Pancreatic/Pancreas Cancer Treatment in Delhi, India

Pancreatic cancer is a disease in which healthy cells in the pancreas stop working as required and start growing out of control. These cancerous cells can build up and form a mass called a tumour. A cancerous tumour is malignant, meaning it can grow and spread to other parts of the body. As it grows, a pancreatic tumour can affect the function of the pancreas, grow into nearby blood vessels and organs, and eventually spread to other parts of the body through a process called metastasis.

While the causes of pancreatic cancer are still unclear, experts have identified various risk factors that may increase the chances of an individual developing pancreatic cancer. These include:

Age: The risk of pancreatic cancer increases with age, with the majority of cases diagnosed in people over 60 years old.

Tobacco Use: Smoking is a significant risk factor for pancreatic cancer, and it is one of the most preventable causes of the disease.

Family History: Individuals with a family history of pancreatic cancer or certain genetic syndromes, like Lynch syndrome, hereditary breast and ovarian cancer syndrome, or familial atypical multiple mole melanoma (FAMMM) syndrome, are at higher risk.

Obesity: Being overweight or obese increases the likelihood of developing pancreatic cancer.

Chronic Pancreatitis: Long-term inflammation of the pancreas, often caused by excessive alcohol consumption or other factors, can elevate the risk.

Diabetes: People with long-standing diabetes, especially type 2 diabetes, are at an increased risk of pancreatic cancer.

Diet: A diet high in red meat, processed meats, and low in fruits and vegetables may contribute to a higher risk.

Race and Ethnicity: Pancreatic cancer is more common in African Americans than in whites. Some studies have also suggested an increased risk among Ashkenazi Jews.

Occupational Exposure: Certain workplace exposures, such as to certain chemicals or dyes used in metalworking and dry cleaning, may pose a risk.

Gender: Men are slightly more likely to develop pancreatic cancer than women.

There are several types of pancreatic cancer, mainly depending on what part of the pancreas the cancer began. So, to understand the types of pancreatic cancer, it is important to know about the two primary parts of the pancreas: Exocrine and Endocrine.

Exocrine: This part has little tubes and small sacs called acini at the end of these tubes, which make special proteins called enzymes. These enzymes are extremely important as they go into the small intestine and help the body break down and digest food, especially fats.

Endocrine: This part consists of groups of cells called “islets of Langerhans. These cells produce important hormones. The most important one is insulin, which helps control the amount of sugar in the blood. The cells also produce other important hormones like glucagon, somatostatin, pancreatic polypeptide (PP), and vasoactive intestinal peptide (VIP).

Moving on to the types of pancreatic cancer.

Exocrine Tumours 

Exocrine tumours are the most common underlying condition that can lead to pancreatic cancer, with Adenocarcinoma being the most common exocrine tumour accounting for the majority of cases. Other rare types of exocrine tumours include:

• Acinar Cell Carcinoma: This cancer starts in the cells that produce pancreatic enzymes.
• Squamous Cell Carcinoma: This rare cancer starts in the squamous cells that line the ducts of the pancreas.
• Adenosquamous Carcinoma: This rare cancer is a combination of adenocarcinoma and squamous cell carcinoma.
• Colloid Carcinoma: This rare cancer is made of mucus-secreting cells.

Neuroendocrine Tumours (NETs) 

These tumours are less common than exocrine tumours, accounting for less than 10% of cases. They start in the cells that produce hormones in the pancreas. The most common type of NET is insulinoma, which produces insulin. Other types of NETs include:

• Gastrinoma: This tumour produces gastrin, a hormone that stimulates the stomach to produce acid.
• VIPoma: This tumour produces vasoactive intestinal peptide, a hormone that causes watery diarrhoea.
• Glucagonoma: This tumour produces glucagon, a hormone that raises blood sugar levels.
• Somatostatinoma: This tumour produces somatostatin, a hormone that inhibits the release of other hormones.

Pancreatic cancer can cause a variety of symptoms. However, at an early stage, it may not show any symptoms. By the time symptoms occur, the cancer may have already spread to other parts of the body. The most common early signs of pancreatic cancer include:

• Jaundice: This is a yellowing of the skin and eyes. Jaundice is caused by a blockage of the bile duct, which carries bile from the liver to the small intestine.
• Pain in the Upper Abdomen: This pain may be constant or intermittent, and it may radiate to the back.
• Weight Loss: Unexplained weight loss of 10 pounds or more can be a sign of pancreatic cancer.
• Loss of Appetite: People with pancreatic cancer often lose their appetite and find it difficult to eat.
• Nausea and Vomiting: These symptoms can be caused by the tumour or by blockage of the bile duct.
• Fatigue: People with pancreatic cancer often feel tired and weak.
• Abdominal Bloating: This is caused by a buildup of fluids in the abdomen.
• Changes in Bowel Habits: These changes can include diarrhoea, constipation, or a change in the consistency of the stool.
• Dark Coloured Urine: This is caused by bilirubin, a waste product that is normally removed from the body by the liver.
• Itchy Skin>: This can be caused by a buildup of bile in the bloodstream.

