A diagnosis of pancreatic cancer is generally considered a death knell. While it is an aggressive disease and overall outcomes are poor, some patients do benefit from surgery, especially those with localised disease. Statistics do not tell the actual story.
The pancreas is a long, flatted gland located deep in the abdomen. It has three main parts: a head, a body and a tail. Majority of the pancreatic cancers occur in the head of the pancreas. This cancer is rare before the age of 40, and more than 50 per cent occur after the age of 70. Risk factors are smoking, chronic pancreatitis and certain hereditary conditions. Patients who are obese are also at a higher risk.
Signs and symptoms
The greatest difficulty in the treatment of pancreatic cancer lies in the fact that there are very few symptoms in its early stages. The tumour has usually spread by the time the patient observes significant symptoms. The common symptoms of pancreatic cancer are: 1 Moderated to severe continuous upper abdominal pain radiating to the back that gradually increases over a period of time. 2 Severe loss of both appetite and weight, which is sometimes the earliest symptom. 3 Jaundice, which occurs when the tumour involves the bile duct that is very close to the pancreas.
A preliminary ultrasound of the abdomen may provide a clue to the diagnosis, but cross-sectional imaging such as a CT scan or an MRI is needed to confirm the diagnosis and assess the spread of the disease. In patients with larger or locally advanced tumours, a radio nucleotide scan, known as a PET scan, should be done to assess the spread of the disease. An endoscopic ultrasound is another investigation that is useful to assess the local involvement of blood vessels. It is also possible to do a biopsy in certain cases.
The surgical removal of the tumour is the only treatment with a chance of long-term cure. However, only about 20 to 30 per cent of pancreatic cancers are operable at diagnosis. When operable, a surgery known as a ‘Whipples pancreaticoduodenectomy’ is the most common surgery performed.
When there is no spread outside the pancreas, a five-year survival is at 20 to 30 per cent. When the tumour involves adjacent vessels with distant spread, pre-operative chemotherapy (known as Neoadjuvant Therapy) may shrink the tumour and make it operable.
When the tumour has spread to distant sites, the prognosis is dismal and the patient is offered palliative care. With advances in palliative care techniques and protocols, a lot can be done to make these patients live more comfortably.