What Is Pancreatic Cancer?

The pancreas is a vital organ located within the abdomen behind the stomach. It has many important functions, two most important being – Regulation of blood sugar level and digestion. Pancreas helps regulate blood sugar levels by producing two important hormones: glucagon and insulin. Insulin helps the cells absorb glucose from food digested, and glucagon nourishes the body by raising the glucose level when it is low. The pancreas plays a vital role during digestion by supplying enzymes required to digest fats, proteins and carbohydrates.

The formation of malignant cells in the tissues of the pancreas is called pancreatic cancer or pancreas cancer. This cancer is often diagnosed at a later stage due to the location of the organ, which makes it difficult to diagnose the disease earlier. Pancreatic cancer thus carries very high mortality rate.

Symptoms Of Pancreatic Cancer

Pancreatic cancer symptoms may be very nonspecific and sometimes absent even at advanced stage of cancer resulting in late diagnosis of the disease. Some of the symptoms which may be seen in pancreatic cancer patients are-
- Un-intentional and progressive loss of weight
- Persistent upper abdominal pain sometimes radiating to back
- Jaundice , i.e Yellowish discoloration of eye and skin
- Reduced appetite
- Easy fatiguability
- New onset diabetes in elderly
- Weakness & tiredness
- Dark urine
- Generalized pruritus( itching )
- Nausea and vomiting
- Sudden onset severe abdominal pain and vomiting secondary to pancreatitis

What Is Pancreatic Cancer?

Pancreas cancer appears when the DNA of the pancreatic cells undergo alteration. The altered cells proliferate to form tumours, which invade the pancreas's healthy part, thus killing the healthy cells. If left untreated, these tumours can spread to nearby lymph nodes, blood vessels, tissues, organs, bones, and the brain. Most often, cancer of the pancreas is found in the cells that line the ducts of the pancreas. This type of pancreatic cancer is called pancreatic exocrine cancer or pancreatic adenocarcinoma. Sometimes, cancer can be formed in hormone-producing cells or neuroendocrine cells of the pancreas. The tumours formed during this type of cancer are pancreatic neuroendocrine, islet cell, and pancreatic endocrine cancer.

The primary causes of Pancreatic cancer are still unknown. The growth & death rate of normal cells is moderate; however, in the case of cancer, the growth rate increases rapidly, which destroys healthy cells. Doctors and researchers have not found a definite cause for this issue, but studies show that inherited gene mutation could be one of the major reasons behind the cause.

Types Of Pancreatic Cancer

There are two types of pancreatic cancers. These are -

Pancreatic adenocarcinoma: This type of pancreatic cancer affects the exocrine cells present in the pancreas. Exocrine cells are abundant in the pancreas, which helps produce pancreatic enzymes like proteases, lipase, and amylase and helps form pancreatic ducts. This is the most common type of pancreatic cancer, seen in 95% of pancreatic cancer patients.
Pancreatic Neuroendocrine Tumours (NETs): This type of pancreas cancer is rare and grows in the pancreas's endocrine cells. Endocrine cells play a vital role in making hormones and regulating blood sugar, among other vital activities.

Pancreatic Cancer Risk Factors

Though there are no causes found for the development of pancreatic cancer, there are certain risk factors considered to develop pancreatic cancer.

Intake of food with high-fat content: The increased intake of high-fat food increases cholesterol levels in the body, which damages the functionality of several organs, including the pancreas.
Diabetes: When sugar levels in the blood are not under control, it disturbs the functionality of internal organs and causes severe damage to them.
Smoking: Smoking is the leading cause of many cancerous diseases. Smoking increases the production of cancer cells by killing the healthy ones.
Lack of Exercise and Obesity: Regular exercise is a perfect way to stay healthy. Working out regularly for at least 30 minutes a day keeps your immune system strong to fight against several deadly diseases. Obesity increases hormone production, which leads to hormonal imbalances that can cause pancreatic cancer.
Excessive Alcohol Intake: Most often, people who abuse alcohol are prone to various kinds of diseases. Alcohol weakens the functionality of internal organs, and the pancreas is one of them.
Exposure to Toxic Chemicals: Avoid frequent exposure to toxic chemicals and pesticides by following the required safety measures.
Liver Damage: If you are suffering from prolonged kidney illness, you are more likely to get affected by pancreatic cancer. The liver and pancreas work together to help digest and purify food.
Family History: If you have a family history of your ancestors or immediate family suffering from pancreatic cancer, you are at a higher risk of getting affected by pancreatic cancer too. It could be caused due to genetic mutation.

