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Surgical Treatment of Pancreatic Cancer in India

Pancreatic Cancer

The pancreas is a gland behind your stomach and in front of your spine. It produces the juices that help break down food and the hormones that help control blood sugar levels. Pancreatic cancer usually begins in the cells that produce the juices. Some risk factors for developing pancreatic cancer include

Smoking Long-term diabetes Chronic pancreatitis

Certain hereditary disorders

Pancreatic cancer is hard to catch early. It doesn't cause symptoms right away. When you do get symptoms, they are often vague or you may not notice them. They include yellowing of the skin and eyes, pain in the abdomen and back, weight loss and fatigue. Also, because the pancreas is hidden behind other organs, health care providers cannot see or feel the tumors during routine exams. Doctors use a physical exam, blood tests, imaging tests, and a biopsy to diagnose it.

Because it is often found late and it spreads quickly, pancreatic cancer can be hard to treat. Possible treatments include surgery, radiation, chemotherapy, and targeted therapy. Targeted therapy uses substances that attack cancer cells without harming normal cells.

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.

Treatment

Treating pancreatic cancer can be challenging. Your doctors will consider several different factors when choosing the best treatment for you. These include the grade and stage of the cancer, the location and extent of the disease. Other facts include:

• Your age, overall health, and medical history• Your tolerance of specific medicines, procedures, or therapies• Expectations for the course of the disease• Your opinion or preference

For most patients diagnosed with pancreatic cancer, the main goal of treatment is to control symptoms. All treatments have benefits and risks. You and your doctor should carefully balance the potential benefits of any cancer treatment with its potential risks.

Treatment options may include:

Surgery - Surgery for pancreatic cancer may be curative or palliative. Potentially curative surgery is used when imaging studies tell the surgeon that it is possible

to remove all the cancer. Research has shown that the risk of major complications and mortality are significantly reduced if the Whipple procedure or other pancreatic surgery is performed at an institution that performs a high volume of these procedures

Palliative surgery may be done if imaging studies show that the tumor is too widespread to be completely removed. Palliative surgery can relieve symptoms like jaundice and prevent certain complications.

Radiation therapy - Radiation therapy uses high-energy radiation to kill cancer cells and shrink tumors.

Chemotherapy - Chemotherapy is the use of cytotoxic (anti-cancer) medicines to target and destroy cancer cells.  It is an important treatment option for many types of cancer and clinical trials.

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