Cancer Treatment

Pancreatic Cancer

The pancreas is an elongated organ located posteriorly, below the stomach within the curve of the upper part of the small intestine, called the duodenum and comprises two types of glands the exocrine and endocrine glands.

The exocrine gland plays an important role in the digestion of fats, proteins and carbohydrates, by secreting digestive pancreatic juices and the endocrine gland helps in keeping the blood sugar levels under control by secreting insulin. Pancreatic cancer originates in the tissues of the pancreas located behind the lower portion of the stomach and is relatively more common in men than in women.

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Symptoms of Pancreatic Cancer:

The symptoms of pancreatic cancer may include:

Abdominal pain that radiates to the back

Loss of appetite or unintended weight loss

Jaundice i.e. yellowish discolouration of the skin and the ‘whites’ of the eyes

Light or clay-coloured stools

Dark coloured urine

Excessive skin itching

Generalised weakness

New diagnosis of diabetes or existing diabetes that's becoming more difficult to control

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Types of Pancreatic Cancer

Pancreatic cancer originates in the exocrine or the endocrine glands, which form the basis for differentiating the cancer type:

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Exocrine pancreatic cancer:

This form of cancer is more common and includes:

Pancreatic ductal adenocarcinoma: accounts for 90% of the cases of pancreatic cancer, it arises from the cells lining the ducts of the pancreatic glands and is of the following types.
Squamous cell carcinoma
Adenosquamous cell carcinoma
Colloid carcinoma

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Endocrine pancreatic cancer:

These are also called neuroendocrine or islet-cell tumours. These tumours can be ‘functional’ i.e. they secret extra amounts of hormones such as insulin, glucagon, and gastrin, that cause different signs and symptoms or ‘non-functional’ i.e. they do not secrete extra hormones. These include:

Endocrine pancreatic cancer: These are also called neuroendocrine or islet-cell tumours. These tumours can be ‘functional’ i.e. they secret extra amounts of hormones such as insulin, glucagon, and gastrin, that cause different signs and symptoms or ‘non-functional’ i.e. they do not secrete extra hormones. These include:
- Gastrinomas (excess secretion of gastrin hormone)
- Glucagonomas (excess secretion of glucagon hormone)
- Insulinomas (excess secretion of insulin hormone)
- Somatostatinomas (excess secretion of somatostatin hormone)
- ‘VIP’ omas (excess secretion of Vasoactive intestinal peptide)

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Causes of Pancreatic Cancer

Factors that increase the risk of pancreatic cancer include:

Smoking
Diabetes
Chronic inflammation of the pancreas (pancreatitis)

Family history of pancreatic cancer or genetic syndromes in families like BRCA2 gene mutation, Lynch syndrome and Familial atypical mole-malignant melanoma (FAMMM) syndrome is associated with an increased risk of pancreatic cancer.

Obesity
Older age

When to see the Doctor?

The symptoms and characteristics can vary in individuals; hence it is best advised to consult our specialists to rule out cancer possibilities as a preventive measure if you are experiencing a combination of any of these symptoms.

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Smoking, diabetes, chronic inflammation of the pancreas, obesity and old age increase the risk of pancreatic cancer.

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Thangam Hospital has competent specialists to provide specialized care and meticulously handle complex procedures and excellent support personnel.

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Prevention of Pancreatic Cancer

Some of the preventive measures are:

Stop smoking

Maintain a healthy weight by exercising daily and eating a healthy diet.

Consider meeting with a genetic counsellor if you have a family history of pancreatic cancer.

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Maintaining a healthy weight, limiting alcohol consumption and avoiding tobacco products can help minimize the risk of acquiring Pancreatic Cancer.

Tests for Pancreatic Cancer

Physical examination: A thorough physical examination will be carried out after obtaining a detailed history of your symptoms.

CT scan: A special technique called ‘Pancreatic protocol CT scan’ is done, to determine the exact stage of the cancer, which in turn helps determine the best treatment approaches for the patient.