Pancreatic Cancer Diagnosis

Early diagnosis and treatment are the only ways to achieve meaningful survival in pancreatic cancer . Once your doctor suspects the presence of pancreatic cancer, they would recommend you to undergo one or more of the following tests to diagnose the issue:

CT & MRI Scan: During this test, a cross-sectional picture of your internal organs is captured to find details about the inside tumour. It is done using ultrasound scans, X-rays, and magnetic beams. A positron emission tomography (PET) scan is recommended occasionally to diagnose the issue further.
Endoscopic Ultrasound: This test passes a fine tube into the throat (oesophagus), which reaches your abdomen and records pictures of the pancreas internally. The procedure is followed by ultrasound images shown through the camera attached to the flexible tube.
Biopsy: A small piece of tissue is collected from the pancreas to know more about the cancer. It is done by passing fine needles through the skin to reach the pancreas with the help of ultrasound images. Once the sample tissue is obtained, it is further studied under a microscope for further details, such as the cancer stage and the infection's severity.
Blood test: Pancreatic cancer is very rarely diagnosed through a blood test. However, doctors look for a particular protein - CA19-9 in the blood, which confirms the presence of cancer. The level of this protein is measured to evaluate the treatment process.

Pancreatic Cancer Treatment

The mainstay of treatment of pancreatic cancer is by surgical resection whenever the tumour is localized.

For the surgical management pancreatic tumours are classified as pancreatic head tumours and tumours of pancreatic body and tail

Surgery in the pancreatic head: An operation is performed to remove the tumour present in the pancreatic head. This procedure is called a Whipple procedure (pancreaticoduodenectomy). This procedure can be done by open surgery or by minimal invasive technique. It is a complex surgery requiring expertise and multidisciplinary post operative management and is best performed in specialized centres. In some cases complex vascular resections may be required to achieve complete removal of the tumour.

Surgery in the pancreatic body and tail: This procedure is called distal pancreatectomy. During this procedure, the left side of the pancreas is removed to eradicate the tumour. Sometimes, the spleen is also removed during this surgery. Distal pancreatectomy surgery can also be performed by open technique or by more advanced minimal invasive technique

Surgery to remove the entire pancreas: This procedure is called total pancreatectomy, and is very rarely required to eradicate the tumour. With the help of aggressive hormonal and enzyme replacement, life expectancy after this procedure can be extended.

Post surgery care after pancreatic resection

Pancreatic surgeries are complex and carry several immediate and late post operative complications. Immediate complications includes bleeding , anastomotic leak , pancreatic fistula , inability to tolerate oral diet etc. Late complications may include – new onset diabetes or worsening of prior diabetes , persistent nausea / vomiting , vitamin deficiencies, need for long term pancreatic replacement therapy etc .

Chemotherapy: It is a targeted drug therapy that kills cancer cells. In this treatment, the drugs are given orally or injected into the veins through an IV. The chemotherapy drugs vary from patient to patient, and the combination of drugs may differ depending on the severity of the disease. In the case of advanced stages where cancer has spread beyond the pancreas, chemotherapy combined with radiation therapy is performed, called chemoradiation. Chemoradiation therapy is used before the surgery to reduce the size of the tumour and after surgery to avoid the recurrence of pancreatic cancer.
Radiation Therapy: Radiation therapy is often combined with chemotherapy to treat pancreatic cancer. This treatment is conducted with the help of high-energy beams made from X-rays and protons. Doctors recommend combined therapy when surgeries fail to cure the disease. In this treatment, a series of rays from a moving machine point are directed towards the body at particular points. Radiation therapy is a treatment method frequently used to cure cancer at its advanced stage.
Clinical Trials: Clinical trials allow the oncologist to try new treatment methods to cure the disease. Clinical trials do not guarantee a cure and can cause immediate side effects. These trials are done with approval from patients and are monitored closely to avoid any mishappenings. Clinical trials are not done on all pancreatic patients.
Palliative Care: Palliative or supportive care is the last hope for many cancer patients in advanced stages, where medical treatments fail to work. This treatment targets relieving pain and discomfort caused by illness. The treatment helps strengthen emotions and mental health during the recovery process. When palliative care is combined with other treatment methods, there are signs of faster recovery.

