About Pancreatic Cancer

The pancreas is a fish-shaped organ located behind the stomach in the abdomen. Its primary role is to produce enzymes that help digestion. The pancreas also produces insulin and glucagon– two hormones that control blood sugar levels. When changes occur in the cells of the pancreas, they begin to grow and multiple uncontrollably, resulting in pancreatic cancer. Pancreatic cancer treatment options depend upon its type and where cancer originates. This cancer can develop in exocrine and neuroendocrine cells. Exocrine pancreatic cancers are the most common type called adenocarcinoma, accounting for over 90% of the cases. Thankfully, not all pancreatic growths are cancerous. Some are benign but, if left untreated, can turn cancerous. Many risk factors have been associated with pancreatic cancer. While some like age, gender, family history and medical conditions cannot be changed, factors like obesity and smoking can be modified to reduce your risk of developing the disease. However, not everyone at risk of developing this condition will get it. Pancreatic cancer life expectancy depends upon many factors, including stage and spread at the time of diagnosis.

Symptoms

In the early stages, pancreatic cancer does not cause any symptoms. However, as the disease progresses, common symptoms may include: 

  • Pain in the upper part of the abdomen that may spread to the upper back or arms
  • Yellowish skin and white of the eyes, dark urine, pale stools (signs of jaundice)
  • Loss of appetite
  • Fatigue or tiredness
  • Unexplained weight loss
  • Burning feeling in the stomach, indigestion and bloating
  • Nausea and vomiting
  • Fever, chills and night sweats

Some people may also experience pancreatitis (swelling of the pancreas) and sudden onset of diabetes. If you experience any of the symptoms mentioned above, visit your doctor for further evaluation.

Diagnosis

Diagnosing pancreatic cancer, especially in its early stages, can be difficult as the pancreas is deeply seated in the abdomen and a physical examination is impossible. If your doctor suspects pancreatic cancer, they will prescribe a few tests:

  • Blood tests: Check for routine blood parameters and abnormal bilirubin levels (a chemical substance produced by the liver whose level increases in pancreatic cancer). A tumour marker test is a blood test during which a protein called CA19-9 released by cancerous pancreatic cells can be detected.
  • Endoscopic ultrasound (EUS): This is an endoscopic test where a thin tube with a camera at its tip is passed through the mouth and stomach to get a detailed view of the structures inside the body.
  • Imaging tests: MRI, CT scan and PET scan, may be performed to assess the exact location of cancer and its spread to nearby organs like the liver, gall bladder and intestines.
  • Biopsy: A guided biopsy may be performed to collect a tissue sample from the pancreas and sent for confirmation of cancer. A biopsy can also be done using the fine needle aspiration technique. The tissue sample collected during a biopsy is also used to stage and grade cancer.

Treatment options vary based on the stage of your cancer, with early-stage cancer being localised and easier to treat, while treatment for advanced stage 3 and stage 4 pancreatic cancer depends upon the spread of cancer.

Treatment

Pancreatic cancer is usually treated by a multidisciplinary team comprising a medical oncologist, gastroenterologist, surgical and radiation oncologists. After evaluating your symptoms, medical history, and diagnostic test results, your experienced healthcare team will decide how to treat pancreatic cancer in your body.

The pancreatic cancer treatment options suggested to you will depend upon several factors such as:

  • Stage
  • Spread
  • Your age
  • Overall health

Standard treatment options for pancreatic cancer include:

  • Surgery: Most onco-surgeons try to remove the entire cancer by surgery, especially when the tumour is early-stage and limited to the pancreas.
  • Ablation or embolisation: These treatments cannot cure pancreatic cancer by themselves but help reduce symptoms.
  • Radiation therapy: This treatment uses high-energy radiation to kill cancer cells. After surgery, radiation therapy is used as adjuvant therapy to kill any remaining cancer cells.
  • Chemotherapy: Though most people are worried about the side effects of chemotherapy and pancreatic cancer, it is routinely used in treating pancreatic cancer. Chemotherapy uses potent drugs to kill cancer cells. It is often used with radiation therapy before surgery to shrink the tumour, making it easy to remove or after surgery to kill remaining cancer cells and prevent cancer recurrence.

Other treatments that may be combined with those mentioned above include targeted therapy, immunotherapy and participation in clinical trials.

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