Understanding Pancreatic Cancer - Doctor Q&A

In Singapore, pancreatic cancer is the 4th most common cause of cancer death in males and females.

Pancreatic cancer is one of the more challenging cancers to detect and treat, often because early symptoms can be subtle or easily overlooked. It is also generally aggressive.

Vast majority of pancreatic cancer pateints are aged between 50 and 80 years old, with men having a slightly higher incidence rate than women.

When the cancer progresses, some symptoms may show including:

• Fatigue and weakness
  
• Jaundice (yellow colouration of the skin and whites of the eyes)
• Loss of appetite
• Nausea or vomiting
  
• Unexplained and unintentional weight loss
  
• Pain or discomfort in the upper part of the abdomen
  
• Diarrhoea
  
• Indigestion or bloating

In recent years, advances in imaging, surgery, chemotherapy, and targeted therapies have improved outcomes for selected patients.

However, many people still have questions about risk factors, warning signs, screening, treatment choices, and what to expect during care.

In this Q&A forum, don't miss this chance to ask our specialist about pancreatic cancer — from symptoms and diagnosis to current treatment approaches and supportive care.

Our specialist will provide medically accurate, easy-to-understand answers to help you better navigate this condition.

Hurry, submit your question now as this Q&A is for a limited time only!

Related articles:
Pancreatic Cancer: Is It Preventable?

Pancreatic Cancer: Risks and Treatment

Dr Darren Chua is a Consultant in Hepatopancreatobiliary and Transplant Surgery at the Singapore General Hospital (SGH).

He graduated from the NUS Yong Loo Lin School of Medicine with an MBBS (Honors) in 2015, earning a Dean's List in every academic year.

He completed his residency with the SingHealth General Surgery program in 2020, receiving his MMed (NUS) and FRCS (Edinburgh). His residency achievements include his graduation from the Singhealth Residency Leadership Program and receiving the Residency in Service Excellence (RISE) awards in 2017 and 2020.

In addition, Dr Chua was awarded the College of Surgeons Gold Medal for top performance in General Surgery exit examinations. He subsequently pursued a Master's in Clinical Investigation (MCI) from NUS in 2023 and was awarded an MOH HMDP scholarship to pursue liver transplantation under Professor Jeng Long Bin from the China Medical University Hospital in Taiwan.

Dr Chua has authored and co-authored multiple articles in various international peer-reviewed journals. He is committed in advancing minimally invasive surgery for complex liver and pancreatic resections, as well as liver and multi-organ transplantation.

1. Question by Lim

Hi Dr,

Would consumption of high potency probiotics help reduce the occurrence of digestive issues post-pancreatic surgery? Thank you.

Answer by Dr Darren Chua

After pancreatic surgery, digestive problems are common because the pancreas produces enzymes needed to digest fats and proteins. Many patients require pancreatic enzyme replacement in order to aid in digestion.

Probiotics may help improve gut balance and reduce bloating or diarrhea in some individuals, but they do not replace pancreatic enzymes.

Evidence for high-potency probiotics specifically after pancreatic surgery is still limited. They are generally safe for most people and should be used as a supportive measure.

2. Question by Seok

Hi Dr,

What type of regular screening should we go for to detect early pancreatic cancer since relying on symptoms may be too late? Thank you.

Answer by Dr Darren Chua

Hi, there is currently no recommended routine screening for the general population as pancreatic cancer is uncommon and early screening tests are generally not cost-effective.

Screening may be considered in high-risk individuals (e.g. those with known genetic syndromes or a strong family history of pancreatic cancer).

The most practical approach is to remain vigilant for warning signs such as tea-coloured urine or unexplained weight loss.

At the same time, adopting healthy daily habits — including a balanced diet, regular physical activity, and avoiding smoking and excessive alcohol — plays an important role in maintaining overall health.

3. Question by CK

Hi Dr,

My dad was diagnosed with stage 4 Pancreas cancer when discovered last month and he has passed away before having the chance to meet with the Chemo doctor on treatment.

He became weak and had fallen on the floor when discovered, which doctor said he might have coronary attack.

Given I am his daughter, is my chance of having such disease high? Thank you.

Answer by Dr Darren Chua

Dear CK, firstly, I would like to express my heartfelt condolences on the passing of your father.

The majority of pancreatic cancers are not inherited. Only a small proportion — about 5 to 10% — are associated with strong family history or genetic factors.

Having one close family member affected may slightly increase your risk, but most individuals in this situation do not go on to develop pancreatic cancer.

If there is a history of several relatives with cancer or cancers occurring at a young age, genetic counselling or specialist screening may be considered.

In the absence of these factors, maintaining good general health and being attentive to possible symptoms is usually sufficient.

4. Question by Ktyeo

Dear Dr,

My questions are:

a) What is the best golden standard method for early detection?

b) What is the most practical and cost-efficient method vs the best golden standard method?

c) When or what symptoms would trigger one to seek such an early detection?

Answer by Dr Darren Chua

a) In the appropriate clinical setting where we suspect pancreatic cancer, endoscopic ultrasound or MRI of the pancreas are sensitive methods for early cancer detection.

b) For most people, routine screening is not needed. The most practical method is actually maintaining daily healthy habits such as diet and exercise and to watch for red flag symptoms of cancer should they present themselves (e.g. weight loss, jaundice, tea coloured urine).

c) Unexplained weight loss, jaundice, tea-coloured urine, persistent abdominal pain or bloating, new onset of diabetes. It is important to note that some of these symptoms do not always mean cancer, so it is important to speak to your primary health provider.

5. Question by Ang CH

Dear Doctor Darren,

I am writing to share my father’s medical condition and to seek your advice on the prevention and early detection of pancreatic cancer.

