India's leading Cancer hospitals now have some of the world's moset advanced radiation equipment : Pancreatic Cancer

Pancreatic Cancer

The pancreas is in the upper abdomen and lies behind the stomach and intestines (guts). The shape of the pancreas is like a tadpole, and so the pancreas has a 'head', a 'body' and a 'tail'. The head section is nearest to the duodenum (the part of the gut just after the stomach). The pancreas makes a fluid that contains enzymes (chemicals) that are needed to digest food. The enzymes are made in the pancreatic cells and are passed into tiny ducts (tubes). These ducts join together like branches of a tree to form the main pancreatic duct. This drains the enzyme-rich fluid into the duodenum. The enzymes are in an inactive form in the pancreas (otherwise they would digest the pancreas). They are 'activated' in the duodenum to digest food.

Symptoms of Pancreatic Cancer 

In most of the cases the tumour first develops in the head of the pancreas and it tends to block the bile duct. This stops the flow of bile into the duodenum which leads to :

• Jaundice (yellow skin caused by bile seeping into the bloodstream due to the blockage).
• Dark urine - caused by the jaundiced blood being filtered by the kidneys.
• Pale faeces - as the faeces contain no bile which causes their normal brown colour.
• Pain is often not a feature at first. Therefore a 'painless jaundice' that becomes worse is often the first sign of pancreatic cancer. Nausea and vomiting are also fairly common symptoms..
• Pain in the upper abdomen. Pain can also pass through to the back.

Diagnosis Of Pancreatic Cancer 

The initial tests revolve around the symptoms of Jaundice to confirm if its because of blocked gallstone or hepatitis (liver inflammation) or if the cause of jaundice is a blockage from the head of the pancreas..

• CT scan (computerised tomography) is a commonly used test to assess pancreatic cancer. It is a specialised X-ray test that can give quite clear pictures of the inside of your body.

• MRI scan is sometimes done. MRI stands for magnetic resonance imaging. An MRI scan uses a strong magnetic field and radio waves to create pictures on a computer of tissues, organs and other structures inside your body.

• Endoscopic ultrasound (EUS). An endoscope (gastroscope) is a thin, flexible, telescope. It is passed through the mouth, into the oesophagus and stomach and on into the duodenum. The endoscope contains fibre optic channels which allows light to shine down so the doctor or nurse can see inside. Some endoscopes are fitted with a tiny ultrasound scanner at their tip which can obtain pictures of structures behind the gut such as the pancreas.
• Endoscopic retrograde Cholangiopancreatography (ERCP): a test that uses a flexible scope inserted through the nose, stomach, and into the pancreas and may be used to introduce a dye for X-rays or to place a stent (a metal or plastic tube that can help keep a duct open and functioning)

• Magnetic resonance cholangiopancreatography (MRCP): a type of MRI that is used to see the pancreas, its ducts, and the bile ducts more clearly, often used before or instead of ERCP.

                                             

Treatment of Pancreatic Cancer 

Surgery - One of the following types of surgery may be used to take out the tumor:

Whipple procedure: A surgical procedure in which the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct are removed. Care is taken to preserve pancreas to produce digestive juices and insulin.

Total Pancreatectomy: This surgery removes the whole pancreas, part of the stomach, part of the small intestine, the common bile duct, the gallbladder, the spleen and nearby lymph nodes.

Distal Pancreatectomy: The body and the tail of the pancreas and usually the spleen are removed. If the cancer has spread and cannot be removed, the following types of palliative surgery may be done to relieve symptoms:

Surgical Biliary Bypass: If cancer is blocking the small intestine and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine to create a new pathway around the blocked area.

Endoscopic Stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin tube) to drain bile that has built up in the area. The doctor may place the stent through a catheter that drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.

