Pancreas cancer occurs when certain cells within the pancreas, grow and spread forming a malignant tumour. The exact cause for pancreas cancer is not known.
Clinical Presentation
- Jaundice – Jaundice is one of the commonest symptoms of development of pancreas cancer. It occurs due to obstruction of the bile duct , from the tumouras it travels through the pancreas . Most cancers of the pancreas originate in the head region of the pancreas presenting as jaundice
- Weight loss – unexplained weight loss
- Nausea
- Vomiting
- Recent development of diabetes or worsening of pre-existing diabetes
- Cancers of the pancreas can be silent and may not show any defined or specific symptoms or signs. Hence very often these are discovered at an advanced stage. This is specially so with some cancers in the body and the tail of the pancreas, which can be silent for a long time. Unlike cancers in the head of the pancreas, cancers within the body and tail of the pancreas do not present with jaundice.
Diagnosis
Diagnosis of pancreas cancer is made through a series of tests which include a CT scan, blood tests including tumour markers (CA 19-9, CEA).
CT scan will accurately stage the cancer which will help define the treatment plan.
ERCP / EUS
These are specialised endoscopic tests which may be done to either establish the diagnosis of pancreas cancer.
Sometimes prior to surgery for pancreas cancer – biliary stenting (stenting of the bile duct) – will be required prior to surgery. This is not always required, but may be needed in some specific cases to lower the jaundice and once the level of jaundice reduces a pancreatico duodenectomy (whipples procedure) will be done.
Treatment of Pancreas Cancer
Treatment will depend on the stage of the cancer / tumour, for which CT scan is an accurate investigation. At times additional investigations including PET scans and MRI will be required for additional information.
Pancreas is located deeply within the abdominal cavity and in vicinity of major and vital blood vessels supplying blood to the liver and the intestines.
Accurate mapping of the tumour is required and its relationship to these blood vessels need to be accurately defined while making treatment decisions.
Surgery
Surgery is the only defined and ideal treatment with a potential for cure.
Surgery for pancreas cancer will depend on the location of the tumour within the pancreas.
Whipple Procedure
This is a complex operation involving removal of the head of the pancreas, along with lower bile duct, part of the stomach and initial portion of the small intestine (jejunum) to remove tumours located in the head of the pancreas, periampullary region, duodenum (small intestine) and lower bile duct.
Distal Pancreatectomy
This operation is usually done for tumours located in the body and tail of the pancreas (left side of the pancreas). The operation also sometimes involves removal of the spleen alongside, although the spleen can be preserved in certain select cases.
Chemotherapy
At times chemotherapy may be required for certain advanced cancers prior to surgery (Neoadjuvant chemotherapy). This helps in reducing the size of the tumour and making them smaller to facilitate complete removal. Different regimes of chemotherapy are available which are individualised based on patient condition.
Following Surgery, chemotherapy is given after analysis of the pathology report (adjuvant chemotherapy). This is usually done after complete recovery from surgery.