With an unusually high mortality rate, pancreatic cancer is the 11th most prevalent cancer in India. According to Conservative reports, pancreatic cancer is more common in men than women and barely 29 percent of people survive for not more than a year without an interventional procedure. This makes early detection and timely treatment extremely important. Some known figures who suffered from pancreatic cancer include Alan Rickman, Steve Jobs and Joan Crawford. It is time to bring to light the importance of raising awareness about the disease and possible treatment options available.
Understanding the disease profile
Pancreatic cancer develops when cells in the pancreas begin to grow uncontrollably. Most pancreatic cancer begins in the cells that line the ducts of the pancreas. This type of cancer is called pancreatic exocrine cancer. When cancer forms in the hormone-producing cells or the neuroendocrine cells of the pancreas, these types of cancer are called islet cell tumors, pancreatic endocrine cancer, and pancreatic neuroendocrine tumor. A patient might not exhibit symptoms of the disease until it has advanced, therefore it is important to know your body and be vigilant about any alarming changes the person experiences. Some symptoms associated with pancreatic cancer are – yellowing of the eyes and skin (jaundice), itchy skin, dark-colored urine, belly and back pain, unexplained weight loss, nausea, vomiting and loss of appetite.
Some lifestyle factors such as smoking, obesity, drinking and others can trigger as well increase the chances of an individual developing cancer in the pancreas. The reason this disease is diagnosed in the later stage is because of the location of the organ. The early tumor does not show any visible symptoms since pancreas is located in the posterior part of the body. It is only when the tumor starts spreading and affecting other organs that a patient begins to demonstrate symptoms. Some of the commonly observed signs of the cancer are—jaundice, new onset diabetes at a later age, sudden weight loss and itching.
Potential treatment for pancreatic cancer
If diagnosed in early stages, pancreatic cancer can be treated effectively with surgery. For patients at advanced stage, surgery can still be used for restoring function, relieving pain and improving survival rates.
After the symptoms have appeared, a patient should go for routine check-ups so that the doctor can assess their condition and decide a suitable therapeutic option. Conventionally, procedures like Whipple’s surgery that involves removing the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct, is used to treat cancer in head of pancreas. Other procedures include – total pancreatectomy (removal of the pancreas) and distal pancreatectomy with removal of spleen. Most patients are diagnosed for the cancer only after multiple tests such as MRIs, CT scans. A procedure that can directly visualize the presence of malignancy in the pancreas and treat it in time, has been missing in the treatment options used so far. At present, Endoscopic ultrasound is an investigation of choice for detecting small pancreatic tumors. Even tumors missed by CT, MRI can be picked EUS. Not only, EUS diagnose small tumor with accuracy, it also gives more information about the vascular invasion and local spread. We can also take targeted biopsies with EUS.
Thanks to scientists, who introduce newer treatment methods and with dramatic transformation in the field of oncology, patients now have access to minimally invasive procedures to detect as well treat cancer in the pancreas. A procedure known as cholangioscopy which allows direct visualization of bile duct and pancreatic duct is used now. Combining pancreatoscopy with ERCP helps a gastroenterologist to have a clear understanding of the pancreatic duct. During this procedure, a spyglass cholangioscopeis passed into the pancreatic duct. The cholangioscope comes with a tiny 1mm HD vision camera facilitating a gastroenterologist to diagnose, take tissue samples and prepare further course of treatment. It is an important diagnostic tool for confirming as well as ruling out cancer of the pancreas. It is very useful in the evaluation of pancreatic duct strictures where we can go inside the pancreatic duct and take biopsies directly.
With technological advents, it is the patient’s responsibility to take the next step and help fight the lethal disease better. Minimally invasive procedures offer the best chance of controlling pancreatic cancer but unfortunately, most patients are diagnosed at later stages and are not eligible for surgeries. As pancreatic cancer is becoming a major health concern, it is imperative to raise awareness about the disease profile and its possible treatment options.
(Disclaimer: The writer is Dr Vinoth Kumar, Senior Consultant, Department of Medical Gastroenterology and Intraventional Endoscopy, GEM Hospital, Chennai. Views expressed are a personal opinion.)