About pancreatic cancer:

• Pancreas is a mixed gland which acts as both a digestive and an endocrine organ. It produces digestive enzymes that break down fats, proteins and carbohydrates in the small intestine. This is its exocrine function.

Its endocrine function involves secreting hormones, primarily insulin and glucagon, to regulate the sugar level of the blood.

• Pancreatic cancer occurs when there is an abnormal growth of cells in the pancreas, forming tumors.
• Genetic mutations, a combination of inherited and acquired changes, along with smoking, obesity, diabetes etc., can cause pancreatic cancer.
• Pancreatic cancer survival is low as the disease is difficult to detect in the early stages, hence it has poor prognosis.

Statistics:

• Age, male, gender and African American race are key factors associated with a higher incidence of pancreatic cancer.

The average age at diagnosis is 70, and majority of the patients are over 45. The incident rate is the highest among those aged 80 and above.

• Study even shows that pancreatic cancer is rising faster in individuals under 55, particularly women.
• Pancreatic cancer is a rare but deadly cancer with a low five-year survival rate, which was around 9% in 2019, though it has increased to about 12% by 2023.

Types of pancreatic cancer:

• Pancreatic exocrine tumors: about 93% of pancreatic cancers are exocrine tumors. They start in the exocrine cells of the pancreas, which produces enzymes that help in the digestion.
• Pancreatic neuroendocrine tumors: these are rare and slow growing tumors originating from the hormone producing cells of the pancreas. It accounts of all pancreatic tumors.

Location:

• Pancreatic cancer can form in any part of the pancreas.
• 65%-70% of the cases occur in the head, the eidest part, located on the right side of the abdomen, near the curve of the small intestine.
• It may also occur in the body and tail, having a worse prognosis.

Causes:

• Pancreatic cancer is caused by DNA mutations in pancreatic cells that lead to uncontrolled growth, though specific causes are often unclear.
• Tobacco use is a major risk factor, with a direct link to a significant percentage of pancreatic cancer cases.
• Long term diabetes, especially type 2, is also a risk factor.
• Being overweight or obese, particularly abdominal fat.
• A personal or family history of pancreatic cancer and inherited genetic conditions like those linked to Lynch syndrome or BRCA mutations increase risk.
• Long-term inflammation of the pancreas is a significant risk factor.
• Heavy alcohol use
• Diets high in red and processed meats and low in fruits and vegetables may increase risk.

Stages:

• Stage 0 (carcinoma in situ): abnormal cells found in the lining of the pancreas. The cells may become cancerous and spread into nearby normal tissues.

Detection the cancer at this stage provides an excellent chance for complete recovery.

• Stage 1 (localized): it is a very early form of the disease. the cancer is only confined to the pancreas and has not spread.

It is divided into stage 1A, where the tumor is 2cm or smaller tumor and stage 1B, where the tumors are bigger than 2 cm.

The cancer can be potentially removed by surgery, and the prognosis is generally favorable.

• Stage 2 (locally advanced): the cancer has not spread to distant sites, but has grown outside the pancreas or into nearby lymph nodes.

This stage is divided in to stage 2A, where the tumor size is lager than 4cm, and the cancer has not spread to nearby lymph nodes or distant organs.

And stage 2B, where the tumor can be of any size and it has spread to 1 to 3 lymph nodes.

The tumors can be removed by surgery.

• Stage 3: the tumor has become too large to be removed by surgery and has also spread into nearby major blood vessels and nerves. The cancer has still not spread to distant parts.

The tumor becomes unresectable, so it is shrunk with the help of chemotherapy and radiation therapy, to make it resectable.

The tumor can be of any size, and spread to four or more nearby lymph nodes. It may also spread to major blood vessels like the portal vein, celiac axis or superior mesenteric artery.

• Stage 4 (metastatic): the cancer has spread to distant parts like the liver or lungs. This stage is often treated to manage the disease and symptoms rather than to cure it, because its removal and cure become difficult.

The cancer is not curable at this stage, and the main focus is improving the quality of life and prolonging life, using treatments like chemotherapy.

It is often referred to as advanced cancer. The survival rate for this stage is very low.

Symptoms:

Pancreatic cancer often doesn't cause symptoms until the disease is advanced. When they happen, signs and symptoms of pancreatic cancer may include:

• Belly pain that spreads to the sides or back.
• Loss of appetite.
• Unexplained Weight loss.
• Yellowing of the skin and the whites of the eyes, called jaundice.
• Light-coloured or floating stools.
• Dark-coloured urine.
• Itchy skin
• New diagnosis of diabetes or diabetes that's getting harder to control.
• Pain and swelling in an arm or leg, which might be caused by a blood clot.
• Tiredness or weakness.
• Abdominal and back pain

Prevention:

• Quit smoking
• Maintaining a healthy weight: being over weight or obese can increase the risk
• Intake of a healthy diet, rich in fruits, veggies, whole grains etc. limited intake of red meat, sugary drinks and highly processed foods.
• Exercising regularly
• Limited intake of alcohol
• Regular medical check ups
• Genetic counselling

Diagnosis:

• Imaging tests: this takes the picture and shows the inside of the body. This includes ultrasound, CT scans, RI scans and positron emission tomography scans.
• Endoscopic ultrasound: it is a test to make pictures of the digestive tract, nearby organs and tissues, which can also be used to take pictures of the pancreas. It uses sound waves to create images.
• Biopsy: it removes the sample tissue for testing in the lab. Special tools are passed down during EUS, to take the tissues of the pancreas. It can also be collected by inserting a needle through the skin and into the pancreas. This is called fine needle aspiration. The tissue then goes to the lab for testing to see if it is cancer.
• Blood tests: Blood tests might show proteins called tumour markers that pancreatic cancer cells make. One tumour marker test used in pancreatic cancer is called CA19-9.
• Genetic testing: Genetic testing uses a sample of blood or saliva to look for inherited DNA changes that increase the risk of cancer. The results can show whether the family members have the risk of getting the cancer.
• Physical examination:
• A doctor will check for masses or fluid buildup in the abdomen and look for signs of jaundice.
• PET scan: positron emission tomography scan: Uses a radioactive tracer to identify cancerous cells.

