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

Exocrine Tumors (most common – 90%)

These begin in the ducts of the pancreas:
- Adenocarcinoma (most common type)
- Acinar cell carcinoma
- Squamous cell carcinoma
Neuroendocrine Tumors (NETs)
- Arise from hormone-producing cells
- Tend to grow slower
- Includes insulinoma, gastrinoma, etc.

How Common Is Pancreatic Cancer

Pancreatic cancer is a relatively rare but highly aggressive form of cancer. Worldwide, it accounts for about 3% of all cancers but is the seventh leading cause of cancer-related deaths due to its late diagnosis and poor prognosis. In India, the incidence of pancreatic cancer is rising steadily, with improved diagnostic facilities and awareness contributing to increased detection rates.

The disease is commonly diagnosed in people over 60 years old, though it can affect younger individuals as well. Early detection remains challenging because symptoms often develop only in advanced stages.

However, advances in imaging technology and awareness help improve early diagnosis, which is crucial for better survival outcomes. Despite its rarity compared to other cancers, pancreatic cancer’s mortality remains high, making public education and early screening efforts important components in managing this disease both globally and in India.

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?

Pancreatic cancer develops due to a mix of genetic, lifestyle, and environmental factors. Smoking is one of the most significant lifestyle risks, doubling the chance of developing this cancer. Other contributors include chronic pancreatitis, obesity, diabetes, and high-fat diets. Exposure to certain chemicals or toxins in industrial settings may also increase risk.

On the genetic side, inherited mutations such as BRCA1, BRCA2, and familial pancreatic cancer syndromes play a role in some cases. While a definitive cause is often unclear, adopting healthy habits like quitting smoking, maintaining a healthy weight, controlling blood pressure, and regular medical check-ups can help reduce the risk of pancreatic cancer. Ongoing research is working to better understand the underlying mechanisms to improve prevention strategies.

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

Rewrite this content and write about – Pancreatic cancer diagnosis involves imaging, blood tests, laparoscopy, and genetic testing to detect tumors, assess stage, and identify hereditary risks.

Early diagnosis is difficult, but tests include:

Ultrasound or CT Scan
- To detect masses or blockages in the pancreas
MRI or MRCP
- Provides detailed imaging of pancreatic ducts and biliary tract
Endoscopic Ultrasound (EUS)
- Camera inserted via mouth to visualize and biopsy pancreatic tissue
ERCP (Endoscopic Retrograde Cholangiopancreatography)
- Helps relieve bile duct blockages and collect samples
Blood Tests
- CA 19-9 tumour marker (may be elevated but not specific)
- Liver function tests to check for bile duct obstruction
Biopsy
- Confirms cancer via needle aspiration or during EUS/ERCP

What Are The Complications Of Pancreatic Cancer?

Pancreatic cancer can lead to several serious complications, often due to its aggressive nature and late diagnosis. One of the most common complications is jaundice, which occurs when the tumor blocks the bile duct, causing yellowing of the skin and eyes. Pain is another significant issue, as the cancer may invade nearby nerves.

Additionally, pancreatic cancer can cause digestive problems due to obstruction of the pancreatic duct, leading to malabsorption and weight loss. Patients often experience diabetes or worsening control of existing diabetes because the pancreas plays a key role in insulin regulation.

Advanced pancreatic cancer can metastasize to the liver, lungs, or peritoneum, leading to organ failure and further clinical deterioration. These complications significantly impact quality of life and underscore the importance of early diagnosis and comprehensive management to alleviate symptoms and improve patient outcomes.

Resectable Vs. Unresectable Pancreatic Cancer: What’s The Difference?

Aspect	Resectable Pancreatic Cancer	Unresectable Pancreatic Cancer
Definition	Tumor confined and operable with surgery aiming for cure	Tumor involving major vessels or distant spread, surgery not feasible
Treatment Approach	Surgical removal (Whipple procedure or distal pancreatectomy) often combined with chemotherapy or radiation	Primarily chemotherapy, radiation, or palliative care to manage symptoms
Prognosis	Better prognosis with potential for long-term survival	Poor prognosis, focuses on life quality and symptom relief
Detection Stage	Usually diagnosed early or before extensive spread	Often diagnosed late with vascular invasion or metastases
Symptoms	May be less severe or localized	More systemic symptoms like weight loss, jaundice, pain
Goal	Complete tumor excision	Disease control and symptom management

How Long Does It Take To Notice Pancreatic Cancer?

Pancreatic cancer is often called a “silent” disease because its symptoms don’t appear until the cancer has grown large or spread beyond the pancreas. Many people do not notice any signs during the early stages, which can last months or even years without detection. When symptoms do develop, they are usually vague, such as abdominal pain, weight loss, jaundice, or digestive difficulties, and often resemble less serious conditions.

Because of this, pancreatic cancer is frequently diagnosed late, reducing treatment options and survival chances. Early detection is challenging but crucial, especially for those at higher risk, such as individuals with a family history or certain genetic conditions. Seeking medical advice when persistent abdominal discomfort or other related symptoms occur can lead to earlier diagnosis and better outcomes.

Treatment Options at Onco-Life Cancer Centre

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

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.
Chemotherapy
- Used before (neoadjuvant) or after (adjuvant) surgery
- Also used in unresectable or metastatic cancer
- Common drugs: Gemcitabine, FOLFIRINOX
Radiation Therapy
- External beam radiation or Tomotherapy to shrink tumours or relieve pain
- Often combined with chemotherapy (chemoradiation)
Targeted Therapy
- For tumours with specific gene mutations (e.g., PARP inhibitors for BRCA mutations)
Immunotherapy
- In select patients with microsatellite instability (MSI-high)
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