If pancreatic cancer is left untreated, it will lead to complications such as -

Weight loss: The tumours in the pancreas proliferate when not treated on time. These tumours compress the stomach walls, resulting in a loss of appetite. The feeling of nausea and vomiting are also reasons behind the loss of appetite. When food intake is reduced, it leads to massive weight loss. Once diagnosed, doctors usually prescribe pancreatic enzyme supplements to help the digestion process.
Jaundice: Pancreatic cancer causes jaundice as it obstructs the liver's bile duct. Doctors suggest surgery in which a plastic or metal tube is placed inside the bile duct to keep it open. This surgery is called Endoscopic Retrograde Cholangiopancreatography (ERCP).
Pain: Pancreatic cancers are difficult to cure when diagnosed at an advanced stage. The tumours found in the advanced stages cause severe pain as they compress nearby organs, tissues, and blood vessels. Doctors prescribe certain painkillers that can help cope with this pain. When the pain is unbearable, doctors inject alcohol into the nerves to control abdominal pain. This procedure interrupts the communication between the nerves and the brain through nerve signals.
Bowel obstruction: Pancreatic cancer causes difficulty in bowel movements due to the obstruction caused by the growth of the tumour. This complication can be rectified by surgery to keep your small intestine open.

Steps To Prevent Pancreatic Cancer

The causes of pancreatic cancer are unknown; however, it can be prevented by following a few essential tips. Risk factors such as age, heredity and gender cannot be prevented. Here are a few tips to avoid pancreatic cancer-

Quit smoking: Smoking is the leading cause of several types of cancer, and pancreatic cancer is one of them.
Maintain a healthy weight: Exercise regularly and eat healthy to maintain a healthy weight. Being obese raises the risk of hormonal changes, which causes several life-threatening diseases.
Limit Alcohol Intake: Excessive consumption of alcohol damages the internal organs severely. Alcohol abuse causes several types of cancer, and pancreatic cancer is one of them.
Undergo regular screening in case of a positive family history or known chronic pancreatitis

Stages Of Pancreatic Cancer

Once an oncologist diagnoses pancreatic cancer after several diagnoses, the treatment is provided based on the stage of cancer. Cancer gets challenging to cure when it is at its advanced stages. There are four stages of pancreatic cancer-

Stage 1: The tumour is restricted only to the pancreas. No symptoms are shown at this stage; however, if the cancer is diagnosed, it can be treated easily.

Stage 2: At this stage, pancreatic cancer has started to spread to nearby lymph nodes. The infection has not reached the blood vessels and tissues at this stage. The symptoms are not evident at this stage either and are rarely diagnosed, making it challenging to treat. In some rare cases, few faint symptoms are shown, such as

Change in urine colour
Sudden weight loss
Tiredness
Reduced appetite
Jaundice - the skin and white of eyes turn yellow
Pain and swelling in the upper abdomen

Once cancer is diagnosed, it is treated by combining the following methods to eradicate the tumour or prevent its invasion of healthy body parts.

Chemotherapy
Radiation
Surgery
Targeted drug therapies

The survival rate of Stage 2 pancreatic cancer patients is around 30%, which gives them around five years of extended life.

Stage 3:

At this stage, cancer has started spreading to nearby blood vessels, lymph nodes and tissues. The tumour is still restricted to the pancreas. At this stage patients usually have significant pain and/or jaundice. At this stage, cancer becomes challenging to cure. Once diagnosed at this stage, the treatment can prevent the disease from spreading to healthy body parts. The treatment options at this stage are-

Surgical resection which sometimes would require resection of major blood vessels as well

Anti-cancer drugs

Radiation therapy

Immunotherapy

Despite rigorous treatment, the cancer is more likely to recur.

