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Three to 10 percent of patients with pancreatic cancer have relatives with the same condition .
The pancreas is an essential organ for digestion and blood sugar regulation
majority of cases , healthy people would be exposed to unnecessary and potentially risky tests .
Such diagnostic challenges are also compounded by the lack of specific symptoms that could raise the alarm about pancreatic cancer at an early stage .
Typical patients are usually in their �0s and will first experience vague problems like back and stomach pains , which are pretty common for that age group and only in a minority of instances associated with pancreas cancer , stressed Dr Manji . Doctors usually treat them with simple pain medications , and only when symptoms persist and are accompanied by weight loss or jaundice ( abnormal yellowing of the skin ) can the malignancy be finally detected . �ut by that time , it ’ s likely to be in an advanced stage .
Despite that , some people considered at risk of developing pancreas cancer may be recommended for testing .
“ Currently , although there is no role for screening , there are subgroups of people we would focus on ,” said Dr Sharmila . �First , those with a very strong family history of the disease , where more than one first-degree relative has pancreatic cancer . Second , people with chronic pancreatitis – they have a slightly higher risk than the normal population . Third , patients with mucinous pancreatic cysts – fluid-filled sacs containing a jelly-like substance ( mucin ), and an emerging group would be those who develop unexplained diabetes after the age of 50 . �
These criteria are based on data showing that three to 10 percent of patients with pancreatic cancer have relatives with the same condition . The most common hereditary mutations associated with pancreatic cancer are found in the BRCA1 and BRCA2 genes of two to three percent of patients . ���CA mutations are also linked to ovarian and breast cancers ,” said Dr �ee . �Healthy people with these mutations and a history of pancreatic cancer will have to consider some form of early screening . �
There also seems to be a similar link between pancreatic cancer and diabetes , which is a risk factor for a variety of other cancers . �Studies are showing the incidence of pancreatic cancer is higher in patients who get diabetes after the age of 50 ,” said Dr Sharmila , noting this is a worrying sign especially for countries where diabetes is prevalent like Malaysia .
In addition , some pancreatic cysts , but not all of them , can develop into cancer . If there are signs of potential malignancy , patients will be advised to have them surgically removed . Otherwise , they will be monitored closely .
Other risk factors for pancreatic cancer include smoking , alcohol drinking , physical inactivity as well as obesity , hypertension , and high cholesterol levels in the blood .
Surgery : an invasive cure but for just a handful of patients The only proven way to cure pancreatic cancer is to cut it out during surgery when it ’ s still located within the pancreas , a stage called �localised disease .’ The anatomy of the organ , however , presents other roadblocks to achieving that .
�Pancreas cancer is difficult to treat because it ’ s often awkwardly positioned . For instance , if the cancer is in the head of the pancreas , it ’ s surrounded by part of the stomach , small bowels , bile duct and major blood vessels supplying the gut and the liver ,” said Dr Siong-Seng Liau , a Consultant Hepatopancreatobiliary surgeon at the Addenbrooke ’ s Hospital in Cambridge , U� . �When a tumour involves those vessels , surgery is high risk or , if the disease is more advanced locally , this may make surgery not possible . �
This means that even some patients with localised disease , a stage during which any cancer is normally easier to deal with , can ’ t go under the knife and be cured .
As a result , only 15 to 20 percent of patients are suitable for surgery when diagnosed . And even then , they have to embark on a “ marathon journey ,” in Dr Liau ’ s words .
The journey begins with understanding where the tumour has taken root within the pancreas , which is divided into four areas – head , neck , body , and tail . Most cancers affect the head of the organ , where the most common surgery , called the Whipple procedure ,
36 AUGUST 2021 GlobalHealthAsiaPacific . com