Pancreatic cancer

Pancreatic cancer can arise from different types of cells in the pancreas:

• Exocrine tumours: The most common type, arising from the cells that produce digestive juices.
• Endocrine tumours (pancreatic neuroendocrine tumours): A rarer type, arising from hormone-producing cells.

Pancreatic cancer is often called a “silent disease” because it may not cause clear symptoms in its early stages, especially with tumours in the body and tail of the pancreas. 

• Jaundice (yellowing of eyes and skin): One of the most common symptoms, which occurs due to obstruction in the bile duct. Most cancers originate in the head of the pancreas and present as jaundice; those in the body and tail of the pancreas do not present with jaundice.
• Unexplained weight loss
• Nausea and vomiting
• Recent development of diabetes or worsening of pre-existing diabetes: Sudden diabetes or worsening control in existing diabetes can sometimes be a warning sign.

The exact cause of pancreatic cancer is not known. Factors increasing the risk of cancer are:

• Genetic predisposition (family history or inherited mutations)
• Newly diagnosed diabetes
• Alcohol consumption
• Smoking tobacco
• Chronic pancreatitis (long-term inflammation of the pancreas)

Several tests are used to diagnose pancreatic cancer and plan treatment:

• Computed tomography (CT) scan: Helps determine the stage of the cancer, which helps define the treatment plan. At times, additional investigations, including positron emission tomography (PET) scans and magnetic resonance imaging (MRI), may be required for further information.
• Blood tests for CA 19-9 and CEA: These are tumour markers (proteins linked to cancer) that may be elevated in pancreatic cancer.
• 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 to reduce jaundice.

Treatment depends on the stage of the cancer/tumour, its location, and whether it involves neighbouring blood vessels or has spread. The treatment options include:

• Surgery (only possible when cancer is localised):
  • Whipple procedure (pancreatoduodenectomy): Removal of the lower bile duct along with the head of the pancreas, a portion of the stomach, and initial portion of the small intestine (jejunum) to eliminate the tumours located in the head of the pancreas, small intestine, and lower bile duct.
  • Distal pancreatectomy: Removal of the body and tail of the pancreas (left side of pancreas). Sometimes involves removal of the spleen, 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 tumour size for facilitating complete removal of the tumour.
  • Adjuvant chemotherapy: This is provided after complete recovery from the surgery to lower the risk of recurrence.

Seek medical attention if you experience persistent or unexplained abdominal pain, jaundice, unintentional weight loss or sudden onset or worsening of diabetes. Early consultation can lead to earlier diagnosis and more treatment options.

There is no guaranteed way to prevent pancreatic cancer, but the risk can be reduced by:

• Avoiding smoking and tobacco use
• Limiting alcohol consumption
• Maintaining a healthy diet and body weight
• Managing diabetes and chronic pancreatitis with regular medical care

Patients with suspected or confirmed pancreatic cancer should consult:

• Gastroenterologist: For initial diagnosis and endoscopic procedures.
• Hepatobiliary and Pancreatic Surgeon / Surgical Oncologist: For surgical treatment.