Stage 4: It is the last and final stage of pancreatic cancer. The cancer is very severe at this stage, where symptoms are very evident, and the treatment gets tough. At this stage, the cancer has metastasised to nearby organs and gradually moved to bones and the brain. Some of the evident symptoms noticed at this stage are-

Severe back pain
Depression
Sudden loss of weight
Yellowing of skin and white of eyes (jaundice)
Loss of appetite
Tiredness
Pain and swelling in the upper abdomen

At this stage, pancreatic cancer cannot be cured. Unfortunately, most pancreatic cancer patients are diagnosed at the last stage of cancer, where there is no cure. Doctors work towards easing discomfort and pain. Few treatments are provided to stop the growth of cancer cells, which are -

Chemotherapy
Gastric bypass surgery
Bile duct bypass surgery
Bile duct stent
Palliative pain treatments

Road To Recovery And Aftercare

As mentioned above, pancreatic cancer is one of the deadliest cancers as it is tough to cure. Cancer can be cured to a certain extent, with a five-year life extension, when diagnosed early. The possibilities get complicated later, leading to slimmer chances of survival. Life after surgeries and pancreatic cancer treatment is not easy, as it is never back to normal. Specific lifestyle changes have to be implemented to extend the rate of survival. Here are a few tips to follow on the road to recovery-

Collaborate on pain relief: Work closely with the oncologist to control postoperative pain. Doctors will suggest strong painkillers in the beginning and gradually decrease the dosage to bring the pain under control. Certain painkillers cause severe chest burn and acidity problems. Reach out to an expert for an alternative.
Plan lighter meals: During Whipple surgery, the infected parts of several internal organs connected to the pancreas are removed, which causes discomfort while eating. Eating small amounts many times a day rather than three larger meals is wise. This way, the stomach will be less pressurised, and digestion will become easier.
Monitor blood sugar: Monitor blood sugar levels regularly after the Whipple surgery, as conditions may worsen. During the surgery, surgeons remove part of the pancreas, the organ responsible for insulin production. It leads to an imbalance in blood sugar levels, with some patients developing diabetes for the first time after a Whipple surgery.
Watch for cramps, gas, and bloating: Due to insufficient pancreatic enzymes, cramps, gas, and bloating are regular occurrences. This problem affects about half of all Whipple patients. People with this condition must take oral pancreatic enzyme supplements to promote digestion. Most pancreatic cancer patients also take prescription antacids and multivitamins with iron to replace lost nutrients.

Pancreatic Cancer Faqs: All Your Concerns Addressed

Q. Can pancreatic cancer be prevented?
A. Unfortunately, most pancreatic cancer cannot be prevented, but you can reduce your risk by maintaining a healthy weight, stopping smoking and limiting your alcohol intake. Other risk factors include chronic pancreatitis and family history. Occasionally, precancerous lesions can be identified and, if removed early, can prevent pancreatic cancer from developing.

Q. Is pancreatic cancer a genetic disease?
A. Pancreatic cancer can be genetic, but the vast majority of pancreatic cancer is irregular. Many genes play a role in the growth of pancreatic cancer. The four major driver genes include KRAS, P53, P16 and SMAD4. If you have a strong family history of pancreatic cancer, you should contact a genetic counselling and screening program. Familial pancreatic cancer is defined as having two or more first-degree relatives with pancreatic cancer.

Q. What are the chances of a pancreatic cyst becoming cancerous?
A. Pancreatic cysts are prevalent, and the majority are not cancerous. However, some may be, and others may be precancerous. There are several different types of pancreatic cysts, ranging from benign to malignant, which are declared after a series of diagnoses.

Q. Can I live without a pancreas?
A. Yes, you can live without a pancreas, but you will have diabetes, which means you will have to take insulin regularly. You will also need to take enzyme pills to help digest food.

