Pancreatic Cancer Treatment in India -Problems in early detection and

treatment failures render pancreatic cancer a gloomy prognosis

The pancreas is a long leaf shaped organ, almost resembling a flattened
obelisk. The broad end is called the head, the tapering point called the tail
and the intervening part called the neck and body. It lies transversely in
front of the spine in the abdomen. The head end is situated on the right
side and the tail on the left, touching the spleen. The common bile duct
runs through the head, on its way from the liver to the intestines. The
pancreas produces a plethora of digestive enzymes which are secreted
into the gut. In addition, it produces the hormone insulin, the lack of
which causes diabetes mellitus.

The most common cancer that arises in the pancreas is the
adenocarcinoma, which carries the worst prognosis. The main risk
factors are smoking, excessive alcohol consumption, obesity and
diabetes mellitus. There is also a strong relation to chronic pancreatitis
and a family history of cancer. Hence this cancer can be guarded against
by lifestyle modifications, such as cessation of smoking, change in
drinking habits, regular exercise and a healthy lifestyle.










Signs And Symptoms
The initial signs and symptoms of this disease are very
nonspecific and emulate everyday troubles like indigestion and
acidity. However, cancer of the pancreatic head announces itself
comparatively early by blocking the common bile duct and thus
causing jaundice, which is initially painless. Hence any painless
jaundice should be immediately investigated with an abdominal
ultrasound. Cancer of the other parts of the pancreas do not
cause jaundice and are consequently diagnosed even later. They
usually cause severe abdominal pain spreading to the back,
weight loss, vomiting and onset diabetes.










Diagnosis is done by imaging, such as CT scan, MRI, CT
guided fine needle biopsy (FNAC) and a blood test to
detect a specific protein called CA 19.9, the level of
which is elevated in pancreatic cancer. It is not always
possible to do preoperative biopsy or FNAC successfully,
and it frequently happens that the surgeon decides to
operate on clinical and radiological suspicion alone.
During the operation, a frozen section biopsy is used to
confirm the disease.
Diagnosis










Treatment
Upon diagnosis, the fate of the affected person hinges on whether the cancer is limited to
the pancreas and, if so, whether it can be surgically removed. Like most other solid
cancers, surgery is the keystone to the treatment of this cancer. If the cancer has spread
to other distant organs such as the liver, it is in the incurable stage and the average
survival of these patients is 6 to 9 months from diagnosis. Anticancer chemotherapy
drugs can be used to ameliorate the painful symptoms, but it does not increase survival at
this stage. If the cancerous tumour is not limited to the pancreas but has extended to
involve surrounding vital structures, then it is inoperable, which means it cannot be
surgically removed. These patients are treated with a combination of chemotherapy and
radiotherapy, which can give an extended survival of 42 to 60 weeks.










Treatment
If the tumour is limited to the pancreas and is operable, then surgery carries the best
chance of cure. The operation varies according to where the tumour is located. If it is in
the head of the pancreas, then the surgery is called a Whipple procedure
(pancreaticoduodenectomy). This is a long and complicated surgery carrying significant
chance of post-operative complications and even death, up to 5 per cent.

If successful, it carries a 5 year survival rate of 20 per cent, which means that 20 per cent
of patients are likely to live more than 5 years. The average survival of these patients is 19
months. If the tumour is in the mid-part or body of pancreas, it is rarely operable, but
sometimes a total pancreatectomy or removal of whole pancreas can be done. For
cancers in the tail of the pancreas, a distal pancreatectomy operation with removal of the
spleen is done.










Treatment
Of all the patients diagnosed with pancreatic cancer, 80 per cent are inoperable at
diagnosis. Surgery is also not a guarantee of cure. Thus it is apparent that treatment
options for this disease are limited, even when detected relatively early. Research is
ongoing to find better options. As of now, it appears that prevention is better than cure,
and therein lies the importance of a healthy lifestyle.
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