Treatment:

• Chemotherapy: it uses drugs to kill the cancer cells. This method can be used before the surgery to shrink the tumor, or after the surgery to kill the remaining cells, or as a standalone treatment for advanced pancreatic cancer.
• Radiation therapy: it uses high energy beams to kill cancer cells. Radiation therapy can be used before surgery to shrink the tumour, after surgery to kill any remaining cancer cells, or as a standalone treatment for advanced pancreatic cancer.
• Targeted therapy: it is the use of drugs to target specific molecules involved in the cancer growth and spread.
• Immunotherapy: it uses the body’s own immune system to fight cancer.
• Surgery: it is the only realistic way to remove a pancreatic tumor. It is only recommended if the tumor can be completely removed, otherwise it would be useless.
• Palliative care

The treatment for pancreatic cancer depends on the stage of the cancer, the patient's overall health, and their individual preferences. Some patients, for instance, are not in a condition to endure surgery or chemotherapy, whereas many are reluctant about surgery. The best pancreatic cancer treatment plan, therefore, varies from person to person, and it is important to consult a pancreatic cancer doctor to choose a suitable treatment plan.

Side effects of the treatment:

Chemotherapy side effects:

• Digestive issues
• Fatigue
• Mouth sores
• Hair loss
• Neurotherapy
• Increased infection risk

Radiation therapy side effects:

• Fatigue
• Skin changes
• Digestive problems
• Appetite loss

Surgery side effects:

• Pain
• Complications such as bleeding, infection blood clots, leakage of blood fluids.

Targeted therapy side effects:

• It varies by drug. It may include diarrhea, liver issues, skin rashes etc.

Maintenance:

• Rest
• Exercise: short walks can help boost blood flow and prevent complications like pneumonia and constipation. Avoid any strenuous exercises.
• Avoid lifting anything for 4 to 6 weeks that can cause strain like child, groceries.
• Small and frequent meals, like 5 to 6 small meals and snacks is better than 2 or 3 large ones
• Take prescribed pancreatic enzyme supplements to help your body absorb fats, carbohydrates, and proteins.
• Be mindful of high-sugar foods, as they can cause dumping syndrome, leading to diarrhoea, nausea, and light-headedness. Limit liquids during and immediately after meals to help with digestion.
• Monitor your incision for redness, swelling, warmth or drainage.
• If you have a drain, follow your doctor's specific instructions for its care and emptying.
• You may shower, but avoid baths until your doctor gives the okay. Pat the incision dry after showering and replace any dressing.
• Watch for infections, chills, or sweating.
• If you are a patient of diabetes, check your sugar levels regularly.

FAQS:

1. What is pancreatic cancer?

Ans- Pancreatic cancer is when cells in the pancreas grow abnormally and uncontrolled, forming a tumour.

1. Can pancreatic cancer go undetected?

Ans- yes, very often this cancer may go undetected. Early stages have vague symptoms, that we have for other causes too. As pancreas is deep inside the body, the tumors are hard to feel or detect, imaging may miss small lesions.

1. What should I expect after pancreatic cancer surgery?

Ans- after the surgery you will have to spend some days in the hospital. Pain, fatigue, and discomfort is expected. You will have drips and tubes to support body functions. You may lose weight. There can be difficulty in digesting fat. It can worsen diabetes.

1. Is pancreatic cancer curable if caught early?

Ans-Yes, there is greater chance of cure when pancreatic cancer is detected very early and is still localized (hasn’t spread to major blood vessels or other organs). Surgical removal is the treatment most associated with potential cure.

1. Do certain foods fight pancreatic cancer?

Ans-

1. How long is the recovery after surgery?

Ans- it depends on the extent of the surgery and the patient. You might return to normal daily routine or light work in 4 weeks after leaving hospital (for some people) but full strength may take 3 months or more.

1. Symptoms for pancreatic cancer.

• Ans- Belly pain that spreads to the sides or back.
• Loss of appetite.
• Unexplained Weight loss.
• Yellowing of the skin and the whites of the eyes, called jaundice.
• Light-coloured or floating stools.
• Dark-coloured urine.
• Itchy skin
• New diagnosis of diabetes or diabetes that's getting harder to control.
• Pain and swelling in an arm or leg, which might be caused by a blood clot.
• Tiredness or weakness.
• Abdominal and back pain

8.Should we panic if we have pancreatic cancer?

Ans- It’s natural to be very worried—pancreatic cancer is serious. But panicking is not productive. What’s more helpful is:

• Seeking prompt medical evaluation if you have symptoms. Early diagnosis improves options.
• Getting care from experienced specialists (surgical oncologists, gastroenterologists, etc.).
• Understanding realistic expectations: what treatments are possible, what side effects to expect.
• Focusing on what you can control: nutrition, managing symptoms, working with your team.

Many people live meaningful lives during and after treatment; quality of life, palliative care, and support are very important.