Pancreatic Cancer early Detection and Treatment in India

What is Pancreatic Cancer?

The cancer that grows inside the pancreas is known as pancreatic cancer. Pancreas is the gland that is about 6 inches long that makes hormones including the enzymes responsible for controlling blood sugar and also helps in digesting food. The development of pancreatic cancer starts when the cells inside the pancreas grow out of control. This cancer may metastasize or spread top surrounding organs and lymph nodes such as lungs and liver.

The Pancreas

The pancreas is a long leaf shaped organ, almost resembling a flattened obelisk. The broad end is called the head, the tapering point called the tail and the intervening part called the neck and body. It lies transversely in front of the spine in the abdomen. The head end is situated on the right side and the tail on the left, touching the spleen. The common bile duct runs through the head, on its way from the liver to the intestines. The pancreas produces a plethora of digestive enzymes which are secreted into the gut. In addition, it produces the hormone insulin, the lack of which causes diabetes mellitus.

The most common cancer that arises in the pancreas is the adenocarcinoma, which carries the worst prognosis. The main risk factors are smoking, excessive alcohol consumption, obesity and diabetes mellitus. There is also a strong relation to chronic pancreatitis and a family history of cancer. Hence this cancer can be guarded against by lifestyle modifications, such as cessation of smoking, change in drinking habits, regular exercise and a healthy lifestyle.

Signs and Symptoms

The initial signs and symptoms of this disease are very nonspecific and emulate everyday troubles like indigestion and acidity. However, cancer of the pancreatic head announces itself comparatively early by blocking the common bile duct and thus causing jaundice, which is initially painless. Hence any painless jaundice should be immediately investigated with an abdominal ultrasound. Cancer of the other parts of the pancreas do not cause jaundice and are consequently diagnosed even later. They usually cause severe abdominal pain spreading to the back, weight loss, vomiting and onset diabetes.

Diagnosis

Diagnosis is done by imaging, such as CT scan, MRI, CT guided fine needle biopsy (FNAC) and a blood  test to detect a specific protein called CA 19.9, the level of which is elevated in pancreatic cancer. It is not always possible to do preoperative biopsy or FNAC successfully, and it frequently happens that the surgeon decides to operate on clinical and radiological suspicion alone. During the operation, a frozen section biopsy is used to confirm the disease.

Upon diagnosis, the fate of the affected person hinges on whether the cancer is limited to the pancreas and, if so, whether it can be surgically removed. Like most other solid cancers, surgery is the keystone to the treatment of this cancer. If the cancer has spread to other distant organs such as the liver, it is in the incurable stage and the average survival of these patients is 6 to 9 months from diagnosis. Anticancer chemotherapy drugs can be used to ameliorate the painful symptoms, but it does not increase survival at this stage. If the cancerous tumour is not limited to the pancreas but has extended to involve surrounding vital structures, then it is inoperable, which means it cannot be surgically removed.

If the tumour is limited to the pancreas and is operable, then surgery carries the best chance of cure. The operation varies according to where the tumour is located. If it is in the head of the pancreas, then the surgery is called a Whipple procedure (pancreaticoduodenectomy).

If the tumour is in the mid-part or body of pancreas, it is rarely operable, but sometimes a total pancreatectomy or removal of whole pancreas can be done. For cancers in the tail of the pancreas, a distal pancreatectomy operation with removal of the spleen is done.  Thus it is apparent that treatment options for this disease are limited, even when detected relatively early. Research is ongoing to find better options. As of now, it appears that prevention is better than cure, and therein lays the importance of a healthy lifestyle.

Treatment ofPancreatic Cancer

 There are different types of surgeries that help in removing the pancreatic cancer. These surgeries are further categorized into-

    • Curative that helps in treating the cancer by   removing it 
    • Palliative that helps in easing the symptoms 

·       Curative Surgeries :

o  Pancreaticoduodenectomy : This is considered as the most common surgery for removing a pancreatic tumor. This surgery is also termed as Whipple procedure that removes –

§ Part of the common bile duct

§ Head of the pancreas

§ Gallbladder

§ Duodenum

§ Body of the pancreas

§ Lymph nodes close to the pancreas

§ Part of the stomach

§ A small part of the jejunum

o  Total Pancreatectomy : This procedure involves the removal of the spleen and the complete pancreas.

o  Distal Pancreatectomy : This procedure involves the removal of a part of the body of the pancreas and tail of the pancreas. It also removes the spleen. This procedure is more commonly used with islet cell tumors.

·       Palliative Surgeries :

o  Gastric Bypass : When the stomach has been blocked by the cancer then it is sewn with the small intestine. This process allows a patient to eat normally.

o  Stent Placement : In order to avoid blockage, the insertion of the metal tubes is done that helps in keeping the bile duct open.

o  Biliary Bypass : A small surgical cut is made in the bile duct or gallbladder that is then sewed to the small intestine. This surgical procedure is helpful when the tumor has blocked small intestine and has caused bile to accumulate in the gallbladder. Pain is also relieved by the means of this procedure.

·       Laparoscopy : The minimally invasive surgical techniques of laparoscopy are normally used directly before a scheduled pancreatic resection to determine if a more invasive operation is the best course of action. Since metastases can sometimes be missed on CT, MRI or other imaging studies, laparoscopy is a reliable way to check for metastasis to other organs. If metastases are found and the surgeon decides an operation is not the best course of action, then the patient will have a shorter recovery time compared to that of a major surgery and will be in better shape to receive alternate forms of treatment.

·       Radiotherapy :It destroys cancer by focusing high-energy rays on the cancer cells. This causes damage to the molecules that make up the cancer cells and leads them to commit suicide. Unlike chemotherapy which is a systemic treatment, radiation therapy is a local treatment meant to destroy only tumor cells. During the treatment, a beam of radiation is directed through the abdomen to the cancerous area. The radiation is similar to that used for diagnostic X-rays, only in a higher dose.

·       Chemotherapy :Chemotherapy uses drugs to help kill cancer cells. Chemotherapy can be injected into a vein or taken orally. Chemotherapy can also be combined with radiation therapy (chemoradiation). Chemoradiation is typically used to treat cancer that has spread beyond the pancreas, but only to nearby organs and not to distant regions of the body. This combination may also be used after surgery to reduce the risk of recurrence of pancreatic cancer.

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