medicine (Internal Medicine) from NUS, and her Membership of the Royal College of Physicians (UK). Subsequently, she went on to complete her advanced specialist training in Medical Oncology in the National University Hospital (NUH), Singapore and was awarded the NCIS research scholarship for her Sarcoma research fellowship with Professor Robert G Maki in the Tisch Cancer Institute, Mount Sinai Hospital, New York.
With a specific interest in the optimisation of care in elderly cancer patients, Dr Pang further pursued a Graduate Diploma in Geriatric Medicine with the Yong Loo Lin School of Medicine (YLLSOM). In order to integrate her expertise in both geriatrics and oncology, she also trained in Geriatric Oncology with Dr Beatriz Korc and Dr Stuart Lichtman in the Memorial Sloan Kettering Cancer Center, New York.
Dr Pang’s main clinical interests are in bone/soft tissue sarcomas, gastrointestinal cancers and geriatric oncology. She was the co-lead for the Musculoskeletal oncology service in NCIS, and had set up of the multi-disciplinary Geriatric Oncology service in NCIS and NTFGH.
She was also a principal investigator for several international multi-centre cancer clinical trials and also a recipient of several grants. Her research work has been published in peer reviewed journals including the Journal of Clinical Oncology (JCO), Journal of American Society of Medicine (JAMA) Oncology, Nature Communications, Clinical Cancer Research, British Medical Journal (BMJ) GUT, Oncogene, Oncotarget and others.
She is a member of several professional bodies, including the American Society of Clinical Oncology (ASCO), European Society of Medical Oncology (ESMO), International Society of Geriatric Oncology (SIOG) and the Connective Tissue Oncology Society (CTOS).
Dr Pang was also actively involved in both undergraduate and post graduate educations at the YLLSOM and NUH respectively. She has been awarded for teaching excellence and was previously appointed as Assistant Professor for Faculty of Medicine, YLLSOM and had served as core faculty of the undergraduate education (Medical Oncology) and Senior Residency (Medical Oncology) of NUH.
Dr Pang is fluent in English, Mandarin and Hokkien. She is able to converse in simple Malay/Bahasa. She has taken care of patients from many regional and overseas regions including Malaysia, Indonesia, Vietnam, Myanmar, China, Bangladesh, Sri Lanka, India, Canada and Mongolia.
1) Cancer physicians’ attitude towards treatment of the elderly cancer patient in a developed Asian country. Angela Pang, Shirlynn Ho and Soo-Chin Lee, BMC Geriatr. 2013 Apr 16;13:35. doi: 10.1186/1471-2318-13-35.
2) Hepatitis B virus reactivation risk varies with different chemotherapy regimes commonly used in solid tumours. Ling WH, Soe PP, Pang AS, Lee SC.Br J Cancer. 2013 May 28;108(10):1931-5. doi: 10.1038/bjc.2013.225. Epub 2013 May 7.
3) Lymphadenopathy and airway obstruction. Li A, Khoo KL, Tan CL, Pang A, Lee P. Am J Respir Crit Care Med. 2015 Jan 1;191(1): e1-3. doi: 10.1164/rccm.201409-1622IM.
4) Contemporary Therapy for Advanced Soft-Tissue Sarcomas in Adults: A Review. Angela Pang, Mariana Carbini, Robert G. Maki. JAMA Oncol. 2016;2(7):941-947.
5) Phase Ib/II randomized, open-label study of doxorubicin and cyclophosphamide with or without low-dose, short-course sunitinib in the pre-operative treatment of breast cancer. Andrea L.A. Wong, Raghav Sundar, Ting-Ting Wang, Thian-C Ng, Bo Zhang, Sing-Huang Tan, Thomas I.P. Soh, Angela S.L. Pang, Chee-Seng Tan, Samuel G.W. Ow, Lingzhi Wang, Jannet Mogro, Jingshan Ho, Anand D. Jeyasekharan, Yiqing Huang, Choon-Hua Thng, Ching-Wan Chan, Mikael Hartman, Philip Iau, Shaik A. Buhari, Boon-Cher Goh, Soo-Chin Lee Oncotarget. 2016 Sep 27; 7(39): 64089–6409
6) Carcinosarcomas and Related Cancers: Tumors Caught in the Act of Epithelial-Mesenchymal Transition. Angela Pang, Mariana Carbini, Andre L. Moreira, Robert G. Maki. Journal of Clinical Oncology 2018 36:2, 210-216
7) Longitudinal monitoring reveals dynamic changes in circulating tumor cells (CTCs) and CTC-associated miRNAs in response to chemotherapy in metastatic colorectal cancer patients. Karen Tan, Sai Mun Leong, Zizheng Kee, Patrick Vincent Caramat, James Teo, Michael Vito Martin Blanco, Evelyn S.C. Koay, Wai Kit Cheong, Thomas I-Peng Soh, Wei Peng Yong, Angela Pang. Cancer Letters, Volume 423, 1 – 8
8) Bromodomain and extraterminal proteins foster the core transcriptional regulatory programs and confer vulnerability in liposarcoma.
