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Pancreatic Cancer

Pancreatic cancer is one of the common GI cancers in India. Adenocarcinomas account for about 95% of pancreatic cancers, and they originate from exocrine cells of the pancreas.

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Overview

Pancreatic cancer is a type of gastrointestinal cancer that occurs with the uncontrollable division of abnormal cells. Exocrine and endocrine cells make up the pancreas, and in most cases, pancreatic malignancies originate from exocrine cells.

Pancreatic cancers commonly cause abdominal pain, lower back pain, jaundice and sudden weight loss. It is important to note that symptoms of pancreatic cancer usually do not appear until the later stages of the disease.

Types

Based on the type of cells that they originate from, pancreatic cancers are categorised into the following types:

  • 1. Adenocarcinomas: Adenocarcinomas account for about 95% of pancreatic cancers, and they originate from exocrine cells of the pancreas.
  • 2. Neuroendocrine Tumours: Neuroendocrine tumours arise from islet cells and form a small percentage of pancreatic cancers.

HCG houses the best pancreatic cancer specialists in India who are trained to treat pancreatic cancers with customised and result-oriented treatment plans that lead to positive clinical outcomes.

Symptoms

Early-stage pancreatic cancers generally go unnoticed, and later symptoms are often vague and non-specific. As a result, pancreatic cancers are frequently identified after they have progressed to advanced stages. Main symptoms of pancreatic cancers include:

  • Upper abdominal pain that spreads to the back
  • Lack of appetite
  • Nausea and vomiting
  • Loose stools
  • Unintentional weight loss
  • Heartburn
  • Jaundice, which may be accompanied by itching
  • Pulmonary embolisms caused by pancreatic tumours that produce blood-clotting substances
  • Diabetes mellitus: Many people with pancreatic cancer acquire diabetes months or even years before being diagnosed with pancreatic cancer; this may imply that the advent of diabetes among aged individuals could be an early warning sign of pancreatic cancer.

Causes

Although the exact cause of pancreatic cancer is unknown, various risk factors that may increase one’s risk have been identified:

  • Age:Pancreatic cancer can happen at any age, but it is most common in those between the ages of 50 and 80. Around 63 % of pancreatic cancer patients are above the age of 70.
  • Smoking:Smoking is found to cause up to 1/3rd of all pancreatic cases. Tobacco consumption in any form is found to increase one’s pancreatic cancer risk.
  • Chronic Pancreatitis: Pancreatic cancer is more likely to happen among those who have chronic pancreatitis (long-term pancreatic inflammation). Patients with inherited pancreatitis are at an increased risk of developing pancreatic cancer, especially beyond the age of 40.

Diagnosis

There are multiple tests that a doctor may recommend for the detection and conclusive diagnosis of pancreatic cancer. Following are the commonly recommended tests for pancreatic cancer diagnosis:

a. Physical Examination: Physical examination is recommended if a patient presents with pancreatic cancer symptoms. The examination begins with the doctor inquiring about the patient’s medical history, as well as any physical complaints or symptoms, such as recent weight loss, pain, appetite changes, etc. After that, the doctor will perform a full physical examination that includes an inspection of the chest and abdomen region.

b. Lab Tests: Blood tests are rarely recommended for pancreatic cancer detection. However, the levels of bilirubin and liver enzymes in a patient’s blood, which measure the functioning of the liver and pancreas, are of great relevance to the doctor.

CA19-9 (carbohydrate antigen 19-9) test is usually recommended for pancreatic cancers. CA19-9 is a tumour marker that can be discovered in larger concentrations if cancer is present. An increased CA19-9 test by itself cannot be used to confirm a pancreatic cancer diagnosis. Elevated CA19-9 levels could indicate a range of other illnesses, including pancreatitis or liver cirrhosis. Also, some people with pancreatic cancer may not have this marker at all. CA 19-9 test is also carried out to assess the efficacy of cancer therapy administered.

c. Imaging tests: Imaging tests such as ultrasound and CT scans create detailed images of the pancreas and nearby tissues which help in arriving at a more accurate diagnosis and subsequent treatment planning. Other imaging tests that are particularly used for pancreatic cancer diagnosis include:

  • Endoscopic Ultrasound: Endoscopic ultrasound is a unique testing procedure used for the diagnosis of pancreatic cancer. This procedure allows the doctor to have a better look at the esophagus, stomach, and anterior portion of the guts, along with the pancreas and liver. A thin flexible tube, called an endoscope, is introduced through the mouth into the stomach and small intestine while the patient sleeps. An ultrasound probe is attached to the tube’s end, which transmits sound waves that create images of the abdominal organs. If the doctor notices any abnormal masses, a small sample may be collected (biopsy) for further evaluation.
  • Endoscopic Retrograde Cholangiopancreatography (ERCP): During this procedure, the endoscope is guided into the patient’s stomach and the small intestine by the doctor. ERCP combines two imaging techniques: direct visualisation of interior structures (endoscopy) and live-action x-ray (fluoroscopy). The doctor can use these two techniques to examine the structures of the liver, gallbladder, and pancreas ducts for cancer growth.
  • Magnetic Resonance Cholangiopancreatography (MRCP): MRCP is a non-invasive procedure that employs radio waves and a strong magnet connected to a computer to create detailed images of the biliary and pancreatic ducts. These images can distinguish between healthy and abnormal tissues, as well as reveal bile duct obstruction.

d. Biopsy: A biopsy is a procedure that allows a doctor to remove and examine a small piece of tissue. The biopsy sample can be collected during endoscopy. This sample is further examined under a microscope for the presence of cancer cells. A biopsy can help in achieving a definitive diagnosis.