MRI scan: In some cases, an MRI scan is taken to determine the relationship between vessels and tumours.

PET CECT scan: A PET CT scan may sometimes be suggested to rule out the spread of cancer to other sites like the liver, lungs

Biopsy/FNAC: For patients in the advanced stages where it's not possible to perform an upfront surgery but requires a bout of chemotherapy or radiation, a small biopsy is done using any of the following FNAC approaches:

Endoscopic Ultrasound-guided FNAC or biopsy: An endoscopic ultrasound or EUS is a device that uses ultrasound waves to create images of the pancreas inside the abdomen and has a thin flexible tube. This device is inserted into the stomach and a biopsy/FNAC is done to obtain tissue samples of the tumour.

USG-guided Biopsy or FNAC: This is another method of performing biopsy/FNAC, wherein a thin needle is inserted through the skin under USG guidance to obtain tissue samples for pathological analysis to confirm the type of pancreatic cancer.

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Treatment for Pancreatic Cancer

Treatment approaches for pancreatic cancer include:

Surgery

Surgical procedures to remove cancer include:

Whipple’s procedure: In cancers involving the proximal part of the pancreas, a Whipple’s procedure is usually performed. In this, the proximal part of the pancreas along with the adjacent small intestine (duodenum), distal part of the stomach, gall bladder and distal part of the bile duct are removed along with adjacent lymph nodes. Reconstruction is then performed by joining a segment of the small bowel (jejunum) with the remaining part of the pancreas, bile duct and stomach.

Pylorus preserving pancreaticoduodenectomy: This surgery is similar to Whipple’s procedure, except that the distal part of the stomach along with the pylorus (distal-most part of the stomach) is preserved.

Distal Pancreatico-splenectomy: For cancer involving the distal part of the pancreas, a distal Pancreatectomy with or without splenectomy is performed.

Total Pancreatectomy: The removal of the entire pancreas is called Total Pancreatectomy, resulting in the patients requiring lifelong insulin and enzyme replacement.

Chemotherapy - Drugs to treat cancer cells are injected into the body, these drugs have tolerable side effects, and the side effects have been minimized with new forms of chemotherapy drugs with the evolving changes in medical and treatment approaches. Chemotherapy is crucial to contain the cancer cells circulating in the blood.

Bypass surgeries: In some of the advanced cases (stage IV), bypass procedures like gastro-jejunostomy, and hepaticojejunostomy are performed, to bring down jaundice levels, enabling the patient to eat well during treatment.

Chemotherapy

Chemotherapy in the form of injections or tablets may be suggested depending on the stage of the disease.

Adjuvant chemotherapy: The chemotherapy given after surgery, comprising 6 cycles wherein each cycle varies between 2-3 weeks.

Neoadjuvant chemotherapy: The chemotherapy given prior to surgery is called neoadjuvant chemotherapy, consisting of 3 cycles wherein each cycle constitutes a duration of 3 weeks, another boot of chemotherapy is given post-surgery as adjuvant chemotherapy consisting of 3 cycles.

Chemo-radiation

Chemotherapy can also be recommended along with radiation treatment; called concurrent chemo-radiotherapy, and can be given in a neoadjuvant or adjuvant treatment approach.

Radiation therapy

Radiation therapy is given alone or in combination with chemotherapy depending upon the surgical histopathological report. In some cases, concurrent chemo-radiation is the only treatment approach, in patients with locally advanced disease wherein surgical resection cannot be performed safely.

Targeted therapy

Targeted therapy uses drugs to target specific proteins within the cancer cells, to kill them. For example, Trastuzumab targeting Her2neu protein in pancreatic cancer cells expressing Her2neu protein may be suggested.

Immunotherapy

In advanced cases, biological therapy or immunotherapy may be suggested for treatment. Immunotherapy targets the cells, which affect the body’s immune response and helps the body in killing cancer cells.