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Pancreatic Cancer

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Pancreatic Cancer

The Silent Cancer of the Digestive System

What is Pancreatic Cancer?

Pancreatic cancer is a type of cancer that begins in the pancreas — a gland located deep in the abdomen, behind the stomach. The pancreas helps with digestion by producing enzymes and controls blood sugar by making insulin.

In pancreatic cancer, abnormal cells grow uncontrollably and form tumors, interfering with the gland’s essential functions. It is often called a “silent killer” because symptoms typically appear only in advanced stages, making early detection challenging.

Types of Pancreatic Cancer

  1. Exocrine Tumors (most common – 90%)

    These begin in the ducts of the pancreas:

    • Adenocarcinoma (most common type)
    • Acinar cell carcinoma
    • Squamous cell carcinoma

  2. Neuroendocrine Tumors (NETs)

    • Arise from hormone-producing cells
    • Tend to grow slower
    • Includes insulinoma, gastrinoma, etc.

Symptoms of Pancreatic Cancer

Symptoms are often vague at first. As the disease progresses, the following may appear:

  • Jaundice (yellowing of skin and eyes)
  • Dark-colored urine
  • Pale or greasy stools
  • Unexplained weight loss
  • Loss of appetite
  • Back or abdominal pain
  • Nausea or vomiting
  • New-onset diabetes, especially after age 50
  • Fatigue and weakness
  • Blood clots (unusual sign)

Note: If you have sudden, unexplained diabetes or weight loss with any of the above signs, consult a doctor immediately.

Where Does Pancreatic Cancer Occur?

The pancreas has three parts:

  • Head (near the duodenum) – where most tumors occur
  • Body
  • Tail

Tumors in the head often cause jaundice early; tumors in the tail or body may grow silently until advanced.

Stages of Pancreatic Cancer

  • Stage 0: Abnormal cells in the pancreas lining (precancer)
  • Stage I: Localized tumor in the pancreas
  • Stage II: Spread to nearby tissues or lymph nodes
  • Stage III: Involvement of major blood vessels near the pancreas
  • Stage IV: Distant spread (liver, lungs, abdomen)

Causes and Risk Factors

  • Smoking (doubles the risk)
  • Chronic pancreatitis (inflammation of the pancreas)
  • Family history or genetic mutations (BRCA1/2, Lynch syndrome)
  • Diabetes (especially new-onset)
  • Obesity and sedentary lifestyle
  • High-fat diet
  • Heavy alcohol use
  • Older age (common after 60)

Diagnosis of Pancreatic Cancer

Early diagnosis is difficult, but tests include:

  1. Ultrasound or CT Scan

    • To detect masses or blockages in the pancreas

  2. MRI or MRCP

    • Provides detailed imaging of pancreatic ducts and biliary tract

  3. Endoscopic Ultrasound (EUS)

    • Camera inserted via mouth to visualize and biopsy pancreatic tissue

  4. ERCP (Endoscopic Retrograde Cholangiopancreatography)

    • Helps relieve bile duct blockages and collect samples

  5. Blood Tests

    • CA 19-9 tumour marker (may be elevated but not specific)
    • Liver function tests to check for bile duct obstruction

  6. Biopsy

    • Confirms cancer via needle aspiration or during EUS/ERCP

Treatment Options at Onco-Life Cancer Centre

Treatment depends on cancer stage, location, and patient health.

  1. Surgery

    • Whipple procedure (pancreaticoduodenectomy) – removes the head of the pancreas, part of the small intestine, gallbladder, and bile duct
    • Distal pancreatectomy – for tail/body tumors
    • Total pancreatectomy – for widespread tumors within the pancreas
    Surgery is an option only if cancer hasn’t spread to major vessels or distant organs.

  2. Chemotherapy

    • Used before (neoadjuvant) or after (adjuvant) surgery
    • Also used in unresectable or metastatic cancer
    • Common drugs: Gemcitabine, FOLFIRINOX

  3. Radiation Therapy

    • External beam radiation or Tomotherapy to shrink tumours or relieve pain
    • Often combined with chemotherapy (chemoradiation)

  4. Targeted Therapy

    • For tumours with specific gene mutations (e.g., PARP inhibitors for BRCA mutations)

  5. Immunotherapy

    • In select patients with microsatellite instability (MSI-high)

  6. Palliative & Supportive Care

    • Bile duct stents for jaundice relief
    • Pain management
    • Nutritional support, pancreatic enzyme supplements
    • Counselling and emotional support

Prevention Tips

  • Avoid smoking and alcohol
  • Maintain a healthy weight
  • Eat a diet rich in fruits, vegetables, and fiber
  • Manage diabetes and chronic pancreatitis
  • Be alert to new digestive or metabolic symptoms
  • Family members of affected individuals may consider genetic counseling

Pancreatic Cancer in India

  • Accounts for ~2–3% of all cancers, but rising in incidence
  • Late diagnosis is common due to lack of early symptoms
  • Urban lifestyle changes, diabetes, and smoking are major contributors
  • Low awareness leads to missed early warning signs

Most Popular Questions

Pancreatic Cancer

1. Is pancreatic cancer curable?

It can be cured if detected early and completely removed with surgery. Most cases are detected late and require long-term treatment.

2. What is the Whipple surgery?

It’s a complex surgery that removes the pancreatic head and surrounding structures. It offers a potential cure in early-stage disease.

3. Can I live without a pancreas?

Yes, but you’ll need insulin and enzyme supplements for life.

4. What is the survival rate of pancreatic cancer?

Survival depends on the stage. Early-stage cancers have 5-year survival of ~30–40%. Advanced cancers have a poor prognosis but can be managed for quality of life.

5. What are the early warning signs?

Jaundice, sudden weight loss, loss of appetite, and new-onset diabetes in an older adult should be investigated.

6. How is pancreatic cancer different from stomach cancer?

Pancreatic cancer originates in the pancreas, not the stomach. It often causes back pain, jaundice, and diabetes, unlike stomach cancer.

7. Is pancreatic cancer painful?

Yes, it may cause abdominal or back pain, especially in advanced stages. Pain management is essential.

8. Does it cause diabetes?

Yes. Pancreatic cancer can destroy insulin-producing cells, leading to diabetes.

9. Can blood tests detect pancreatic cancer?

There’s no single reliable test, but CA 19-9 and imaging help in diagnosis.

10. Can chemotherapy shrink pancreatic tumors?

Yes. It can shrink tumours enough to make surgery possible in some patients.

11. How long is treatment?

Chemotherapy may last 3–6 months or more, depending on response and stage.

12. Is it hereditary?

Some cases are linked to inherited mutations like BRCA1/2. Family history increases risk.

13. What should I eat during treatment?

Small, frequent, high-calorie meals. Include protein, avoid greasy/fatty food. Pancreatic enzyme supplements help digestion.

14. Does pancreatic cancer cause itching?

Yes. Jaundice can cause intense itching due to bile buildup in the skin.

15. How is pain managed?

With medications (opioids), nerve blocks, and palliative care services.

16. Can pancreatic cysts turn into cancer?

Some cysts (IPMNs or mucinous cysts) can become cancerous. Regular monitoring is essential.

17. What is the role of Tomotherapy?

It provides precise radiation that targets tumours while sparing healthy tissue.

18. Is immunotherapy useful?

In select genetic profiles (MSI-high, dMMR), immunotherapy may work well.

19. Can I work during treatment?

Depends on your condition and energy levels. Many take time off due to fatigue or side effects.

20. Are there screening tests for pancreatic cancer?

Not for the general public. High-risk individuals (family history, genetic mutations) may need regular imaging and tests.