Gastric Bypass: If the tumor is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body

Radiation therapy

India's leading Cancer hospitals now have some of the world's moset advanced radiation equipment like Linac, Novelis, Gamma Knife and Cyberknife for treating Pancreatic Cancers. High technology radiation is used to kill cancer cells without affecting the healthy tissues

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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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Pancreatic cancer is hard to catch early It doesn't cause symptoms right away - Best Cancer Hospital in India

What is Pancreatic Cancer?

Cancer is a class of diseases characterized by out-of-control cell growth, and pancreatic cancer occurs when this uncontrolled cell growth begins in the pancreas. Rather than developing into healthy, normal pancreas tissue, these abnormal cells continue dividing and form lumps or masses of tissue called tumors. Tumors then interfere with the main functions of the pancreas. If a tumor stays in one spot and demonstrates limited growth, it is generally considered to be benign. 

More dangerous, or malignant, tumors form when the cancer cells migrate to other parts of the body through the blood or lymph systems. When a tumor successfully spreads to other parts of the body and grows, invading and destroying other healthy tissues, it is said to have metastasized. This process itself is calledmetastasis, and the result is a more serious condition that is very difficult to treat. 

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.

What Are The Symptoms Of Pancreatic Cancer?

Cancer symptoms are quite varied and depend on where the cancer is located, where it has spread, and how big the tumor is. Pancreatic cancer is often called a "silent" disease because it rarely shows early symptoms and presents non-specific later symptoms. Tumors of the pancreas cancers are usually too small to cause symptoms. However, when the cancer grows, symptoms include:

• Pain in the upper abdomen from the tumor pushing against nerves
• A painless yellowing of the skin and eyes and darkening of the urine called jaundice, created when the cancer interferes with the bile duct and the liver.
• Loss of appetite, nausea, and vomiting
• Significant weight loss and weakness
• Acholic stool (pale or grey stool) and steatorrhea (excess fat in stool)

These symptoms of pancreatic cancer have numerous other causes, making it difficult to diagnose the disease before it is in an advanced stage.

What Are The Stages Of Pancreatic Cancer?

After a diagnosis is made, doctors find out how far the cancer has spread to determine the stage of the cancer. The stage determines which choices will be available for treatment and informs prognoses. The standard pancreatic cancer staging method is called the TNM (Tumor - Node - Metastasis) system. T indicates the size and direct extent of the primary tumor, N indicates the degree to which the cancer has spread to nearby lymph nodes, and M indicates whether the cancer has metastasized to other organs in the body. A small tumor that has not spread to lymph nodes or distant organs may be staged as (T1, N0, M0), for example.

Group staging, from 0 to IV, for pancreatic cancer follows from TNM categories. Stage 0 is written as (Tis, N0, M0) where Tis stands for carcinoma in situ. This is when the tumor is confined to the top layers of pancreatic duct cells and has not invaded deeper tissues nor spread outside of the pancreas. Stage IV is written as (Any T, Any N, M1) and describes cancer that has spread to distant sites throughout the body.

Physicians also use a simpler staging system that classifies tumors based on the likelihood that they can be surgically removed. Resectable cancers are isolated to the pancreas and can be entirely removed. Locally advanced (unresectable) tumors have not spread to distant organs but cannot be completely removed surgically. Metastatic tumors have spread to distant organs, and surgery would only be used to relieve pain or unblock ducts

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.

Treatment

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. These patients are treated with a combination of chemotherapy and radiotherapy, which  can give an extended survival of 42 to 60 weeks.

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). This is a long and complicated surgery carrying significant chance of post-operative complications and even death, up to 5 per cent.

If successful, it carries a 5 year survival rate of 20 per cent, which means that 20 per cent of patients are likely to live more than 5 years. The average survival of these patients is 19 months. 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.

Of all the patients diagnosed with pancreatic cancer, 80 per cent are inoperable at diagnosis. Surgery is also not a guarantee of cure. 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 lies the importance of a healthy lifestyle.

For more information visit:          http://www.medworldindia.com      
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Please scan and email your medical reports  to us at care@medworldindia.com and we shall get you a Free Medical Opinion from India’s Best Doctors.

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