April 24, 2019
Recently, Manohar Parrikar, the chief minister of Goa and a politician of national stature succumbed to pancreatic cancer after battling with it for over a year. This has brought to the public awareness about a cancer that in the Indian context is less but is probably the most dangerous of all. From a terminological perspective, pancreatic cancer is cancer of the pancreas, an important organ involved in releasing the enzymes that are important in digestion and also hormones like glucagon, insulin and somatostatin that are important in the regulation of blood sugar. The pancreas is present in the abdomen horizontally behind the lower part of the stomach. Reports indicate that men have a higher likelihood of developing pancreatic cancer than women and that this may be due to increased tobacco and alcohol use.
Pancreatic cancer is arguably one of the most dangerous forms of cancer and has exceptionally high mortality rate worldwide. This is because the diagnosis is often delayed and pancreatic cancer is detected only when it has reached an advanced stage. The pancreas is in the abdomen, a large area of the body and when anything starts enlarging it takes time for symptoms to appear. The most common symptoms of this cancer are jaundice, weight loss, nausea, vomiting and back pain. However, to make matters worse symptoms like pain in the abdomen cannot lead to a diagnosis of pancreatic cancer directly. It is only when it spreads to areas like the liver do the symptoms start showing up. Pancreatic cancer also spreads faster than many other types of cancers, and this makes it difficult for doctors to control it. To compound the problem, to date there are no general screening tools. The signs and symptoms of pancreatic cancer often don't occur until the disease has spread to different organs. The three most important signs commonly seen in most patients are:
1. Pain in the upper abdomen that radiates to the back or pain in the back or the stomach. The pain may come and go at first and is often worse when lying down or after having food.
2. Loss of appetite or unintended weight loss.
3. Jaundice – the most obvious sign is yellowing of the skin and whites of the eyes; it also causes your urine to be dark yellow or orange and stools (faeces) to be pale-colored.
The other possible symptoms include:
1. Nausea and vomiting
2. Bowel changes
3. Fever and shivering
5. Blood clots
6. New-onset diabetes
7. Unexplainable fatigue
8. Yellowing of your skin and the white of eyes (jaundice)
9. Changes in bowel motions – like diarrhea, severe constipation, or pale, oily and foul- smelling stools.
The risk factors for pancreatic cancer include:
1. Smoking (cigarette smokers are about twice as likely to develop pancreatic cancer)
2. Ageing (people aged 50-80 are more at risk)
3. Type 2 diabetes
5. Chronic pancreatitis (long-term inflammation of the pancreas)
6. Certain types of cysts in the pancreatic duct known as intraductal papillary mucinous neoplasms (IPMNs)
7. Drinking too much alcohol
8. Family history and inherited conditions
9. Being very overweight
10. Stomach (Gastric) ulcer
11. Infection by Helicobacter pylori
12. Family history of genetic syndromes like mutation in BRCA2 gene mutation, Lynch syndrome and familial atypical mole-malignant melanoma (FAMMM) syndrome
Diagnosis of pancreatic cancer
In most cases, a clinical examination that includes physical examination of the abdomen for a lump and liver enlargement, examination of skin and eyes for signs of jaundice is the starting point. Following this, certain blood tests and radiological methods like ultrasound scan, computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan or a positron emission tomography (PET) scan may be carried out. When there is a suspicion for pancreatic cancer an endoluminal ultrasonography (EUS) or an endoscopic retrograde cholangiopancreatography (ERCP) may be performed. Finally a laparoscopy guided biopsy is to be performed to confirm the tumor.
Treating pancreatic cancer
The treatment of pancreatic cancer is very challenging and will depend on the type and location of cancer, as to how far it is advanced and the age and general health of the individual. Treatment may include surgery, chemotherapy, radiation therapy or a combination of these. Surgery is the most preferred and suitable treatment modality when the tumor is removable in the early stage. However in advanced stages chemotherapy is the treatment of choice. Radiotherapy may also be used after surgery for local control. Some types of pancreatic cancer only require one form of treatment, whereas others may require two types of treatment or a combination of all three.
Pancreatic cancer in India and Mangaluru
When compared to the western countries the incidence of pancreatic cancer is very less in India. However, recent reports suggest that their numbers are increasing in India. When compared to the last fifteen years the incidence of pancreatic cancer is also increasing in Mangaluru. Abstinence from smoking and heavy drinking, regular exercising, eating a proper diet rich in fruits and vegetables is the best lifestyle choice for overall health, and that being vigilant to the signs enlisted above is also important especially in the high risk group.