Chintamani – Chairman and Head Department of Surgical Oncology Sir Ganga Ram Hospital New Delhi

Pancreatic cancer is a life-threatening malignancy that originates in the tissues of the pancreas, a hidden though crucial organ located behind the stomach. Pancreas plays an essential role in digestion and blood sugar regulation through its exocrine and endocrine functions. Sadly this cancer is mostly detected late and in an advanced stage and progresses aggressively, is often called the soldier of the army of death . It has one of the lowest survival rates among cancers, making early detection and understanding of the disease critical.

Majorly there are two types of Pancreatic Cancers

1. Exocrine Tumors: The most common type, accounting for about 90-95% of cases, arises in the pancreas’s exocrine cells that produce digestive enzymes. The majority of these are adenocarcinomas.
2. Endocrine Tumors: Less common, these originate from the islets of Langerhans, which regulate hormones like insulin. These are often referred to as pancreatic neuroendocrine tumors (PNETs).

Risk Factors

Several factors increase the likelihood of developing this lethal cancer:

• Lifestyle Factors: Smoking, obesity, and heavy alcohol consumption.
• Genetics: Family history of pancreatic or related cancers and inherited genetic mutations (e.g., BRCA1/2, Lynch syndrome).
• Age and Gender: Typically affects individuals over 60 and is slightly more common in men.
• Chronic Conditions: Chronic pancreatitis, type 2 diabetes, and long-standing inflammation of the pancreas [sometimes sudden appearance of diabetes in an elderly person could be an indicator of the impending pancreatic cancer].

Symptoms

Often nonspecific and may not appear until the disease is advanced. Common signs include:

• Jaundice: Yellowing of the skin and eyes due to bile duct obstruction.
• Abdominal Pain: Radiating pain to the back, often worsening after eating or lying down.
• Weight Loss and Appetite Loss: Unexplained weight loss and persistent nausea.
• Digestive Issues: Fatty stools, bloating, or difficulty digesting food.

Modes of making a diagnosis :

Diagnosing pancreatic cancer involves a combination of imaging tests, blood tests, and biopsies:

• Imaging: CT scans, MRIs, and endoscopic ultrasound (EUS)
• Biopsy: Tissue sample analysis to confirm malignancy which may not always be feasible but is desirable before planning optimum management.
• Blood tests for some Markers: CA 19-9 blood test, which again is not specific, and is mostly used while following up these cases to look for tumor progression.

Management : depends on the stage and type of pancreatic cancer:

1. Surgery: For localized tumors, procedures like the Whipple surgery (pancreaticoduodenectomy) can be performed.
2. Chemotherapy: Drugs like gemcitabine or FOLFIRINOX are used to shrink tumors and slow progression.
3. Radiation Therapy: Targets cancer cells to reduce tumor size, often combined with chemotherapy.
4. Targeted Therapy: Explores drugs that specifically block cancer growth pathways.
5. Palliative Care: Focused on improving the quality of life in advanced stages by managing pain and symptoms.

Prognosis

Pancreatic cancer has a five-year survival rate of less than 10%, primarily due to late diagnosis. Early detection improves survival rates, emphasizing the need for greater awareness and research.

Prevention and Awareness

Since most cases present late and as advanced cancers, increasing awareness is the key . Lifestyle modifications such as quitting smoking, regular exercises , maintaining a healthy weight, and managing diabetes can lower risk. Regular screenings are recommended for individuals with a family history or genetic predisposition to pancreatic cancer.