A silent disease
Pancreatic cancer is considered to be most deadly among all cancers due to the lack of characteristics symptoms, writes PRITHA BANERJEE
Goa Chief Minister Manohar Parrikar is reportedly suffering from an advanced stage of pancreatic cancer. He has been flown to the US from Mumbai for treatment. The former Defence Minister was admitted to Goa Medical College and Hospital on February 15 when he was complaining of stomach pain. Later, he was flown to Lilavati Hospital in Mumbai and was initially getting treated for food poisoning. According to the Global cancer statistics, 2002, Pancreatic Cancer is 13th most common cancer worldwide. It is 11th most common cancers in India, says Dr S K Mathur, Hepato Pancreato Biliary and liver transplant surgeon at Zen Multispecialty Hospital. “Among the gastrointestinal tract (GI tract) it is sixth most common, after esophagus, stomach, large intestine, liver, and gallbladder,” he adds.
Most deadly
The cancer of the pancreas is considered deadly because of its low survival rate. Pancreatic Cancer rarely shows any symptoms during the early stages when it is treatable. Dr Yogen Chheda, Onco-Surgeon at SRV Hospital, Goregaon Mumbai, says that the data that is available for pancreatic cancer is very limited compared to any other form of cancer. “Most of the time chemo-radiation is not that effective. Sometimes after detection, when the patient is taken to the operation, 30% of cancer goes undetectable and only a very small subset is actually operated. These patients, even after surgery, survive for only five years and again develop the disease after that.”
For early detection of the disease, there are no screening tools specific to this kind of cancer, says Dr Chheda. For reasons unknown, pancreatic cancer is more common in men than women. The survival rate is one year for 29% of people who don’t undergo surgery and five years for 7% people who do, according to the cancer statistics. The survival rates are based on the stage at which the cancer is detected.
“As pancreas is located in the posterior part of the body, the early tumor does not show any symptom. It is only when the tumor starts affecting the surrounding organs the patients start showing any symptoms,” claims Dr Chheda.
Symptoms and treatment
The pancreas is a pear-shaped organ and has three main parts. The head produces the digestive juices that are secreted into the digestive tract and it is where the stomach empties the partially digested food for more digestive enzymes to get into these contents. It is the juncture where the stomach meets the first part of the small intestine. The center part is also known as the neck and body and the tail of the organ produces insulin that helps to control the blood sugar.
Dr Mathur says, “When the tumor is in the head of the pancreas the exocrine function gets affected and the patient shows the symptoms of jaundice that is yellowing of the skin and the whites of the eye. They might show new-onset diabetes if the tumor is in the tail of the pancreas.”
About 95% of cancerous (malignant) tumors of the pancreas are adenocarcinomas and occurs in the head that is the first segment of the small intestine. He adds, “The patient is presented with jaundice is accompanied by itchiness all over the body resulting from the deposit of bile salt crystals under the skin. There may be vomiting when cancer in the head of the pancreas as the tumor is obstructing the flow of stomach contents into the small intestine.”
“When detected at a stage where curative surgery is an option, the patient undergoes a complex procedure known as Whipple. The operation removes the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct. It is done when the cancer is confined to only the head of the pancreas. In the end, the remaining organs are reconnected for the person to digest food normally after surgery,” avers Dr Chheda.
Only 20% of pancreatic cancer patients are eligible for Whipple procedure and even less for whom it is done laparoscopically through several small incisions. Other procedure includes total pancreatectomy, removal of the pancreas and distal pancreatectomy removal of pancreas and spleen.
Chemo and radiation therapy is given at an advanced stage when cancer has spread too much to be operated. “For patients, who are dealing with the fourth stage of pancreatic cancer, are given stronger painkillers, such as codeine or morphine for back pains. Oral enzyme preparation to treat the lack of pancreatic digestive enzymes and insulin treatment for diabetes,” says Dr Chheda.
Causes
Lifestyles choices like smoking and drinking put a person at the risk of developing pancreatic cancer. Apart from that, Type 2 Diabetes, chronic pancreatitis, and obesity are the major causes of pancreatic cancer. The risk is higher for individual more than 50 years of age than younger persons. Dr Chheda claims smoking cigarettes as a direct cause of pancreatic cancer and drinking alcohol as indirect. “People who are drinking alcohol have a high risk of developing chronic pancreatitis which causes cancer.”
These types of tumors are more common among smokers than nonsmokers. “Only 5% of patients may have the disease due to the genetic factor. Longstanding diabetes may also be a major risk factor,” adds Dr Chhedda. Poor diet may also increase the risk of this type of cancer. For people consuming red and processed meat and suffering from obesity, the risk is more because pancreas produces more insulin.
Love your body
Maintaining a proper diet and exercise can help a lot. “Balanced diet with fruits and vegetables and avoiding smoking completely is the best measure,” says Dr Mathur.
“For patients who are long-term diabetic must undergo evaluation and investigation to be sure that they are not developing pancreatic cancer,” says Dr Chheda.
Apart from that, for a person who wants to be extra careful can meet a genetic counsellor to review the family health history and consider a genetic test to understand the risk of pancreatic cancer.
A person who wants to be extra careful can meet a genetic counsellor to review the family health history and consider a genetic test to understand the risk of pancreatic cancer.