Pancreas Cancer

Cancers of the pancreas can be silent and may not show any defined or specific symptoms. Hence, they are often discovered at an advanced stage. This is especially true for cancers in the body and tail of the pancreas, which can remain silent for a long time. Unlike cancers in the pancreatic head, those in the body and tail of the pancreas do not present with jaundice

• Jaundice: Jaundice is one of the most common symptoms in the development of pancreatic cancer. It occurs due to obstruction in the bile duct. Most cancers of the pancreas originate in the head region of the pancreas and present as jaundice
• Unexplained weight loss
• Nausea
• Vomiting
• Recent development of diabetes or worsening of pre-existing diabetes

• Computed tomography (CT) scan: CT scan will accurately stage the cancer, which will help to define the treatment plan
• Blood tests for CA 19-9 and CEA (tumour markers)
  Endoscopic retrograde cholangiopancreatography (ERCP)/ endoscopic ultrasound (EUS): These are specialised endoscopic tests done to establish the diagnosis of pancreatic cancer.  In some cases, biliary stenting (stenting of the bile duct) may be required before surgery. While not always necessary, it can help reduce jaundice. Once the jaundice level decreases, a pancreatoduodenectomy (Whipple's procedure) may be performed

Treatment will depend on the stage of the cancer/tumour, which can be accurately obtained using a CT scan. At times, additional investigations, including positron emission tomography (PET) scans and magnetic resonance imaging (MRI), may be required for further information. Accurate mapping of the tumour and its relationship with the neighbouring blood vessels need to be defined, while making treatment decisions. The treatment includes:

• Surgery: Surgery is the only ideal treatment with a potential for cure. Surgery for pancreas cancer will depend on the location of the tumour within the pancreas.
  • Whipple procedure: This procedure is an operation in which the lower bile duct along with the head of pancreas, a portion of stomach and initial portion of the small intestine (jejunum) is removed to eliminate the tumours located in the head of the pancreas, periampullary region, duodenum (small intestine) and lower bile duct.
  • Distal pancreatectomy: This operation is usually done for tumours located in the body and tail of pancreas (left side of pancreas). The operation also sometimes involves removal of the spleen alongside, although the spleen can be preserved in certain select cases.
• Chemotherapy: At times, chemotherapy may be required for certain advanced cancers prior to surgery (neoadjuvant chemotherapy). This helps in reducing the size of the tumour to make them smaller for facilitating the complete removal of tumour. Different regimes of chemotherapy are available, which are individualised based on the patient conditions. Following surgery, chemotherapy is given after analysis of the pathology report (adjuvant chemotherapy). This is usually done after complete recovery from the surgery.