Pancreatic cancer develops when the pancreas' cells undergo modifications (mutations), which cause them to proliferate uncontrollably. The tissue might become a bulk. This tumour may occasionally be benign (not cancerous) but the mass could be cancerous or malignant.
Dr. Chinnababu Sunkavalli, Clinical Director-Surgical Oncology, Sr. Consultant Surgical Oncology and Robotic Surgical Oncology, Yashoda Hospitals, Hyderabad explains, pancreatic cancer is one of the most aggressive type of cancers in body. It usually occurs in middle and old aged individuals. The common risk factors are smoking, recent onset diabetes, chronic pancreatitis. Uncommon risk factors are genetic syndromes which account a small burden of pancreatic cancer. The different types of pancreatic cancer are those arising from exocrine cells called adenocarcinomas which have worst prognosis compared to those arising from endocrine cells called islet cell tumors and neuroendocrine tumors which are relatively indolent compared to adenocarcinomas.
The common symptoms of pancreatic cancer are
- Pain abdomen
- Weight loss
- Loss of appetite
- High colored urine
- Yellowish skin and eyes
- Pale stools, pruritus.
- Endocrine tumors present with pain abdomen
- Gastric ulcers
- Raised blood sugars or low blood sugars
- Skin rashes
How is pancreatic cancer diagnosed?
The common diagnostic modalities for pancreatic cancer are ultrasound abdomen, Computed tomography , Endoscopic Ultrasound and Pet- CT abdomen. Localization of endocrine pancreatic lesions is quite challenging. The are certain blood tumor markers for prognostic purpose like CA19-9 levels for exocrine pancreatic cancer. When chemotherapy is planned first or when the disease is widespread then biopsy is a diagnostic modality. Depending on the extent of disease pancreatic cancer is staged between I to IV.
Treatment for pancreatic cancer
The treatment modalities for pancreatic cancer depends on the stage or extent of disease. Localized pancreatic cancer, which is limited to the pancreas are managed by surgical resection. The surgery for pancreatic cancer is technically challenging and requires good surgical acumen.
- Depending of the location of tumor, the surgical procedures can be Whipple's procedure, Distal pancreatectomy or Total Pancreatectomy. Sometimes it includes vessel resections and reconstructions.
- The morbidity or mortality of Whipples procedure is considerably high although in experienced hands the outcomes are in acceptable ranges.
- If the lesion is large, extensive or encasing vessels then chemotherapy is given first to make the lesion amenable for surgery.
- When the disease is widespread then surgery is not a feasible option. The disease has to be treated by systemic chemotherapy. The intent of treatment is then called palliative.
Sometimes surgical treatment maybe needed for unresectable patients for relieving jaundice or vomiting due to obstruction. This is called a bypass procedure. There maybe extreme pain due to involvement of nerves in the abdomen. This might be relieved by blockage of nerves called celiac plexus block or neurolysis. Long acting somatostain analogues are useful in treatment of neuroendocrine lesions of the pancreas and the patients have good symptomatic and disease control with this treatment.
The prognosis of pancreatic tumors is poor. The 5 year overall survival is around 10%. Hence early diagnosis is extremely important if any suspicion or any symptoms suggestive of pancreatic cancer as curative treatment options are feasible in early stage but not in advanced stages and those in early stages have much better survival than advanced or metastatic disease.
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