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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