Disease Description (Causes and Symptoms)
- Definition and pathophysiology: The pancreas is an organ located in the upper abdomen that has exocrine functions (secretion of digestive enzymes) and endocrine functions (secretion of hormones such as insulin). Pancreatic cancer is predominantly adenocarcinoma arising from exocrine cells (more than 90%), and symptoms, diagnosis, and treatment course vary anatomically according to whether the tumor is in the head, body, or tail. Tumors in the head are likely to compress the bile duct and cause jaundice, while lesions in the body and tail tend to produce symptoms later.
- Main causes and risk factors: Age (primarily 50 years or older, with incidence increasing at age 70 or older), smoking (associated with approximately 30% of cases), high-calorie and high-fat diet (approximately 20%), chronic pancreatitis (approximately 4%), and genetic predisposition (approximately 10%), among others. In many cases, the cause is not clear.
- Main symptoms: Abdominal pain (the most common), weight loss, decreased appetite, jaundice (mainly with lesions in the pancreatic head), gray stools/steatorrhea, nausea and vomiting, fever, and newly developed or worsened diabetes. Because there are few symptoms in the early stage, the early detection rate is low (10% or less).
Treatment Methods
- Overview of treatment (determined according to stage and overall condition)
- Curative surgery: For resectable disease, radical resection is considered as the first-line treatment (e.g., pancreaticoduodenectomy [Whipple procedure], or distal pancreatectomy for lesions in the tail). Curative resection is possible in only approximately 15% or fewer of all patients.
- Adjuvant and neoadjuvant chemotherapy:
- After resection (adjuvant therapy): Adjuvant chemotherapy is recommended (the choice of treatment depends on the overall condition and drug indications). Because the recurrence rate after surgery is high, adjuvant therapy is important.
- Borderline resectable disease: Neoadjuvant chemotherapy (or chemotherapy plus radiation) is used to downstage the disease, followed by reassessment and an attempt at surgery.
- Locally advanced (unresectable) and metastatic disease:
- Systemic chemotherapy is the main treatment (e.g., FOLFIRINOX-based regimens or gemcitabine + nab‑paclitaxel; the patient’s physical condition and adverse effects are considered).
- For locally advanced disease, radiation therapy combined with chemotherapy may be considered, with reassessment for resection depending on the response.
- Targeted and immunotherapy: Depending on specific biomarkers such as genetic mutations (e.g., BRCA mutations) or MSI‑High, targeted therapy (e.g., indications for PARP inhibitors) or immune checkpoint inhibitors may be possible (testing is required).
- Symptomatic and palliative treatment:
- Endoscopic or percutaneous biliary drainage (stent placement) in cases of biliary obstruction.
- Pain management (analgesics, nerve blocks such as celiac plexus block, etc.).
- Enzyme replacement therapy (supplementation with digestive enzymes) and nutritional management in cases of pancreatic exocrine insufficiency.
- Blood glucose control, including insulin, when diabetes develops or worsens.
- Procedure- and medication-related precautions: Whether surgery is indicated is determined by major blood vessel involvement and the presence or absence of metastasis on imaging. When a lesion is considered resectable, preoperative tissue biopsy (needle biopsy) is often omitted in practice because of risks such as peritoneal dissemination caused by needle puncture. The choice of anticancer drugs varies according to the patient’s condition, comorbidities, and genetic test results.
Checklist Before an Outpatient Visit (Preparation and Example Questions)
- Items to bring:
- List of currently used medications (including prescription drugs, over-the-counter drugs, and supplements)
- Summary of previous surgeries and medical history, and allergy information
- Recent test results (blood tests, liver and kidney function tests, tumor markers such as CA 19‑9)
- Recent imaging (CT/MRI/ultrasound) films or CD, and radiology reports
- Symptom diary: changes in weight, location, intensity, and timing of pain; digestive problems (such as steatorrhea); and when jaundice began
- Lifestyle information: smoking and alcohol use history, and eating patterns
- Examples of information to tell the doctor during the outpatient visit:
- When symptoms began and how they have progressed (recent rapid weight loss, newly developed diabetes, etc.)
- Characteristics of the pain (whether it is continuous or occurs after meals, and whether it responds to pain medication)
- Changes in bowel habits (steatorrhea, gray stools)
- Recent test or imaging results (bring them if available)
- Precautions before testing:
- Some tests, such as endoscopy, require fasting (follow the doctor’s instructions).
- If taking anticoagulants or antiplatelet drugs, be sure to consult in advance about whether they should be discontinued.
Examples of General Questions to Ask the Doctor
- "What is my stage, and is the cancer resectable?"
- "What are the recommended standard treatment options, and what are the expected effects and adverse effects of each?"
- "What are the main adverse effects of chemotherapy, and how can they be managed?"
- "What is the likelihood of recurrence and what is the prognosis after surgery?"
- "What should I be careful about regarding lifestyle habits, such as diet, exercise, and smoking cessation?"
Examples of Disease-Specific Questions
- "How will the results of genetic tests (e.g., BRCA, MMR/MSI) affect the choice of treatment? Do you recommend testing?"
- "My jaundice is severe. Is endoscopic biliary drainage (stent placement) necessary in this situation? What are the risks and expected benefits of the procedure?"
(Summary for reference: Diagnosis is often delayed because there are no early symptoms, and because the recurrence rate is high even in patients who undergo resection, systemic treatment and a multidisciplinary approach are important.)