Pancreatic Cancer

Cancer that starts in the pancreas, often diagnosed at advanced stages.

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Pancreatic Cancer

The pancreas is an elongated organ located posteriorly, below the stomach within the curve of the upper part of the small intestine, called the duodenum and comprises two types of glands the exocrine and endocrine glands.

The exocrine gland plays an important role in the digestion of fats, proteins and carbohydrates, by secreting digestive pancreatic juices and the endocrine gland helps in keeping the blood sugar levels under control by secreting insulin. Pancreatic cancer originates in the tissues of the pancreas located behind the lower portion of the stomach and is relatively more common in men than in women.

Symptoms of Pancreatic Cancer

The symptoms of pancreatic cancer may include:

Abdominal pain that radiates to the back
Loss of appetite or unintended weight loss
Jaundice i.e. yellowish discolouration of the skin and the ‘whites’ of the eyes
Light or clay-coloured stools
Dark coloured urine
Excessive skin itching
Generalised weakness
New diagnosis of diabetes or existing diabetes that's becoming more difficult to control

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Causes of Pancreatic Cancer

Factors that increase the risk of pancreatic cancer include:

Smoking
Diabetes
Chronic inflammation of the pancreas (pancreatitis)

Family history of pancreatic cancer or genetic syndromes in families like BRCA2 gene mutation, Lynch syndrome and Familial atypical mole-malignant melanoma (FAMMM) syndrome is associated with an increased risk of pancreatic cancer.

Obesity
Older age

When to see the Doctor?

The symptoms and characteristics can vary in individuals; hence it is best advised to consult our specialists to rule out cancer possibilities as a preventive measure if you are experiencing a combination of any of these symptoms.

Prevention of Pancreatic Cancer

Some of the preventive measures are:

Tests for Pancreatic Cancer

Physical examination: A thorough physical examination will be carried out after obtaining a detailed history of your symptoms.
CT scan: A special technique called ‘Pancreatic protocol CT scan’ is done, to determine the exact stage of the cancer, which in turn helps determine the best treatment approaches for the patient.
MRI scan: In some cases, an MRI scan is taken to determine the relationship between vessels and tumours.
PET CECT scan: A PET CT scan may sometimes be suggested to rule out the spread of cancer to other sites like the liver, lungs
Biopsy/FNAC: For patients in the advanced stages where it's not possible to perform an upfront surgery but requires a bout of chemotherapy or radiation, a small biopsy is done using any of the following FNAC approaches:
Endoscopic Ultrasound-guided FNAC or biopsy: An endoscopic ultrasound or EUS is a device that uses ultrasound waves to create images of the pancreas inside the abdomen and has a thin flexible tube. This device is inserted into the stomach and a biopsy/FNAC is done to obtain tissue samples of the tumour.
USG-guided Biopsy or FNAC: This is another method of performing biopsy/FNAC, wherein a thin needle is inserted through the skin under USG guidance to obtain tissue samples for pathological analysis to confirm the type of pancreatic cancer.

Treatment for Pancreatic Cancer

Treatment approaches for pancreatic cancer include:

Surgery

Surgical procedures to remove cancer include:

Whipple’s procedure: In cancers involving the proximal part of the pancreas, a Whipple’s procedure is usually performed. In this, the proximal part of the pancreas along with the adjacent small intestine (duodenum), distal part of the stomach, gall bladder and distal part of the bile duct are removed along with adjacent lymph nodes. Reconstruction is then performed by joining a segment of the small bowel (jejunum) with the remaining part of the pancreas, bile duct and stomach.
Pylorus preserving pancreaticoduodenectomy: This surgery is similar to Whipple’s procedure, except that the distal part of the stomach along with the pylorus (distal-most part of the stomach) is preserved.
Distal Pancreatico-splenectomy: For cancer involving the distal part of the pancreas, a distal Pancreatectomy with or without splenectomy is performed.
Total Pancreatectomy: The removal of the entire pancreas is called Total Pancreatectomy, resulting in the patients requiring lifelong insulin and enzyme replacement.
Chemotherapy - Drugs to treat cancer cells are injected into the body, these drugs have tolerable side effects, and the side effects have been minimized with new forms of chemotherapy drugs with the evolving changes in medical and treatment approaches. Chemotherapy is crucial to contain the cancer cells circulating in the blood.
Bypass surgeries: In some of the advanced cases (stage IV), bypass procedures like gastro-jejunostomy, and hepaticojejunostomy are performed, to bring down jaundice levels, enabling the patient to eat well during treatment.

Chemotherapy

Chemotherapy in the form of injections or tablets may be suggested depending on the stage of the disease.

Adjuvant chemotherapy: The chemotherapy given after surgery, comprising 6 cycles wherein each cycle varies between 2-3 weeks.
Neoadjuvant chemotherapy: The chemotherapy given prior to surgery is called neoadjuvant chemotherapy, consisting of 3 cycles wherein each cycle constitutes a duration of 3 weeks, another boot of chemotherapy is given post-surgery as adjuvant chemotherapy consisting of 3 cycles.