Pancreatic Cancer

It is a small gland located behind the stomach and shaped like a hockey stick. Its main function is to facilitate the digestion of food and regulate blood sugar levels. The pancreas maintains the blood sugar levels by producing two hormones - insulin and glucagon. Both of these hormones regulate blood sugar levels.

Two types of tumours are found in the pancreas - neuroendocrine tumours and exocrine tumours. Around 93% of all the pancreatic tumours are exocrine in nature, the most common one of which are adenocarcinomas. The commonest type of adenocarcinomas originate in the pancreatic ducts, so they are called ductal adenocarcinomas.

The remaining 7% of the pancreatic tumours are neuroendocrine tumours. They are also called islet cell tumours, pancreatic neuroendocrine tumours, or islet cell carcinomas. Some of these tumours release an excess amount of hormones. Their name depends on the hormones they produce. For example, insulinoma is a neuroendocrine tumour that produces excess amounts of insulin.

Symptoms of Pancreatic Cancer

Pancreatic cancer, in its early stages, is asymptomatic. Therefore, it is hard to detect at the stages when it is most curable. Symptoms of pancreatic cancer are often experienced when it is at an advanced stage and include:

• Pain in the abdomen that shifts to the back
• Decreased appetite or unexplained weight loss
• Jaundice or yellow discolouration of the skin and the eyes
• Light-coloured stools
• Dark-coloured urine
• Itchy skin
• Newly diagnosed diabetes mellitus or an uncontrolled exacerbation of the previously diagnosed diabetes mellitus
• Blood clots
• Tiredness

If you persistently experience a combination of the symptoms mentioned above and it worries you, you must visit Kokilaben Dhirubhai Ambani Hospital, Indore and get an appointment with an experienced doctor. There are many other medical conditions that may present with similar symptoms, so even if you do not have pancreatic cancer, you may have other conditions that need diagnosis and treatment.

Causes of Pancreatic Cancer

The exact cause of pancreatic cancers is not known. However, the presence of certain risk factors like being a chronic smoker and having certain inherited gene mutations increases the risk of developing this type of cancer. Pancreatic cancer results from DNA mutations in some pancreatic cells. The DNA contains a set of instructions that directs the cell to carry out its functions normally. Because of the mutations in the DNA of these cells, they keep dividing uncontrollably, giving rise to the development of a tumour. If left untreated, the tumour can metastasise to nearby organs, blood vessels, and even distant body parts.

There are certain risk factors for pancreatic cancer, the presence of which increases the chances of developing the disease. Following are some of those:

• Smoking cigars, cigarettes, or other forms of tobacco
• Obesity is also a risk factor for developing pancreatic cancer. Even if you don’t have obesity but have some extra weight around the waist, you still fall in the high-risk category.
• Type 2 diabetes is associated with obesity, especially if it has been diagnosed at an older age or in a person with a normal body mass index (BMI).
• Exposure to chemicals used by metal workers and dry cleaners
• Presence of chronic pancreatitis— a permanent pancreatic inflammation usually associated with excessive alcohol consumption and smoking.

Apart from the risk factors mentioned above, there are some risk factors of pancreatic cancers that can’t be modified or changed. Those include:

• Family history of pancreatic cancer or hereditary chronic pancreatitis secondary to genetic mutations.
• Age above 45 years.
• Male sex.

• Weight loss
  Many factors are responsible for causing weight loss in patients with pancreatic cancers. One reason is that cancer eats up the body's energy. Another is that the cancer treatment leads to side effects like nausea and vomiting, making it difficult to eat. Additionally, the body may find it difficult to absorb nutrients from the food due to decreased digestive juices produced by the poorly-functioning pancreas.
• Jaundice
  Sometimes, pancreatic cancers may block the liver's bile duct, causing jaundice. Jaundice presents in the form of yellow skin and eyes, dark-coloured urine, and light-coloured stools. A plastic or metal tube called a stent can be placed inside the bile duct to open it up to relieve the symptoms of jaundice.
• Pain
  When the pancreatic tumour increases in size, it may press on the adjacent nerves in the abdomen, giving rise to pain that can sometimes be severe. Pain medications are available to help you feel more comfortable. Also, there are treatment options like radiation and chemotherapy that slow the tumour growth and relieve the pain to a great extent.
• Bowel obstruction
  If pancreatic cancer grows into or presses on the first part of the small intestine called the duodenum, it can obstruct the flow of digested food from the stomach into the intestines. A tube or a stent can be placed in the small intestine to open it up and relieve the symptoms.

• Stop smoking
  If you are a smoker, change the bad habit. If you need help, talk to our doctors about the strategies and measures you can take to quit smoking. Additionally, some medications and nicotine replacement therapy may be prescribed to help with the same.
• Avoid being obese
  If your weight lies within a healthy BMI range, take measures to maintain it. If your BMI is high, you should work towards bringing it down. Set an aim for a slow, steady weight loss of 0.5 to 1 kg per week. Consume a nutritious diet full of fresh fruits and vegetables and combine it with adequate physical activity.