My father was diagnosed with Stage 4 pancreatic cancer. Before the diagnosis, he experienced ongoing stomach discomfort and a general feeling of unwellness over a period of time. He had sought treatment at the polyclinic on several occasions, but no clear cause was identified then.

Later, at his request, we brought him to a hospital for further evaluation. After reviewing his symptoms and medical history, the doctor suspected cancer and arranged additional tests, which unfortunately confirmed pancreatic cancer.

He underwent several rounds of chemo (both injections and oral type). Recently, the treatment has stopped being effective, so we have since stopped the treatment.

He is currently receiving TCM treatment and uses pain-relief patches and medication to help manage his pain.

Through this experience, our family is trying to better understand pancreatic cancer, especially regarding prevention and early detection.

I would appreciate your advice on the following:

a) Is early-stage pancreatic cancer detectable, and what screening methods are available?

b) Are there recommended screenings for individuals with a family history of pancreatic cancer?

c) Is screening generally costly, and would it be advisable in my situation?

d) Is there any other way we can help my father at this stage?

I have read your articles and noted that I experience one of the commonly mentioned symptoms—persistent bloating.

The bloating sometimes occurs in the early morning, most often after meals, and occasionally without any clear trigger. I also experience frequent burping and flatulence, with a bad smell.

I have sought TCM treatment, but it has not provided relief. Despite eating slowly and carefully, the symptoms persist, which raises concern for me given my family history.

Hope to have your advice. I am 53 years old. Thank you.

Answer by Dr Darren Chua

Firstly, I am sorry about your father’s illness. Pancreatic cancer is unfortunately often diagnosed late despite medical attention.

a) Is early-stage pancreatic cancer detectable?

Yes, but only with specialised imaging such as MRI pancreas or using endoscopic ultrasound. Early-stage disease often causes no symptoms, which makes population screening difficult.

b) Screening for family history:

If there is only one affected relative, routine screening is usually not recommended. If multiple close relatives are affected (especially multiple first-degree relatives), referral for genetic screening or a high-risk pancreatic clinic may be recommended.

c) Cost considerations:

MRI and EUS are relatively costly and the latter is also invasive. Therefore, they are reserved for higher-risk individuals rather than the general population.

d)  Supporting your father at this stage:

At this point, the main priorities are effective pain control, nutritional and emotional support, and care for both the patient and family. Involvement of a palliative care team can be very helpful in improving comfort and quality of life.

Regarding your bloating symptoms:

Bloating and frequent burping are common symptoms and are often related to dietary or digestive issues. If these symptoms persist or cause concern, I would recommend discussing them with your primary care doctor, who can arrange further evaluation if needed.

6. Question by JD

Hi Dr,

I was hospitalised 20 years back for inflammation of the pancreas. admitted for 7 days.

Since then all seems ok but my sugar level has been going up. Level averaging 8. Taking all sorts of medication now. Some control in diet. Some walking exercise. It just don't seem to come down.

6-monthly check up at Polyclinic is done. Other than medication and exercise how can I lower my sugar level?

Answer by Dr Darren Chua

Good blood sugar control is best achieved through regular follow-up with your doctor, appropriate adjustment of medications when necessary, a balanced diet with careful carbohydrate intake, and consistent physical activity.

If your sugar levels remain elevated despite these measures, your doctor may consider modifying your medications, assessing pancreatic function, or referring you to a diabetes specialist for further management.

At present, there is no single supplement or quick solution to lower blood sugar effectively. Consistent medical care and healthy lifestyle habits remain the most important factors in achieving good control.

7. Question by Dennis

Hi Dr,

My father was diagnosed with 4th Stage Pancreatic Cancer (PC) a few years ago. He passed less than 6 months after.

I have the following questions:

a) Is pancreatic cancer heritable?

b) What is the best indicator or test to detect PC early?

c) If PC is detected early (Stage 1,) what are the odds and types of treatment available today?

d) What medications or treatments are expected to be available in 5 years?

Thank you for your advice.

Answer by Dr Darren Chua

a) Is pancreatic cancer heritable?

Most are not. About 5–10% have some hereditary linkage.

b) Best early detection test:

For individuals at higher risk, pancreatic MRI or endoscopic ultrasound (EUS) are effective tools for early detection. However, these tests can be expensive, and EUS is also an invasive procedure.

c) If detected at Stage 1:

Surgical removal offers the best chance of cure. When combined with adjuvant chemotherapy, long-term survival can be improved. The estimated 5 year survival for stage 1 disease following surgery and adjuvant chemotherapy ranges from 30-40%. 

d) There have been many promising developments in pancreatic cancer treatment, including targeted therapies, immunotherapy, and emerging personalised gene-based approaches. While these advances are steadily improving outcomes, surgery remains the cornerstone of treatment whenever it is feasible.

8. Question by Kelven

Dear Doctor,

I would like to know the following:

Can the presence of cysts in the pancreas lead to or heighten the risk to pancreatic cancer?

What can I do or eat to prevent pancreatic cancer? Thank you.

Answer by Dr Darren Chua

Some pancreatic cysts are benign and do not cause harm, while others may carry a potential risk of developing into cancer.

Specialist evaluation, coupled with imaging studies, helps determine which cysts require follow up or even surgery.

At present, there is no specific food or supplement proven to prevent pancreatic cancer.

However, adopting healthy lifestyle practices can help reduce overall cancer risk and support general well-being.

These include avoiding smoking, maintaining a healthy weight, keeping diabetes under good control, eating a balanced diet rich in fruits and vegetables, and attending regular medical check-ups.

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