Q. How is pancreatic cancer treated?
A. The treatment of pancreatic cancer depends on several factors, including the stage of the disease (how far it has advanced). The main treatment options include

Surgery
Chemotherapy
Radiation

Pancreatic cancer surgery

Depending on your diagnosis, your doctor may recommend Whipple surgery, which involves removing the head, or a right-hand portion, of the pancreas and parts of the small intestine, gallbladder, bile duct, and sometimes a portion of the stomach. Other types of surgery for pancreatic cancer include distal pancreatectomy (removal of the "tail" of the pancreas, as well as the spleen) and total pancreatectomy (removal of the entire pancreas and spleen). If cancer has spread too far to be removed, your doctor may suggest palliative interventions, which cannot cure the disease but instead help relieve symptoms.

Chemotherapy for pancreatic cancer

Pancreatic cancer can also be treated with chemotherapy, using drugs that kill cancerous cells. Chemotherapy can be given before and after surgery or when surgery isn't possible. It is sometimes used in conjunction with radiation, using high-energy X-rays to kill cancer cells. Likewise, you may receive radiation before and after surgery, with or without chemotherapy, or to ease symptoms in the advanced stages of the disease. Our healthcare team can recommend the treatment that's right for you.

What are the signs and symptoms of pancreatic cancer?

Pancreatic cancer shows no signs or symptoms during the early stages. However, by the time you start noticing the symptoms, the tumours have already grown quite large, and cancer has infected the tissues surrounding the pancreas. You have to note that if you have one or more than one of these signs, it doesn't mean you have pancreatic cancer; some other condition can cause it, but it's always best to go to the doctor for confirmation.

These are some of the signs that you have to look out

Jaundice or jaundice-related symptoms
Consistent belly or backache
Sudden weight loss and poor appetite
Nausea and vomiting
Liver or Gallbladder inflammation
Diabetes
Blood clots

Q. Is there a cure for pancreatic cancer?

A. There is no absolute cure for cancer, but surgery is a way to treat this illness. Several patients , especially those with early stage cancer do well with surgical resection . But if the cancer has already reached advanced stages, surgery is not advisable. If cancer has spread to the surrounding tissues and major organs, then surgical removal of tumours is not suggested. Many factors determine pancreatic cancer treatment, including age, overall health, and personal preferences. It's pretty difficult to treat pancreatic cancer, at least through surgery.

Q. How long can chemotherapy prolong your life?

A. For most cancers where palliative chemotherapy is used, the extended lifespan falls between three and twelve months. The better your response to the treatment, the longer you're expected to live. The Median Duration of Response will tell you how long cancer will take to respond to standard chemotherapy before it starts growing again.

Q. Is there a cure for stage 1 pancreatic cancer?

A. If your cancer is detected during the early stages, then it can be treated with surgery. Surgical extraction of tumours can increase your chances of a cure. However, it's tough to detect pancreatic cancer during the early stages. There is a reason this cancer is called the silent killer, and that's because it spreads undetected. When the patient is diagnosed or the symptoms start showing, it's too late for surgery. Since the warning signs (in the early stages) resemble other illnesses, people don't take it seriously.

Q. How much sleep is required for a chemo patient?

A. A patient undergoing chemotherapy will require seven to nine hours of sleep. During the chemo treatment, a patient will feel sleepy, at least more than normal, because the body needs to repair itself. However, sometimes, a patient is unable to sleep due to side effects from the chemotherapy. If the patient has trouble falling asleep, they can follow these tips-

Maintaining a routine

Avoiding oversleeping

Keeping the sleeping area quiet and cool

Eat your last meal two hours before bedtime

Don't have any caffeine after lunch

Don't drink any alcohol before bedtime

Q. Can stage 4 pancreatic cancer go undiagnosed?

A. Every cancer case is different, but cancer is usually diagnosed by stages 2 or 3. Stage 4 is advanced cancer, and it's pretty hard for it to go undiagnosed. Some patients may have symptoms in stage 2, while some may show signs in stage 4. It's very rare that patients reach stage 4 and have insignificant or no cancer symptoms at all

What is Robotic surgery for pancreatic cancer ?

Pancreatic cancer surgeries are complex and were traditionally done by using a large incision onto the patients abdomen. These complex surgeries are now performed by Robotic surgery in selected patients. Entire surgery can be performed through key holes thus reducing pain and helping in faster recovery. Aso robotic technology adds precision to surgery.