“The cancer that grows inside the pancreas is known as pancreatic cancer. Pancreas is the gland that is about 6 inches long that makes hormones including the enzymes responsible for controlling blood sugar and also helps in digesting food. The development of pancreatic cancer starts when the cells inside the pancreas grow out of control. This cancer may metastasize or spread top surrounding organs and lymph nodes such as lungs and liver.

Types of Pancreatic Cancer

Pancreatic cancer can be categorized into different types that depend on whether or not the cancer began in the endocrine or exocrine component. Pancreatic cancer types include –

Endocrine Tumors : Endocrine tumors also referred to as pancreatic neuroendocrine tumors (PNETs) or islet cell tumors are not so common as compared to exocrine tumors. A pancreatic neuroendocrine tumor could be non-functioning that means it does not make any hormones or it could also be functioning that means it can make hormones. The base of a functioning neuroendocrine tumor is on the hormone that cells usually make –

PPomas
Insulinoma
VIPomas
Gastrinoma
Glucagonoma
Somatostatinoma
Exocrine Tumors: They are considered as the most common type of pancreatic cancer. Adenocarcinoma that begins in gland cells is mostly seen in around 95% people who are suffering from pancreatic cancer. Ductal Adenocarcinoma is the ducts of the pancreas from where the tumor typically begins. Rarely when tumor starts in the acini then it is termed as acinar Adenocarcinoma.

Some of the other rare tumors of the pancreas are –

Lymphoma
Acinar Cell Carcinomas
Cystic Tumors
Neuroendocrine tumors
Diagnosis of pancreatic cancer:

Computed tomography (CT) scans
CT Scanner produces clear and sharp images throughout the body with 33 percent greater detail than traditional scans. The improved imaging helps to diagnose disease earlier and with greater accuracy. More importantly, scan radiation can be reduced up to 50 percent, a critical benefit for cancer patients.

Magnetic resonance cholangiopancreatography (MRCP)
Magnetic Resonance Colangio Pancreatography (MRCP), uses magnetic fields and radio waves to produce detailed images of the pancreas, liver and bile ducts. This noninvasive test is especially helpful for diagnosing bile duct obstructions and for detecting pancreatic cysts (fluid-filled pockets) that can develop on or within the pancreas. Most cysts are benign, but some may become cancerous over time and are followed by our oncologist.

Endoscopic ultrasound (EUS)
During the test, a tiny ultrasound probe is placed in the stomach through an endoscope. The probe produces sound waves that create extremely detailed images of the pancreas, which lies next to the stomach.

Digital analysis of these images can help distinguish cancer from chronic pancreatitis – an ongoing inflammation of the pancreas. During EUS, the oncologist may also do FNAC or remove a small samples of pancreatic tissue (core biopsy). The biopsies can help distinguish autoimmune pancreatitis from pancreatic cancer. Oncologists can also collect pancreatic juices or fluid from precancerous cysts for laboratory analysis. EUS can be technically demanding and produces the best results.

Endoscopic retrograde cholangiopancreatography (ERCP)
ERCP is used to evaluate and treat problems in the bile ducts. During a traditional ERCP, Gastroenterologist injects a dye into the biliary tract through an endoscope before taking a series of X-rays.

Treatment of pancreatic cancer in India:

SURGERY

Surgery is the best option for people whose cancer can be safely and effectively removed. This usually means that the tumor hasn’t grown into any of the major blood vessels located near the pancreas or spread to the liver, abdominal cavity or lungs.

Unfortunately, only about 20 percent of pancreatic cancer patients have tumors that can be surgically removed (resected). And although improvements in diagnosis, staging, surgical techniques and postoperative care have led to much better outcomes after surgery, pancreatic resection is still one of the most difficult and demanding operations for both surgeons and patients.

Pancreatic surgeries

Whipple procedure – This is the most common type of surgery, also known as pancreatoduodenectomy (Whipple procedure) and is potentially curative. The surgery involves removing the “”head”” of the pancreas along with the duodenum, the gallbladder and the lower end of the bile duct. The bile duct, pancreatic duct and intestine are reconstructed. This is a technically demanding procedure, which surgeons perform routinely, within acceptable rate of morbidty.
Other surgical procedures – Other options for pancreatic cancer, include total pancreatectomy, which removes the entire pancreas, along with the gallbladder, part of the stomach and small intestine, the bile duct, spleen, and nearby lymph nodes; and distal pancreatectomy, in which the body and tail of the pancreas are removed.


RADIATION THERAPY AND MULTI-MODALITY THERAPIES


Radiation can be delivered during surgery using intra-operative radiation electron therapy. Intra-operative radiation electron therapy allows doctors to treat tumors with high doses of radiation – the equivalent, in some cases, of 10 to 20 daily radiation treatments – without harming nearby organs.

CHEMOTHERAPY

Inoperable pancreatic cancers require the use of chemotherapy / radiation therapy to shrink / control the tumour growth. Pancreatic cancers with metastatic require chemotherapy. Selection of chemotherapeutic drugs, dosages and schedule depend on the physical condition of the patient and performance status. Patient not fit for injetable chemotherapy may also be offered targeted therapy.

PALLIATIVE CARE

When cancer is so advanced that treatment options are limited, an experienced, integrated team of palliative care providers serves the social, psychological and spiritual needs of patients and their families. The team may include physicians from a number of fields as well as dietitians, medical social workers, psychologists, pharmacists and pain management specialists.”