Chen Y, Xu L, Mayakonda A, Huang ML, Kanojia D, Tan TZ, Dakle P, Lin RY, Ke XY, Said JW, Chen J, Gery S, Ding LW, Jiang YY, Pang A, Puhaindran ME, Goh BC, Koeffler HP.Nat Commun. 2019 Mar 22;10(1):1353. doi: 10.1038/s41467-019-09257-z.
9) The treatment landscape of advanced angiosarcoma in Asia-A multi-national collaboration from the Asian Sarcoma Consortium.
Chen TW, Pang A, Puhaindran ME, Maw MM, Loong HH, Sriuranpong V, Chang CC, Mingmalairak S, Hirose T, Endo M, Kawai A, Farid M, Tan SH, Goh WL, Quek R, Chan JCH, Leung AKC, Ngan RKC.Cancer Sci. 2021 Mar;112(3):1095-1104. doi: 10.1111/cas.14793. Epub 2021 Feb 7.
10) Outcomes of a phase II study of intraperitoneal paclitaxel plus systemic capecitabine and oxaliplatin (XELOX) for gastric cancer with peritoneal metastases.
Daryl Chia, Raghav Sundar, Guo Wei Kim, Jiajun Ang, Jeffrey Lum, Min En Nga, Chee Cheng Ean, Hon Lyn Tan, Jingshan Ho, Natalie Ngoi, Matilda Lee, Vaishnavi Muthu, Gloria Chan, Angela Pang, Yvonne Ang, Joan Choo, Joline Si Jing Lim, Asim Shabbir, Wei-Peng Yong, and Jimmy Bok Yan So. Journal of Clinical Oncology 2021 39:3_suppl, 165-165
11) MNK1 and MNK2 enforce expression of E2F1, FOXM1 and WEE1 to drive soft tissue sarcoma Ke XY, Chen Y, Tham VY, Lin RY, Dakle P, Nacro K, Puhaindran ME, Houghton P, Pang A, Lee VK, Ding LW, Gery S, Hill J, Chen L, Xu L, Koeffler HP.Oncogene. 2021 Mar;40(10):1851-1867. doi: 10.1038/s41388-021-01661-4.
12) Targeting Glycolysis in Macrophages Confers Protection Against Pancreatic Ductal Adenocarcinoma.
Penny HL, Sieow JL, Gun SY, Lau MC, Lee B, Tan J, Phua C, Toh F, Nga Y, Yeap WH, Janela B, Kumar D, Chen H, Yeong J, Kenkel JA, Pang A, Lim D, Toh HC, Hon TLK, Johnson CI, Khameneh HJ, Mortellaro A, Engleman EG, Rotzschke O, Ginhoux F, Abastado JP, Chen J, Wong SC. Int J Mol Sci. 2021 Jun 14;22(12):6350. doi: 10.3390/ijms22126350. PMID: 34198548; PMCID: PMC8231859.
13) Stereotactic radiosurgery in alveolar soft part sarcoma brain metastases: Case series and literature review.
Lim JX, Karlsson B, Pang A, Vellayappan BA, Nga V. J Clin Neurosci. 2021 Nov; 93:227-230. doi: 10.1016/j.jocn.2021.09.002. Epub 2021 Sep 24. PMID: 34656252.
14) Systemic chemotherapies retain anti-tumor activity in desmoid tumors independent of specific mutations in CTNNB1 or APC: A multi-institutional retrospective study. Nathenson MJ, Hu J, Ratan R, Somaiah N, Hsu R, DeMaria PJ, Catoe HW, Pang A, Subhawong TK, Amini B, Sweet K, Feister K, Malik K, Jagannathan J, Braschi-Amirfarzan M, Sheren J, Caldas Y, Moreno Tellez C, Rosenberg AE, Lazar AJ, Maki RG, Benedetto P, Cohen J, Trent J, Ravi V, Patel S, Wilky BA. Clin Cancer Res. 2022 Feb 18: clincanres.4504.2021. doi: 10.1158/1078-0432.CCR-21-4504. Epub ahead of print. PMID: 35180772.