Anyone who experiences any of these symptoms, must see a doctor right away. Early diagnosis and treatment are important for improving the chances of survival for pancreatic cancer.

Pancreatic cancer can be difficult to diagnose as the symptoms are often vague and can be mistaken for other conditions. However, there are a number of tests that can be used to diagnose pancreatic cancer. These include:

Imaging Tests

These tests can create images of the pancreas and surrounding organs to help doctors look for a tumour. Commonly used imaging tests for diagnosing pancreatic cancer include:

• Computerised Tomography (CT): This test uses X-rays to create detailed images of the inside of the body.
• Magnetic Resonance Imaging (MRI): MRI test uses a strong magnetic field and radio waves to create detailed images of the body.
• PET CT: This imaging technique combines nuclear medicine and CT scans, providing comprehensive insights into the metabolic activity and structure of tissues, aiding in the diagnosis and staging of pancreatic conditions.
• Endoscopic Ultrasound (EUS): This test uses an ultrasound probe that is inserted through the mouth and into the stomach to create images of the pancreas.

Blood Tests

These tests can measure the levels of certain proteins and enzymes that can be elevated in people with pancreatic cancer. Blood tests that may be used to diagnose pancreatic cancer include:

• CA19-9: This is a tumour marker that is often elevated in people with pancreatic cancer. However, it can also be elevated in people with other conditions, so it is not a definitive test for pancreatic cancer.
• Amylase and Lipase: These are enzymes that are produced by the pancreas. Elevated levels of these enzymes can be a sign of pancreatitis, but they can also be elevated in people with pancreatic cancer.

Biopsy

A biopsy is the removal of a small piece of tissue from the tumour for examination under a microscope. This is the only way to definitively diagnose pancreatic cancer.

If someone experiences symptoms that could be caused by pancreatic cancer, it is important to see a doctor right away. Early diagnosis and treatment are important for improving the chances of survival for pancreatic cancer.

Commonly prescribed treatments for pancreatic cancer include:

Pancreatic Cancer Surgery

Surgery is the only way to cure pancreatic cancer if the cancer is localised. The goal of pancreatic cancer surgery is to remove the tumour and any surrounding tissue that may be cancerous.

Whipple Procedure/Whipple Surgery 

The Whipple procedure is a surgery used to treat pancreatic cancer. In simple terms, it involves removing the head of the pancreas, part of the small intestine, the gallbladder, and sometimes a portion of the stomach and bile duct. The goal is to take out the cancer and surrounding tissues. While it can be a powerful treatment, not everyone is eligible, and recovery can be challenging, affecting how the digestive system works. Doctors carefully consider the cancer stage and a patient's overall health before deciding if the Whipple procedure is the right option.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Pancreatic cancer chemotherapy 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.

Radiation Therapy

Radiation therapy 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

Targeted therapy uses drugs that target specific molecules involved in cancer growth and spread. Targeted therapy is not a standard treatment for pancreatic cancer, but it may be used in some cases.

Immunotherapy

Immunotherapy uses the body's own immune system to fight cancer. Immunotherapy is not a standard treatment for pancreatic cancer, but it is being studied in clinical trials.

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.

Prognosis in pancreatic cancer is influenced by several critical factors:

Stage at Diagnosis: Pancreatic cancer is often asymptomatic in its early stages, making early detection challenging. Patients diagnosed at a localised stage have a more favourable prognosis than those with advanced, metastatic disease.

Type of Pancreatic Cancer: The type of pancreatic cancer plays a role in prognosis. Pancreatic adenocarcinoma, the most common type, is typically associated with lower survival rates compared to rarer types like pancreatic neuroendocrine tumours (PanNETs).

Overall Health: A patient's overall health and fitness level can impact their ability to undergo surgery or tolerate aggressive treatments. Individuals in better health may have a more favourable prognosis.

Response to Treatment: The effectiveness of treatment, such as surgery, chemotherapy, and radiation therapy, can significantly influence prognosis. A positive response to therapy may extend survival.

The survival rate of pancreatic cancer varies depending upon the stage and type of cancer. 

Localised Pancreatic Cancer: For patients with localised, resectable tumours, the 5-year survival rate is around 20%. Early detection and surgical removal of the tumour offer the best chance of long-term survival.

Locally Advanced Pancreatic Cancer: When the cancer has spread to nearby tissues but is still resectable, the 5-year survival rate drops to approximately 12%.

Metastatic Pancreatic Cancer: Unfortunately, most patients are diagnosed with metastatic disease, where the cancer has spread to distant organs. In such cases, the 5-year survival rate is only about 3%.

