Pancreatic cancer develops when cells in the pancreas, which helps regulate digestion and blood sugar, grow uncontrollably and form malignant tumours. Although it accounts for only about 2% of all cancer diagnoses in Singapore, it remains alarmingly lethal: it ranks as the fourth leading cause of cancer-related death in both men and women. Based on data from 2018 to 2022, this places it among the top ten most commonly diagnosed cancers, even though its share of new cases is comparatively small. The most prevalent form is pancreatic ductal adenocarcinoma, originating from the cells that line the pancreatic ducts.
Pancreatic cancer is a malignant tumour that starts in the pancreas and often causes no symptoms in its early stages.
What is pancreatic cancer?
Pancreatic cancer is a disease in which abnormal cells multiply within the pancreas—a gland located behind the stomach that produces digestive enzymes and important hormones.
Pancreatic cancers fall into two broad categories, based on the type of cells involved:
1. Exocrine pancreatic tumors
These account for about 95% of all pancreatic cancers and develop from the enzyme-producing (exocrine) cells of the pancreas. Key subtypes include:
Pancreatic ductal adenocarcinoma (PDAC) — the most common form, representing 85–95% of cases. It forms in the ducts carrying digestive enzymes.
Squamous cell carcinoma — a rare type arising from flat squamous cells in the ducts
Colloid carcinoma (a type of mucinous carcinoma) — a rare variant characterised by abundant mucin.
2. Neuroendocrine pancreatic tumors (PanNETs)
Also known as islet cell tumors, these originate from hormone-producing (endocrine) cells in the pancreas and comprise only 1–5% of pancreatic cancers. They are generally less aggressive than exocrine tumors. Two main types are recognized:
Functional PanNETs — these actively secrete hormones, leading to distinct clinical syndromes:
Insulinomas, which cause hypoglycemia
Gastrinomas, linked to stomach ulcers
Glucagonomas, VIPomas, somatostatinomas, and others
Non‑functional PanNETs — do not secrete enough hormones to cause symptoms, often diagnosed later and may appear malignant.
Abdominal pain, which can sometimes cause back pain
Loss of appetite
Unexplained weight loss
Nausea and vomiting
Dark urine
Light coloured stool
Itchy skin
Fatigue
New onset of diabetes
Different types of pancreatic cancer may present with different symptoms. Your doctor may suspect pancreatic cancer if you develop new onset diabetes or have pancreatitis, which is the inflammation of the pancreas.
IPMNs — they are often detected incidentally on scans that are done for other reasons, and should be followed up with routine scans to detect malignant change.
Cancer development is mostly caused by genetic mutations of these pancreatic cells; common genes involved in pancreatic cancer development include KRAS, CDKN2A, TP53, and SMAD4.
The development of pancreatic cancer involves many steps and a long time for the precancerous lesions to develop and grow into an invasive tumour. Detection of these precancerous lesions before they progress into pancreatic cancer offers a chance for early treatment, which can improve the patient’s prognosis.
Stages of pancreatic cancer
There are several methods to stage pancreatic cancer. A simple method to know the stages of pancreatic cancer is described as follows:
Stage I — the tumour is isolated in the pancreas and does not extend elsewhere.
Stage II — the tumour has spread to nearby organs and tissues such as the bile duct. However, the lymph nodes remain clear of cancer.
Stage III — cancer cells have infiltrated the lymph nodes, and possibly blood vessels.
Stage IVA — cancer metastases can be found in nearby organs such as the stomach, liver, or diaphragm.
Stage IVB – the tumour has spread to other distant organs such as the lungs.
Cancer stages may vary according to the disease as well. Many staging methods often follow the TNM staging to assess the cancer.
Pancreatic cancer begins when abnormal cells in the pancreas, often in the duct, multiply uncontrollably, forming a tumour that can block digestive pathways.
Who is at risk of pancreatic cancer in Singapore?
While pancreatic cancer can affect anyone, common risk factors include:
Smoking — use of tobacco is associated with at least 20% of pancreatic cancers.
Type 2 diabetes — long-term diabetes increases the risk of pancreatic cancer by 1.5 to 2-fold. Sudden onset of diabetes, or diabetes that is suddenly harder to control can be a sign of pancreatic cancer.
Age — pancreatic cancer is commonly observed in people older than 55 years.
Genetics — some people may be more at risk to pancreatic cancers due to inherited genetic mutations such as mutations of BRCA1 or BRCA2 gene.
Exposure to chemicals — certain occupational chemical exposures also increases the risk of pancreatic cancers. Common examples are pesticides, petrochemicals, dry cleaning agents, and metalworking fluids.
How is pancreatic cancer diagnosed?
Pancreatic cancer is often challenging to detect early, as symptoms typically appear only in the later stages. The signs can also vary depending on the type of tumour and the pancreatic functions involved. To investigate a suspected case, your doctor may recommend one or more of the following diagnostic tests:
Physical examination — your doctor will begin by reviewing your symptoms, medical history, and family history. They may also examine your abdomen for any signs suggestive of pancreatic disease, such as tenderness, masses, or indicators of liver involvement or chronic pancreatitis.
