Pancreatic Cancer Treatment in India – Problems in early detection and treatment failures render pancreatic cancer a gloomy prognosis
Pancreatic cancer is one of the worst cancers which affect the human body. It is difficult to detect early, and treatment failures are common. During the year 2010 in the United States, 43,140 people were diagnosed with this disease, of which approximately 36,800 will die. So it is easy to acknowledge the gloomy prognosis associated with this disease.
The pancreas is a long leaf shaped organ, almost resembling a flattened obelisk. The broad end is called the head, the tapering point called the tail and the intervening part called the neck and body. It lies transversely in front of the spine in the abdomen. The head end is situated on the right side and the tail on the left, touching the spleen. The common bile duct runs through the head, on its way from the liver to the intestines. The pancreas produces a plethora of digestive enzymes which are secreted into the gut. In addition, it produces the hormone insulin, the lack of which causes diabetes mellitus.
The most common cancer that arises in the pancreas is the adenocarcinoma, which carries the worst prognosis. The main risk factors are smoking, excessive alcohol consumption, obesity and diabetes mellitus. There is also a strong relation to chronic pancreatitis and a family history of cancer. Hence this cancer can be guarded against by lifestyle modifications, such as cessation of smoking, change in drinking habits, regular exercise and a healthy lifestyle.
Signs and symptoms
The initial signs and symptoms of this disease are very nonspecific and emulate everyday troubles like indigestion and acidity. However, cancer of the pancreatic head announces itself comparatively early by blocking the common bile duct and thus causing jaundice, which is initially painless. Hence any painless jaundice should be immediately investigated with an abdominal ultrasound. Cancer of the other parts of the pancreas do not cause jaundice and are consequently diagnosed even later. They usually cause severe abdominal pain spreading to the back, weight loss, vomiting and onset diabetes.
Diagnosis is done by imaging, such as CT scan, MRI, CT guided fine needle biopsy (FNAC) and a blood test to detect a specific protein called CA 19.9, the level of which is elevated in pancreatic cancer. It is not always possible to do preoperative biopsy or FNAC successfully, and it frequently happens that the surgeon decides to operate on clinical and radiological suspicion alone. During the operation, a frozen section biopsy is used to confirm the disease.
diagnosis, the fate of the affected person hinges on whether the cancer is limited to the pancreas and, if so, whether it can be surgically removed. Like most other solid cancers, surgery is the keystone to the treatment of this cancer. If the cancer has spread to other distant organs such as the liver, it is in the incurable stage and the average survival of these patients is 6 to 9 months from diagnosis. Anticancer chemotherapy drugs can be used to ameliorate the painful symptoms, but it does not increase survival at this stage. If the cancerous tumour is not limited to the pancreas but has extended to involve surrounding vital structures, then it is inoperable, which means it cannot be surgically removed. These patients are treated with a combination of chemotherapy and radiotherapy, which can give an extended survival of 42 to 60 weeks.
If the tumour is limited to the pancreas and is operable, then surgery carries the best chance of cure. The operation varies according to where the tumour is located. If it is in the head of the pancreas, then the surgery is called a Whipple procedure (pancreaticoduodenectomy). This is a long and complicated surgery carrying significant chance of post-operative complications and even death, up to 5 per cent.
If successful, it carries a 5 year survival rate of 20 per cent, which means that 20 per cent of patients are likely to live more than 5 years. The average survival of these patients is 19 months. If the tumour is in the mid-part or body of pancreas, it is rarely operable, but sometimes a total pancreatectomy or removal of whole pancreas can be done. For cancers in the tail of the pancreas, a distal pancreatectomy operation with removal of the spleen is done.
Of all the patients diagnosed with pancreatic cancer, 80 per cent are inoperable at diagnosis. Surgery is also not a guarantee of cure. Thus it is apparent that treatment options for this disease are limited, even when detected relatively early. Research is ongoing to find better options. As of now, it appears that prevention is better than cure, and therein lies the importance of a healthy lifestyle.
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