Pancreatic Neuroendocrine Tumours (PanNETs): Survival rates for PanNETs tend to be more favourable. The 5-year survival rate for localised PanNETs is around 80%, emphasising the importance of early detection.

Coping with the emotional and physical challenges of pancreatic cancer is a significant part of the journey. Here are key aspects of coping:

Emotional and Psychological Support: A pancreatic cancer diagnosis can evoke a range of emotions, from fear toanxiety and sadness. Seeking emotional support through therapy or counselling can help patients and their families navigate these challenging feelings.

Support Groups: Joining a support group for pancreatic cancer can provide a sense of belonging and shared experiences. These groups offer a safe space to discuss concerns, ask questions, and receive encouragement from others facing similar challenges.

Nutritional Guidance: Maintaining proper nutrition can be difficult due to digestive issues. Consulting with a registered dietitian can help patients manage their diets to ensure adequate nourishment and energy during treatment.

Managing Pain and Side-Effects: Pancreatic cancer and its treatments can lead to pain and various side effects. Effective pain management and strategies for addressing side effects like nausea, fatigue, and loss of appetite are essential for improving the patient's quality of life.

Quality of Life Considerations: Patients should focus on enhancing their overall quality of life. This includes staying engaged in activities they enjoy, spending time with loved ones, and making decisions that prioritise their comfort and well-being.

Lifestyle Choices: Lifestyle choices play a significant role in reducing the risk of pancreatic cancer. Quitting smoking, maintaining a healthy body weight, and adopting a balanced diet rich in fruits and vegetables can lower the risk.

Screening and Early Detection: While routine screening for pancreatic cancer is uncommon, individuals with a family history or known genetic predisposition should consider regular check-ups and screenings. Early detection can significantly improve treatment outcomes.

Q: What is pancreatic cancer, and what are its causes?

Pancreatic cancer is a type of cancer that forms in the pancreas, an organ responsible for producing enzymes that aid digestion and hormones that regulate blood sugar. The exact cause is not always clear, but risk factors include smoking, family history, age, chronic pancreatitis, and certain genetic mutations.

Q: What are the early signs of pancreatic cancer?

Early signs of pancreatic cancer can be subtle and often go unnoticed. They may include abdominal pain that radiates to the back, jaundice (yellowing of the skin and eyes), unexplained weight loss, loss of appetite, and changes in bowel habits.

Q: How is pancreatic cancer diagnosed?

Diagnosis typically involves a combination of medical history, physical examination, blood tests, imaging studies (such as CT scans or MRIs), and often a biopsy to confirm the cancer's presence and determine its type and stage.

Q: What are the common types of pancreatic cancer?

Pancreatic cancer is primarily categorised into two types: exocrine tumours (most common) and endocrine tumours (rarer). Exocrine tumours include adenocarcinomas, while endocrine tumours involve the pancreas's hormone-producing cells, called islet cells.

Q: What are the treatment options for pancreatic cancer?

Treatment options for pancreatic cancer may include surgery, chemotherapy, radiation therapy, and targeted therapy. The choice of treatment depends on the stage of cancer, location, and the patient's overall health.

Q: What is the cost of pancreatic cancer treatment in India?

The cost of pancreatic cancer treatment in India varies depending on factors like the stage of cancer, the type of treatment, and the healthcare facility. It's advisable to consult with Pancreas cancer treatment doctors or hospitals directly for accurate and up-to-date cost estimates based on your specific case.

Q: Can pancreatic cancer be prevented?

Prevention of pancreatic cancer involves making healthy lifestyle choices like quitting smoking, maintaining a healthy weight, and limiting alcohol consumption. Regular medical check-ups and discussing risk factors with a healthcare provider are also crucial.

Q: What is the survival rate for pancreatic cancer?

Pancreatic cancer often has a lower survival rate due to late-stage diagnoses. However, early detection can significantly improve outcomes. Survival rates vary by stage and treatment, so it's essential to consult with a healthcare specialist for personalised information.

Q: Are there support services available for pancreatic cancer patients?

Yes, pancreatic cancer patients and their families can access support services such as counselling, support groups, and patient advocacy organisations. At Max Hospitals, we offer many comprehensive supportive therapy programs to help patients cope with the challenges of cancer.

Q: How does Max Hospitals ensure optimal treatment outcomes for patients?

At Max Hospitals, we have a team of multispeciality oncologists in Delhi. Every doctor has their own exceptional expertise and experience, and you can rest assured that each one is committed to delivering the best possible healthcare and treatment options to their patients. Most importantly, each case is discussed in the tumour board with a team of oncologists to ensure that our patients get the best treatment outcome. 

Reviewed by Dr. Pankaj Kumar Pande - Associate Director, Surgical Oncology, Cancer Care / Oncology, Gastrointestinal & Hepatobiliary Oncology on 16-Jan-2024.

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