The pancreas is a vital organ that regulates blood sugar levels in our body. Pancreatic cancer/pancreatic adenocarcinoma is the formation of cancer cells in the ducts of the pancreas. Sometimes cancer can be formed in hormone-producing cells of the pancreas which are also called neuroendocrine tumors.

It is a rare cancer site and is a very aggressive cancer with a poor prognosis. These poor outcomes are possible because the disease presents asymptomatically in the early stages and by the time symptoms develop, the disease is in a very advanced stage. Hence, it's also called a silent disease.

What are the causes of pancreatic cancer?

·         The risk of pancreatic cancer increases with age. Most people who develop pancreatic cancer are above 45 years.

·         More men are diagnosed with this cancer when compared to women

·         People who smoke tobacco are 2 to 3 times more likely at risk than those who don’t.

·         Regular consumption of high fatty food is a risk factor. Research has shown that obese and even overweight people have a higher risk to develop pancreatic cancer.

·         Chronic, heavy alcohol use also increases the risk, most likely by causing recurrent pancreatitis.

·         A diabetic person for many years is also at risk for this cancer. However, it is important to remember that not all people who have diabetes will develop pancreatic cancer.

·         Pancreatic cancer may run in the family and is linked with genetic conditions that increase the risk of other types of cancer also. This is called familial pancreatic cancer.

·         There is some evidence suggesting that having chronic pancreatitis may increase the risk of developing pancreatic cancer.

·         Exposure to certain chemicals like pesticides, benzene, certain dyes, and petrochemicals may increase the risk.

What are the Symptoms?

·         Jaundice.

·         Pain in the upper abdomen or upper back.

·         Painful swelling of an arm or leg due to a blood clot.

·         Gastric discomfort & Bloating of the stomach.

·         Light colored/greasy stools.

·         Nausea and vomiting.

·         Sudden rise in blood sugar levels.

·         Unexplained sudden weight loss.

What are the treatment options in treating pancreatic cancer?

Treating any cancer patient requires different types of doctors and other health care professionals who work together and come up with a treatment plan that combines different types of treatments. This is called a multidisciplinary team approach.

The current treatment options for pancreatic cancer are:

·         Surgery

·         Radiation therapy

·         Chemotherapy

·         Targeted therapy

·         Immunotherapy

All these treatment options and recommendations depend on several factors like the type and stage of cancer, possible side effects, and finally the patient’s preferences and overall health.

A biopsy and histological confirmation are mandatory before proceeding with the treatment. A baseline blood investigation and imaging with PET CT or a Contrast CT are mandatory. All patients should be staged, and risk should be assessed at diagnosis. Patients are then classified as resectable, borderline resectable, locally advanced, ormetastatic based on the imaging at diagnosis.

·         Surgery remains the standard of care in a disease which can be resectable.

·          Upfront chemotherapy +/- radiotherapy is considered in locally advanced and borderline resectable tumors to minimize the disease burden followed by reassessment for surgery in those with stable or partial regression. This may be followed by adjuvant chemotherapy.

·         Chemotherapy/Targeted therapy/ immunotherapy is the treatment option for patients with metastatic pancreatic cancer. There are various combinations of these drugs which help prolong survival.

·         Palliative or best supportive care is the last hope for many cancer patients in advanced stages where medical treatments fail. This approach targets to relieve pain and discomfort thereby improving the quality of life. This also helps in strengthening his/her emotions and mental health during the recovery process.

·         Patients are always monitored under a close follow up schedule after the treatment with blood investigations and imaging whenever necessary to look for any recurrences.

(Dr. Sanketh Kotne is Consultant Medical Oncologist, HCG Cancer Centre Vizag)