Definition of Pancreatic Cancer
Pancreatic cancer is a disease in which healthy cells in the pancreas stop working correctly and grow out of control. These cancerous cells can build up and form a mass called a tumour. A cancerous tumour is malignant, meaning it can grow and spread to other parts of the body. As it grows, a pancreatic tumour can affect the function of the pancreas, grow into nearby blood vessels and organs, and eventually spread to other parts of the body through a process called metastasis.
The pancreas is a pear-shaped gland located in the center of the abdomen between the stomach and the spine. It is made up of 2 major components:
Although pancreatic cancer accounts for less than 2% of cancers in Singapore, the incidence has increased over the past 40 years. Globally, pancreatic cancer is the eighth most common cancer in women and the tenth most common cancer in men. Incidence rates of pancreatic cancer have gone up by around 1% each year since 2000. Worldwide, an estimated 495,773 patients were diagnosed with pancreatic cancer in 2020.
The most common symptoms of Pancreatic Cancer are:
Patients with pancreatic cancer may experience the following symptoms or signs. As the cancer grows, symptoms may include:
Screening is used to look for cancer before you have any symptoms or signs.
Pancreatic cancer is a “silent disease” because there are not many noticeable symptoms early on. If pancreatic cancer is suspected, exams and tests will be needed to find out for sure. If cancer is found, other tests might then be needed to learn more about it.
Pancreatic Cancer screening tests include:
If a doctor suspects that a person has pancreatic cancer, they will first ask about the person’s medical history and family history. Then, they will examine the person to look for signs of the disease. An appropriate and timely diagnosis is very important. The tests described below may be used when pancreatic cancer is suspected. However, the diagnosis will be confirmed with a sample of tissue from the tumour taken during a biopsy, fine needle aspiration, or surgery.
There are many tests used for diagnosing pancreatic cancer. Not all tests described here will be used for every patient. The doctor may consider these factors when choosing a diagnostic test:
Tests to diagnose Pancreatic Cancer include:
The following factors may increase the risk of Pancreatic Cancer:
Family History: Pancreatic cancer may run in the family and/or may be linked with genetic conditions that increase the risk of other types of cancer.
Pancreatic cancer types can be divided into two larger categories: exocrine pancreatic cancer, which includes adenocarcinoma, and neuroendocrine pancreatic cancer. Each category has several cancer types that may vary in their symptoms and prognosis.
Doctors use several systems to stage pancreatic cancer. The method used to stage other cancers, called the “TNM classification,” is not often used for pancreatic cancer. However, for completeness, it is discussed further below.
The more common way to classify pancreatic cancer is to classify a tumour into 1 of the following 4 categories, based on whether it can be removed with surgery and where it has spread:
Staging is a way of describing where the cancer is located, or if it has spread and whether it is affecting other parts of the body. The tests and scans used to diagnose the patient’s cancer will give some information about:
<h3> Stage 0 Pancreatic Cancer
Stage 0: Refers to cancer in situ, in which the cancer has not yet grown outside the duct in which it started (Tis, N0, M0).
<h3> Stage 1 Pancreatic Cancer
<h3> Stage 2 Pancreatic Cancer
<h3> Stage 3 Pancreatic Cancer
Stage III may be either of these conditions:
<h3> Stage 4 Pancreatic Cancer
Stage IV: Any tumour that has spread to other parts of the body (any T, any N, M1).
Depending on the cancer specialist, a different staging system may be used to describe the progression of the Pancreatic Cancer. This is called the TNM staging system:
Using the TNM system, the “T” plus a letter or number (0 to 4) is used to describe the size and location of the tumour. Tumour size is measured in centimeters (cm). A centimeter is roughly equal to the width of a standard pen or pencil.
The tumour stage helps the doctor develop the best treatment plan for each patient. Specific tumour stage information is listed below.
The “N” in the TNM staging system is for lymph nodes. These small, bean-shaped organs located throughout the body help fight infection and disease as part of the body’s immune system. In pancreatic cancer, regional lymph nodes are those lymph nodes near the pancreas, and distant lymph nodes are those lymph nodes in other parts of the body.
The “M” in the TNM system describes whether the cancer has spread to other parts of the body, called metastasis.
M1: Cancer has spread to another part of the body, including distant lymph nodes. Pancreatic cancer most commonly spreads to the liver, the lining of the abdominal cavity called the peritoneum, and the lungs.