Imaging tests — CT (computed tomography) and MRI (magnetic resonance imaging) scans are commonly used to detect abnormalities in the pancreas that may suggest tumour growth. In some cases, an endoscopic ultrasound (EUS) may be performed, where a thin, flexible tube with an ultrasound probe is inserted through the digestive tract to obtain detailed images. EUS can also assist in guiding a biopsy to collect tissue samples from suspicious areas.
Blood tests — blood tests play a supportive role in diagnosing pancreatic cancer. One commonly measured tumour marker is CA 19-9, which may be elevated in individuals with pancreatic cancer. However, it is not specific and is typically used alongside imaging and other diagnostic methods.
Biopsy — a biopsy involves collecting a small tissue sample from the pancreas for laboratory analysis. This allows pathologists to examine the cells under a microscope to determine whether they are cancerous.
Genetic tests — genetic tests may help identify inherited mutations, such as BRCA1 or BRCA2, which are linked to certain cases of pancreatic cancer. If you are diagnosed, your doctor may recommend genetic testing to guide treatment decisions or assess familial risk.
Early-stage diagnosis of pancreatic cancer is rare, but screening can improve outcomes, especially for those at higher risk. If you fall into a high-risk category, regular cancer screening may help detect precancerous changes or early tumours before symptoms develop.
What are the treatment options for pancreatic cancer in Singapore?
After diagnosis, your doctor will determine whether the cancer is resectable, borderline resectable, locally advanced, or metastatic. Treatment options will depend on the stage of the disease and whether the tumour can be surgically removed.
Surgical resection — surgical removal is currently the only treatment that offers a potential cure for pancreatic cancer. In many cases, surgery is combined with chemotherapy or radiation therapy to improve outcomes. The type of surgical procedure performed depends on the tumour’s location within the pancreas:
Tumour in the head of the pancreas — the most common surgical procedure is the Whipple procedure (also known as pancreaticoduodenectomy). This involves removing the head of the pancreas, the uncinate process, part of the small intestine, the bile duct, gallbladder, and a portion of the stomach.
Tumour in the body or tail of the pancreas —these cases are typically treated with a distal pancreatectomy, often combined with a splenectomy. This involves removing part or all of the pancreas along with the spleen.
Chemotherapy — this method uses anti-cancer drugs to kill or slow the growth of cancer cells. It may be given before surgery (neoadjuvant) to shrink the tumour, after surgery (adjuvant) to reduce the risk of recurrence, or as the main treatment if the cancer cannot be surgically removed. In pancreatic cancer, chemotherapy is often used in combination with other therapies to improve outcomes and manage symptoms.
Radiation therapy — radiation therapy uses high-energy X-rays to destroy cancer cells in the pancreas. It is often recommended for patients who are not suitable candidates for surgery and may also be combined with chemotherapy (chemoradiation) to enhance its effectiveness.
Supportive care — supportive care focuses on relieving symptoms and improving quality of life during pancreatic cancer treatment. This may include pain management, nutritional support, and procedures such as stent placement to relieve bile duct obstruction. Your healthcare team will tailor supportive measures based on your individual needs.
Summary
Pancreatic cancer is a serious condition that often develops without early symptoms, making timely diagnosis and treatment critical. It can arise from different cell types in the pancreas and is typically classified based on its resectability and stage. Diagnosis may involve imaging, blood tests, biopsies, and genetic testing, particularly for those with a family history or known risk factors.
Treatment options depend on the tumour’s location and extent, ranging from surgical procedures like the Whipple operation or distal pancreatectomy to chemotherapy, radiation therapy, and supportive care for symptom management.
If you are experiencing persistent abdominal discomfort, unexplained weight loss, or other concerning symptoms, or if you are at higher risk, schedule a consultation with Tan Siong San Surgery for comprehensive evaluation and personalised care.
Frequently Asked Questions (FAQs)
Surgery offers the only potential cure, but it’s only possible if the cancer is detected early and is resectable. Most cases are diagnosed at a later stage when cure is less likely.
Early symptoms may include abdominal or back pain, unexplained weight loss, jaundice, fatigue, or new-onset diabetes.
It cannot be completely prevented, but risk can be reduced by avoiding smoking, maintaining a healthy weight, and managing chronic conditions like diabetes.
Surgery is the main curative treatment for eligible patients. In advanced cases, chemotherapy or radiation may be used to control disease and relieve symptoms.
Overall five-year survival rates are low, but early-stage, surgically treated pancreatic cancer may offer better outcomes.
There is no reliable blood test for early detection yet. Tumour markers like CA 19-9 can support diagnosis but are not suitable for screening.
A small percentage of cases are linked to inherited genetic mutations. Individuals with a family history may benefit from genetic testing.
On their own, chemotherapy and radiation are not curative but can slow disease progression, shrink tumours, and improve quality of life.
This article has been medically reviewed by Dr. Tan Siong San
Dr Tan is a Senior Consultant Surgeon with over 25 years of clinical experience in the field of Hepato-Pancreato-Biliary (HPB) surgery treating conditions affecting gallbladder, liver and pancreas.
