Pancreatic Cancer

Pancreatic Cancer

Overview

  • The pancreas serves two main functions. The exocrine portion of the gland secrete digestive juices, while the endocrine portion secretes hormones, the most important being insulin.
  • Most pancreatic malignancies are exocrine. Infiltrating ductal adenocarcinomas account for 90% of pancreatic cancers
  • Pancreatic cancer is a much-feared disease due to its notoriously late presentation, early metastases and poor survival rates.
  • Less than a fifth of patients present with localised, potentially curable tumours and the overall five-year survival rate remains less than 5%

Risk Factors

  • The main risk factors are smoking, diet (high BMI, red meat intake, low fruit and vegetables intake), diabetes and alcohol intake
  • Chronic and hereditary pancreatitis: chronic pancreatitis is associated with a 5- to 15-fold increase in risk and hereditary pancreatitis with a 50- to 70-fold increase.
  • Family history of pancreatic cancer and Familial cancer syndromes: BRCA1, BRCA2, familial adenomatous polyposis, Peutz-Jeghers syndrome, familial melanoma syndromes, Lynch syndrome, von Hippel-Lindau syndrome, multiple endocrine neoplasia type 1, Gardner's syndrome.
  • Other medical conditions: inflammatory bowel disease, periodontal disease, peptic ulcer disease.

What are the signs and symptoms?

The most common presentation of pancreatic cancer include

  • Abdominal pain: typically located in the epigastric region, radiating through to the back. Can present as simple back pain. Back pain is typically dull and worse when supine and eased by sitting forward.
  • Jaundice: obstructive jaundice causes dark urine, pale stools and pruritus.
  • Acute pancreatitis: pancreatic cancer should be considered in the differential diagnosis of any elderly patient presenting for the first time with acute pancreatitis, particularly in the absence of known precipitating factors such as gallstones or alcohol abuse
  • Unexplained weight loss, anorexia.
  • Steatorrhoea due to malabsorption.
  • Epigastric mass (late).
  • Palpable gallbladder: Courvoisier's sign (a palpable gallbladder in the presence of painless jaundice) occurs in fewer than 25% of patients.
  • Compression of the duodenum or the stomach may cause gastric outlet obstruction or delayed gastric emptying, leading to nausea and vomiting.
  • Haematemesis, melaena or iron-deficiency anaemia.

Evaluation

  • Blood tests including Liver function tests and tumour marker CA 19-9
  • USG abdomen is the primary imaging investigation
  • CECT abdomen and UGI scopy and EUS and biopsy might be necessary
  • Whole body PET CT for metastatic workup
  • Endoscopic Retrograde cholangio pancreatico graphy helps in visualization of pancreatic and bile duct
  • In patients with obstructive jaundice, ERCP and stenting might be required pre operatively

Treatment options offered in our centre includes

  • Surgical resection of the tumour and neighbouring lymph nodes offers the only chance of cure but only 10-20% of tumours are suitable for resection, due to tumour size and spread at diagnosis
  • Proximal pancreaticoduodenectomy with antrectomy (Whipple's procedure)
  • Proximal pancreaticoduodenectomy with pylorus preservation (modified Whipple's procedure)
  • Distal pancreatectomy: this is performed for tumours of the body and tail of the pancreas.
  • Adjuvant chemotherapy in advanced pancreatic cancer.
  • Stenting in case of inoperable cases

What we offer in our centre?

All advanced surgical procedures for pancreatic tumours and other therapies including

  • Whipple s pancreaticoduodenectomy
  • Triple bypass procedure for advanced pancreatic cancers
  • Distal pancreatectomy for body and tail of pancreas tumours
  • Adjuvant chemotherapy in advanced pancreatic cancer
  • Stenting in case of inoperable cases

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