The cancer that grows inside the pancreas is known as pancreatic cancer. Pancreas is the gland that is about 6 inches long that makes hormones including the enzymes responsible for controlling blood sugar and also helps in digesting food. The development of pancreatic cancer starts when the cells inside the pancreas grow out of control. This cancer may metastasize or spread top surrounding organs and lymph nodes such as lungs and liver.

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What is Pancreatic Cancer?
The cancer that grows inside the pancreas
is known as pancreatic cancer. Pancreas
is the gland that is about 6 inches long
that makes hormones including the
enzymes responsible for controlling blood
sugar and also helps in digesting food.
The development of pancreatic cancer
starts when the cells inside the pancreas
grow out of control. This cancer may
metastasize or spread top surrounding
organs and lymph nodes such as lungs and liver.
The pancreas
The pancreas is a long leaf shaped organ, almost resembling a flattened obelisk. The
broad end is called the head, the tapering point called the tail and the intervening
part called the neck and body. It lies transversely in front of the spine in the
abdomen. The head end is situated on the right side and the tail on the left, touching
the spleen. The common bile duct runs through the head, on its way from the liver to
the intestines. The pancreas produces a plethora of digestive enzymes which
are secreted into the gut. In addition, it produces the hormone insulin, the lack of
which causes diabetes mellitus.

2. The most common cancer that arises in the pancreas is the adenocarcinoma, which
carries the worst prognosis. The main risk factors are smoking, excessive alcohol
consumption, obesity and diabetes mellitus. There is also a strong relation to chronic
pancreatitis and a family history of cancer. Hence this cancer can be guarded against
by lifestyle modifications, such as cessation of smoking, change in drinking habits,
regular exercise and a healthy lifestyle.
Signs and symptoms
The initial signs and symptoms of this disease are very nonspecific and emulate
everyday troubles like indigestion and acidity. However, cancer of the pancreatic
head announces itself comparatively early by blocking the common bile duct and
thus causing jaundice, which is initially painless. Hence any painless jaundice should
be immediately investigated with an abdominal ultrasound. Cancer of the other parts
of the pancreas do not cause jaundice and are consequently diagnosed even later.
They usually cause severe abdominal pain spreading to the back, weight loss,
vomiting and onset diabetes.
Diagnosis
Diagnosis is done by imaging, such as CT scan, MRI, CT guided fine needle biopsy
(FNAC) and a blood test to detect a specific protein called CA 19.9, the level of which
is elevated in pancreatic cancer. It is not always possible to do preoperative biopsy or
FNAC successfully, and it frequently happens that the surgeon decides to operate on
clinical and radiological suspicion alone. During the operation, a frozen section
biopsy is used to confirm the disease.
Upon diagnosis, the fate of the affected person hinges on whether the cancer is
limited to the pancreas and, if so, whether it can be surgically removed. Like most
other solid cancers, surgery is the keystone to the treatment of this cancer. If the
cancer has spread to other distant organs such as the liver, it is in the incurable stage
and the average survival of these patients is 6 to 9 months from diagnosis. Anticancer
chemotherapy drugs can be used to ameliorate the painful symptoms, but it does not
increase survival at this stage. If the cancerous tumour is not limited to the pancreas
but has extended to involve surrounding vital structures, then it is inoperable, which
means it cannot be surgically removed.
If the tumour is limited to the pancreas and is operable, then surgery carries the best
chance of cure. The operation varies according to where the tumour is located. If it is
in the head of the pancreas, then the surgery is called a Whipple procedure
(pancreaticoduodenectomy).
If the tumour is in the mid-part or body of pancreas, it is rarely operable, but
sometimes a total pancreatectomy or removal of whole pancreas can be done. For
cancers in the tail of the pancreas, a distal pancreatectomy operation with removal of
the spleen is done. Thus it is apparent that treatment options for this disease are
limited, even when detected relatively early. Research is ongoing to find better
options. As of now, it appears that prevention is better than cure, and therein lays the
importance of a healthy lifestyle.

3. Treatment of Pancreatic Cancer
There are different types of surgeries that
help in removing the pancreatic cancer.
These surgeries are further categorized
into-
• Curative that helps in treating the
cancer by removing it
• Palliative that helps in easing the
symptoms
 Curative Surgeries :
o Pancreaticoduodenectomy
: This is considered as the most common
surgery for removing a pancreatic tumor.
This surgery is also termed as Whipple
procedure that removes –
 Part of the common bile duct
 Head of the pancreas
 Gallbladder
 Duodenum
 Body of the pancreas
 Lymph nodes close to the pancreas
 Part of the stomach
 A small part of the jejunum
o Total Pancreatectomy : This procedure involves the removal of the
spleen and the complete pancreas.
o Distal Pancreatectomy : This procedure involves the removal of a part
of the body of the pancreas and tail of the pancreas. It also removes
the spleen. This procedure is more commonly used with islet cell
tumors.
 Palliative Surgeries :
o Gastric Bypass : When the stomach has been blocked by the cancer
then it is sewn with the small intestine. This process allows a patient
to eat normally.
o Stent Placement : In order to avoid blockage, the insertion of the metal
tubes is done that helps in keeping the bile duct open.

4. o Biliary Bypass : A small surgical cut is made in the bile duct or
gallbladder that is then sewed to the small intestine. This surgical
procedure is helpful when the tumor has blocked small intestine and
has caused bile to accumulate in the gallbladder. Pain is also relieved
by the means of this procedure.
 Laparoscopy : The minimally invasive surgical techniques of laparoscopy are
normally used directly before a scheduled pancreatic resection to determine if
a more invasive operation is the best course of action. Since metastases can
sometimes be missed on CT, MRI or other imaging studies, laparoscopy is a
reliable way to check for metastasis to other organs. If metastases are found
and the surgeon decides an operation is not the best course of action, then the
patient will have a shorter recovery time compared to that of a major surgery
and will be in better shape to receive alternate forms of treatment.
 Radiotherapy :It destroys cancer by focusing high-energy rays on the cancer
cells. This causes damage to the molecules that make up the cancer cells and
leads them to commit suicide. Unlike chemotherapy which is a systemic
treatment, radiation therapy is a local treatment meant to destroy only tumor
cells. During the treatment, a beam of radiation is directed through the
abdomen to the cancerous area. The radiation is similar to that used for
diagnostic X-rays, only in a higher dose.
 Chemotherapy :Chemotherapy uses drugs to help kill cancer cells.
Chemotherapy can be injected into a vein or taken orally. Chemotherapy can
also be combined with radiation therapy (chemoradiation). Chemoradiation
is typically used to treat cancer that has spread beyond the pancreas, but only
to nearby organs and not to distant regions of the body. This combination
may also be used after surgery to reduce the risk of recurrence of pancreatic
cancer.
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