Why is pancreatic cancer so difficult to detect? Is a sudden rise in blood sugar a warning sign? Doctor: Seek medical attention immediately if your stomach pain is not relieved by taking medicine
“King of Cancer” Pancreatic cancer is difficult to detect early, with more than 85% diagnosed at an advanced stage
Former Executive Yuan Secretary-General Lee Ying-yuan is reported to have resigned due to pancreatic cancer and is undergoing treatment. Pancreatic cancer has no obvious symptoms and is often discovered at an advanced stage. Dr. Wang Wenlun, director of the Department of Digestive Endoscopy at E-Da Hospital, said in an exclusive interview with “healthorn” that about 85% to 90% of pancreatic cancer patients in Taiwan are already in stage 3-4 when diagnosed. The reason why pancreatic cancer is difficult to detect early is the lack of ideal examination tools. Ultrasound, the most commonly used clinical examination, is easily blocked by gastric air and is difficult to observe the overall changes in the pancreatic structure.
Dr. Wang Wenlun pointed out that there are usually no symptoms when tumors appear in the pancreas. When the tumor is large enough to compress the bile duct, causing jaundice and weight loss, or invades peripheral nerves and blood vessels and causes severe pain, it is already a relatively advanced pancreatic cancer. Therefore, it is indeed relatively difficult to diagnose pancreatic cancer early. High-risk groups should find out whether there are pancreatic lesions early through health examinations.
What are the screening tools for early stage pancreatic cancer? Don’t ignore the risks of stomachache and unknown risks
Dr. Wang Wenlun said that to detect early-stage pancreatic cancer, more sophisticated examination tools such as computerized tomography, magnetic resonance imaging, and endoscopic ultrasound are needed. Computed tomography is more precise than ultrasound but has a higher dose of radiation. The patient needs to take a contrast agent and is more likely to put a strain on the kidneys. MRI has no radiation exposure and can detect tiny tumors below 2 centimeters, but the examination is expensive.
The method of endoscopic ultrasound examination is the same as that of gastroscopy. The probe is inserted into the stomach and the pancreas behind the stomach is observed through the stomach wall. Pancreatic tumors of about 1 cm can be seen. However, endoscopic ultrasound is an invasive examination and may not be as effective for asymptomatic and low-risk groups.
Dr. Wang Wenlun pointed out that examination tools such as computed tomography, magnetic resonance imaging, and endoscopic ultrasound are more recommended for high-risk groups, such as patients with a family history of pancreatic cancer, smoking, obesity, and chronic pancreatitis. If you are at high risk and have symptoms such as unknown upper abdominal pain, or if your symptoms are not relieved after taking stomach medicine, you should undergo further detailed examinations.
In recent years, many people have arranged PET examinations for their elders. Dr. Wang Wenlun explained that the principle of PET examination is that tumors absorb and metabolize sugar and are detected through PET examinations. However, for early-stage pancreatic cancer, such as tumors smaller than 2 cm in size, the sensitivity is not ideal. Moreover, orthosonography is expensive and not suitable for long-term tracking by the general public. It is usually used for clinical staging or auxiliary assessment of whether there is spread or metastasis.
Is elevated CA19-9 a warning sign of pancreatic cancer? The chance of being diagnosed with pancreatic cancer is less than 1%
It is also common in the clinic for people to come to the clinic due to elevated pancreatic tumor index CA19-9 and concerns about whether it is a warning sign of pancreatic cancer. Dr. Wang Wenlun explained that statistics show that the chance of being diagnosed with pancreatic cancer due to elevated CA19-9 is less than 1%. The reason why the CA19-9 index increases may be caused by factors such as the body’s own constitution or acquired glandular lesions, such as ovarian blisters, ovarian tumors, and uterine lesions caused by female gynecological diseases. Or factors such as colorectal polyps and biliary lesions may cause CA19-9 to rise. Therefore, CA19-9 is not used as an accurate indicator for screening pancreatic cancer.
Dr. Wang Wenlun explained that the CA19-9 index of pancreatic cancer patients is very high, with values reaching over 1,000. For people who come to general outpatient clinics, the index usually only rises slightly. After examination, it can be found that it is caused by physical constitution or other factors, which is a benign condition. The public is reminded that if CA19-9 is found to be high during a health examination, they can first go to the hospital for an ultrasound examination. If there are risk factors such as a history of pancreatic cancer, more sophisticated computer tomography, MRI and other examination methods can be arranged.