If your family member is suffering from pancreatic cancer, you must consider meeting with a genetic counsellor. After reviewing your overall health and medical history, they will be able to decide if you might benefit from a genetic test to determine your risk of developing pancreatic cancer.

Diagnosis of Pancreatic Cancer

If the doctor suspects pancreatic cancer, they might order certain tests to confirm the diagnosis, including:

• Imaging tests
  Imaging tests like X-rays, CT scans, and MRI help the healthcare provider visualise the internal organs, including the pancreas.
• Biopsy
  A sample of the suspected pancreatic tissue may be resected through an endoscopic procedure and sent for histopathological examination.
• Blood tests
  Blood tests can reveal the presence of specific proteins called tumour markers that confirm the presence of a tumour. There are certain specific tumour markers for each particular cancer. The tumour marker for pancreatic cancers is CA 19-9.

There are five different stages of pancreatic cancer. The staging is done based on the location, size, and extent of spread of the tumour.

• Stage 0
  This stage is also referred to as carcinoma in situ. There are abnormal cells in the pancreatic lining. These cells tend to become malignant or spread to the surrounding tissues.
• Stage 1
  The tumour is confined to the pancreas.
• Stage 2
  The tumour has spread to the tissues, organs, or lymph nodes surrounding the pancreas.
• Stage 3
  The cancer has invaded the major blood vessels surrounding the pancreas. It may also have involved the surrounding lymph nodes.
• Stage 4
  This stage is characterised by the spread of the cancer to distant body parts such as the lungs, liver, or the abdominal cavity.

We provide the best pancreatic cancer treatment by delivering personalised and tailored treatment plans under the care of highly qualified and top oncologists in Indore. The treatment for pancreatic cancer depends on certain factors, including its stage and location, the patient's overall health, and personal preferences. In most cases, the first goal of treatment is to eliminate cancer as much as possible. Should that be impossible, the focus shifts to improving the quality of life of the patient and limiting the spread of cancer.

Treatment options include surgery, radiation therapy, chemotherapy or a combination of these. For advanced pancreatic cancers, these treatments aren't likely to offer a cure and the aim of the treatment shifts to relieving symptoms by providing supportable or palliative care. The palliative care team at Kokilaben Dhirubhai Ambani Hospital, Indore works hard to keep the patients as comfortable as possible and improve their quality of life for as long as possible.

Surgery

Different surgical procedures are used to treat different types of pancreatic cancers, including:

• If tumour is in the head of the pancreas
  In that case, an operation called a Whipple procedure or pancreaticoduodenectomy is recommended. The Whipple procedure is technically challenging and involves the removal of the pancreatic head, the upper segment of the small intestine, the gallbladder, a segment of the bile duct, and local lymph nodes. The surgeons at Kokilaben Dhirubhai Ambani Hospital, Indore are highly skilled and qualified, having years of experience in treating such cancers, making it the best pancreatic cancer treatment hospital in Indore. They try their utmost best to deliver the best care to cancer patients and perform minimally invasive procedures to make the treatment work in their best interests.
• If tumour is in the body and tail of the pancreas
  Distal pancreatectomy is the procedure recommended to resect the body and tail of the pancreas.
• If tumour involves the entire pancreas
  In such a case, the entire pancreas may need to be removed using a procedure called total pancreatectomy. It is possible to live a relatively normal life in the absence of the pancreas, but the patient requires lifelong insulin and enzyme replacement therapy.
• If tumour involves the nearby blood vessels
  If an advanced pancreatic cancer involves the nearby blood vessels, Whipple's procedures and other such surgeries may be too risky to perform. Other extensive, challenging surgeries are required. Such surgeries carry the risk of bleeding, infection and other complications, so the patient needs to be admitted to the hospital for close follow-up several days after the surgery.
• Chemotherapy
  It uses drugs that can be taken orally or injected intravenously to kill and destroy the cancer cells. In advanced pancreatic cancers, when surgery is not an option, chemotherapy may be used to limit the growth of cancer, control its spread, relieve symptoms, and prolong survival.
• Radiation therapy
  This therapy uses high-energy beams from sources such as X-rays and protons to destroy cancer cells. Radiation treatments may be given in combination with chemotherapy before cancer surgery to shrink the size of the tumour or after the surgery to destroy any remaining cancer cells.
• Chemoradiation
  Sometimes chemotherapy is combined with radiation therapy. It is mostly used to treat cancers that are confined to the pancreas.

Receiving a diagnosis of pancreatic cancer can be devastating. If you are not able to deal with the mental and emotional aspects of the diagnosis, you can consider joining a support group and get in touch with people dealing with the same problem.

Also called supportive care, palliative care is specialised medical care that aims to provide relief from pain and other symptoms of cancer or any other serious illness. At Kokilaben Dhirubhai Ambani Hospital, Indore, palliative care is provided by a team of doctors, nurses, social workers and other specially trained professionals. The aim of palliative care is improving the quality of life for patients with cancer and their families. Our palliative care specialists work with the patients, their families, and other doctors to give an extra layer of support that supplements ongoing medical care. When supportive care is given along with other appropriate treatment modalities, people with cancer may feel better and live longer, fulfilled lives.