At HCG, our pancreatic cancer specialists strive to deliver the best pancreatic cancer treatment in India via superior quality diagnostic support and innovative treatment approaches.

Treatment

Treatment for pancreatic cancer is planned upon considering multiple factors, namely the stage of the disease, the exact location, the overall condition of the patient and lastly, his/her preferences. Following are the treatment options that a doctor may recommend for pancreatic cancer management:

a. Surgery: Surgery may be considered if the tumour is confined to the pancreas only. The two main surgical procedures employed for pancreatic cancers include:

  • Surgery for tumours located in the pancreatic head: If the malignancy is in the head of the pancreas, the doctor will recommend Whipple’s procedure. During this procedure, the head of the pancreas, as well as a portion of the small intestine (duodenum), the gallbladder, and a segment of the bile duct, are all removed. A portion of the stomach may be removed as well. Eventually, the remaining components of the pancreas, stomach and intestines are connected to facilitate digestion.
  • Surgery for tumours located in the pancreatic tail and body: Distal pancreatectomy is a surgery that removes the tail of the pancreas or the tail and a small portion of the body of the pancreas. The spleen may also be removed.

b. Radiation Therapy: To kill cancer cells, radiation therapy uses high-energy beams like x-rays and protons. Before or after cancer surgery, the patient may receive radiation therapies, which are frequently combined with chemotherapy. This combination may also be used if surgery is not a feasible treatment option for a particular case.

Through consistent advancements in the field of cancer care, HCG strives to provide the best pancreatic cancer treatment in India.

c. Chemotherapy: Chemotherapy employs potent chemo drugs to destroy cancer cells. Chemotherapy can be administered intravenously or orally, and it may involve one chemo drug or a combination of two or more drugs, depending on the stage of the disease.

Chemoradiation (chemotherapy and radiation therapy) is most commonly used to treat pancreatic cancers that have spread to nearby organs. After surgery, chemoradiation may also be administered to lower the risk of a relapse.

d. Targeted Therapy: Targeted therapy employs drugs that specifically target the cancer cells based on the specific proteins present on the cell surface, specific biomarkers released by the cancer cells, the tumour environment factors, etc. Targeted therapies may work by blocking signals that trigger cancer cells to proliferate and grow. For advanced pancreatic cancers, targeted therapy is administered with chemotherapy.

Frequently Asked Questions

1. Are pancreatic cancers treatable?

Yes, pancreatic cancers are treatable. Nevertheless, like every other cancer, it is important for pancreatic cancers to be detected in their early stages as early detection positively impacts the clinical outcomes and quality of life post-treatment.

Today, there are multiple treatment options available for pancreatic cancers. At HCG, we have the best pancreatic cancer specialists, who are trained and experienced in managing both early-stage and advanced-stage pancreatic cancers with result-oriented treatment approaches.

2. Why are pancreatic cancers usually found in the later stages?

Pancreatic cancers are often diagnosed in later stages because they rarely cause symptoms; almost half of all pancreatic malignancies are not detected until they have progressed to other organs.

3. Can a pancreatic cyst turn into cancer?

Pancreatic cysts are common, and most of them are non-cancerous. However, some are cancer-causing, and others are precancerous. Pancreatic cysts come in a variety of shapes and sizes, ranging from benign to malignant. Benign cysts usually go away after some time without any medical treatment. However, if a cyst is found, it is important to confirm the type of cyst – benign or malignant and take appropriate care, if necessary.

4. Is there a link between breast cancer and pancreatic cancer?

As many are aware, BRCA mutations are strongly associated with the formation of Breast cancer and ovarian cancers. These BRCA mutations appear to be linked to pancreatic cancers as well. A BRCA mutation nearly doubles the risk of pancreatic cancer throughout a person’s lifetime. BRCA mutations are found in about 5% of persons with pancreatic cancer.

5. Can I prevent pancreatic cancers?

Although most pancreatic cancer cannot be prevented, you can lower your risk by keeping your weight in check, quitting smoking and reducing your alcohol consumption. Chronic pancreatitis and having a positive family history of the disease are other risk factors. Precancerous lesions can be detected occasionally and, if they are addressed on time, one may prevent the development of pancreatic cancer.

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