Pancreatic cancer (cancer of the pancreas) mainly occurs in Elderly population (above 65). If it is diagnosed at an early stage, then an operation to remove the cancer gives some chance of a cure.
What is the pancreas?
The pancreas is in the upper abdomen and lies behind the stomach and intestines (guts). The pancreas has a head, a body and a tail.
The bile duct carries bile from the liver and gallbladder. This joins the pancreatic duct just before it opens into the duodenum. Bile also passes into the duodenum and helps to digest food.
What is the incidence of pancreatic cancer?
- It develops in about 1 in 10,000 people each year.The life time risk of getting pancreatic cancer is 1 in 71 (1.41%).
- 22 people die every day from pancreatic cancer
- 10% are diagnosed in time for potentially curative surgery
What are the types of cancer of the pancreas?
Main type of pancreatic cancer is ductal adenocarcinoma of the pancreas. Ductal adenocarcinoma of the pancreas.
This type of cancer develops from a cell which becomes cancerous in the pancreatic duct. This multiplies and a tumour then develops in and around the duct. As the tumour enlarges:
- It can block the bile duct or the main pancreatic duct. This stops the drainage of bile into the duodenum.
- It invades deeper into the pancreas. In time it may pass through the wall of the pancreas and invade nearby organs such as the duodenum, stomach or liver.
- The cancer may then spread to nearby lymph nodes or spread to other areas of the body (metastasise).
Other types of pancreatic cancer
There are some rare types of cancer like neuroendocrine tumours and cystic tumours of the pancreas.
What are the risk factors for pancreatic cancer ?
- Ageing. It is more common in older people. Most cases are in people aged over 60.
- Diet. Eating a diet high in fat and meat increases the risk.
- Chronic pancreatitis -persistent inflammation of the pancreas
- Diabetes. Note: diabetes is common and the vast majority of people with diabetes do not develop pancreatic cancer.
- Genetic and hereditary factors ( Rare-Most cases of pancreatic cancer do not run in families)
What are the symptoms of pancreatic cancer?
- Dark urine -
- Pale faeces –white stoools.
- Weight loss
- Painless jaundice that is often the first sign of pancreatic cancer.
How is pancreatic cancer diagnosed & assessed?
- Besides the standard blood tests like liver function tests; specific tests such as tumour marker ( CA19-9) help in the detection of pancreatic cancer
- CT scan is used to both confirm the cancer and stage the extent ofspread.
- An endoscopic ultrasound (EUS). An endoscope with a tiny ultrasound scanner may be
- needed to assess about the local invasion into the blood vessels and also take a biopsy if needed
By finding out the stage of the cancer, it helps the surgeon to advise on the best treatment options.
What are the treatment options for pancreatic cancer?
Treatment options that may be considered include surgery, chemotherapy and radiotherapy
- Only about 15% of patients who are detected to have a pancreatic head cancer can be offered a surgical operation to remove the tumour; which is the only curative option.
- Any operation on the pancreas is a complex operation and needs a dedicated and specialist team of surgeons.
What happens if my tumour is inoperable- or cannot be removed surgically?
- If the cancer is at an advanced stage then surgery is not an option to cure the disease.
- However some patients may benefit from neo-adjuvant treatment with chemo-radiotherapy. i.e- give 3 cycle of chemotherapy and radiotherapy to reduce the size of the tumour. If a repeat CT scan confirms the operability of the tumour, then an operation can be attempted.
- Palliative chemotherapy and radiotherapy may be used for patients in whom surgery is not an option
- For some inoperable tumours, palliative surgical bypass procedures may be performed
- Commonly, endoscopic stenting is done to relieve jaundice.