Diabetes may increase the risk of pancreatic cancer, and smoking can harm you for up to 20 years
One of the risk factors for pancreatic cancer is diabetes, which is quite prevalent in Taiwan. Dr. Wang Wenlun explained that clinical statistics show that the risk of pancreatic cancer in patients with diabetes is increased, and the explanation can be estimated from two aspects. First of all, the pancreas is responsible for secreting hormones and controlling metabolism. When tumors or other lesions occur in the pancreas, it may lead to unstable blood sugar and insufficient insulin secretion, resulting in high blood sugar and diabetes. Doctors remind you that if your blood sugar suddenly rises after the age of 50 and you are newly diagnosed with diabetes, you should pay special attention to whether there are other problems with your pancreas.
In addition, past studies by Academia Sinica have pointed out that both animal experiments and human experiments have found that excessive sugar intake will increase the incidence of pancreatic cancer, pointing out that “sugar” is one of the culprits of pancreatic cancer. Dr. Wang Wenlun explained that a high-sugar diet can damage the DNA of pancreatic cells and lead to genetic mutations in the oncogene KRAS. Past tests have found that up to 90% of pancreatic cancer patients have KRAS mutations.
Dr. Wang Wenlun reminded that smoking is a high-risk factor for pancreatic cancer. The risk of pancreatic cancer is more than five times higher than that of the average person. The long-term harm caused to the body by smoking will not disappear immediately even after quitting smoking. In the past, Large-scale studies have shown that it takes 20 years after quitting smoking to reduce the risk of pancreatic cancer to the same level as the average person.
Dr. Wang Wenlun said that although the proportion of smoking people in Europe, the United States and Taiwan has decreased, the incidence of pancreatic cancer has not shown a significant downward trend. This is related to three reasons. The first is that the harm caused by smoking to the body lasts for 10 to 20 years, and the second is that the high Sugary diet may increase the risk of pancreatic cancer. The third is obesity. Obesity is related to metabolic symptom clusters, which can affect the metabolism of sugar and fat and cause pancreatic damage. It has also received more and more attention in recent years.
Pancreatic cancer symptoms are not the same for everyone? Is there a difference between the head and the tail?
Pancreatic cancer may cause different symptoms depending on where it occurs. Dr. Wang Wenlun explained that the head of the pancreas is close to the bile duct, mesenteric artery, aorta and other large blood vessels. When a tumor appears in the head of the pancreas and compresses the outlet of the bile duct, bile will not be metabolized normally, causing jaundice, tea-colored urine, gray-white stool, etc. In addition to direct detection, symptoms can sometimes be determined from the dilation of the bile duct to determine whether it is related to a tumor in the head of the pancreas. Tumors that grow in the tail of the pancreas, because there are no bile ducts and other structures around it, usually cause pain symptoms only when the tumor is large enough to compress surrounding organs and nerves.
Dr. Wang Wenlun pointed out that in addition to different symptoms, the location of the tumor also has different treatment methods. The most ideal treatment for pancreatic cancer is surgical resection. When the tumor occurs in the head of the pancreas, a major operation called “Whipple Procedure” (pancreaticoduodenectomy) will be required. Surgery on the tail of the pancreas is relatively simple. Usually, the tumor and the spleen are removed together with part of the pancreas preserved. However, the proportion of pancreatic cancer patients who can undergo resection is not high. Most patients are already in stage 3 or 4 when diagnosed. The tumors have metastasized far away, and systemic therapies such as chemotherapy or targeted therapy can only be used.
The survival rate of late-stage pancreatic cancer is less than 5%. Doctors urge you to eat less high-sugar foods and have regular health check-ups.
Dr. Wang Wenlun said that pancreatic tumors are relatively malignant. After surgery, patients with early-stage cancer are still found to have a very high risk of recurrence after surgery. Therefore, even for patients in stages 1 and 2, the 5-year survival rate is still only The survival rate is about 30%, and the survival rate in stages 3 and 4 is only about 5%. In addition, the pancreas will secrete toxins, destroying the patient’s subcutaneous fat, making the patient appear abnormally thin, have a poor appetite, and the postoperative recovery is even less ideal. . This is the main reason why pancreatic cancer is called the “King of Cancers”. Even with the advancement of medicine, the survival rate of patients has not made great progress.
Dr. Wang Wenlun reminds that high-risk groups who have unexplained abdominal pain, weight loss, jaundice, or a family history of pancreatic cancer or are newly diagnosed with diabetes after the age of 50 should seek medical examination as soon as possible. In order to prevent and detect pancreatic cancer early, you should reduce your intake of high-sugar foods, maintain good living habits, avoid metabolic problems caused by obesity, and receive regular health check-ups.
