a malignant neoplastic disease of the pancreas, characterized by anorexia, flatulence, weakness, dramatic weight loss, epigastric or back pain, jaundice, pruritus, a palpable abdominal mass, the recent onset of diabetes, and clay-colored stools if the pancreatic ducts are obstructed. Insulin-secreting tumors of islet cells cause hypoglycemia, especially in the morning. Nonfunctioning islet cell lesions produce gastrin, causing symptoms of peptic ulcer, or, in some cases, acute diarrhea and hypokalemia, and achlorhydria, the result of the lesion's elaboration of secretin. Diagnostic measures include barium x-ray studies of the stomach and duodenum, transhepatic cholangiography (ERCP), laboratory evaluation of liver function, celiac arteriography, and computerized axial tomography. Exploratory laparotomy is often required for a definitive diagnosis. About 90% of pancreatic tumors are adenocarcinomas; two thirds are in the head of the pancreas. Most tumors are not resectable at the time of diagnosis, but localized cancers in the pancreas may be treated by partial pancreatectomy with excision of the common bile duct, duodenum, and distal part of the stomach. Functioning islet cell lesions may be excised or treated with streptozotocin, an antibiotic toxic to beta cells of the pancreas. Total gastrectomy is recommended for nonfunctioning islet cell tumors that are accompanied by peptic ulcer disease. Radiotherapy or chemotherapy with 5-fluorouracil or mitomycin-C may offer temporary palliation, but cancer of the pancreas has a poor prognosis: Few people live for more than 1 year after diagnosis. Pancreatic cancer occurs three to four times more often in men than in women. Though uncommon, it is increasing in incidence in the industrialized areas of the world. People who smoke more than 10 to 20 cigarettes a day, who have diabetes mellitus, or who have been exposed to polychlorinated biphenyl compounds are at increased risk of developing pancreatic cancer.

DR SOON is a medical practitioner. He holds four degrees. MBBS (University of Malaya), MBA (University of East Asia), LLB (Hons) (University of Wolverhampton), Master of Medicine (Edith Cowan University)