Pancreatic Cancer: Why Early Detection Is Difficult

Pancreatic cancer occurs when cells in the pancreas mutate and multiply uncontrollably, forming a tumour. Pancreas is located in the abdominal cavity, between the spine and the stomach. Most cancerous cells form in the pancreatic duct, that connects the pancreas to the bile duct.
Pancreatic cancer is of two main types –

1. Exocrine tumour – This is the most common type of pancreatic cancer that forms in the lining of the pancreas.
2. Neuroendocrine tumour – This is a fairly rare, slow-growing cancer, that arises from hormone-producing cells of the pancreas.

There are several risk factors, in terms of pre-diagnosed diseases or lifestyle factors that can lead to pancreatic cancer, such as – smoking, obesity, type-2 diabetes, chronic pancreatitis, hereditary problems in the pancreas or gene mutation.

Pancreatic cancer often goes unnoticed, until reaching later stages.

Why Does Pancreatic Cancer Go Undetected in the Early Stages?

Symptomatic Factors:

1. Lack of Early Symptoms
   Most patients either do not show any warning signs in the early stages of pancreatic cancer, while others do not notice anything serious or visibly wrong until the tumour spread to other organs and body parts. These signs and symptoms grow over time and become adverse, forcing patients to seek medical help.
2. Symptoms Mimic Other Conditions
   While common symptoms include – jaundice, dark urine, upper abdominal pain, back pain, fatigue, nausea, loss of appetite, blood clots or new onset of diabetes, these are often ignored or disguised as ‘not-that-serious’ since they mimic other diseases.
3. Location of the Pancreas
   The pancreas is located deep in the abdominal cavity, under the liver right behind the stomach. Since the location is a bit disguised, it creates problems in early detection of any possible tumours, because the other organs hide it. Even the symptoms do not show up until the tumours grow bigger and start affecting or penetrating into other organs. By this time, cancer cells mostly have spread beyond pancreas.

Apart from the above factors, there are certain biological reasons as well, for why pancreatic cancer goes undetected in the early stages. Pancreatic cancer has unique biological traits that make it difficult to catch or diagnose it in the early stages.

Biological Factors:

1. Presence of Desmoplasia
   Pancreatic tumours develop a protective shield around them, called desmoplasia. It is a dense fibrous tissue that protects the cancer cells. It contains extracellular matrix components like collagen, hyaluronan, fibronectin and specialised proteins. The desmoplastic reaction constitutes almost 80-90% of the tumour’s volume and the tumour uses desmoplasia as protection. The desmoplastic tissue creates high pressure inside the tumour, squeezing the blood vessels. This blocks the pathways for drugs to be delivered to fight the cancerous cells. This creates a barrier inhibiting chemotherapy from reaching cancer cells.
2. Low Immunogenicity
   The body has poor immune response to pancreatic cancer. The dense desmoplastic tissue not only blocks drug pathways, but also stops immune cells from getting through. The areas around the tumour attract cells that naturally suppress the immune system. This naturally developed low immunogenicity of the body to pancreatic tumours makes it even more difficult to detect and further in treatment of the disease.
3. Aggressive & Early Spread of Tumour
   The most concerning trait of pancreatic cancer is that the cells can spread to other body parts even before the main tumour grows in size. They invade the nearby tissues, lymph channels and blood vessels.

All these factors explain why surgery alone is not the answer to treat pancreatic cancer. Several new developments in the field point towards immunotherapies and therapeutic vaccines along with liquid biopsies that may show some promise in improving patient outcomes. Early detection, however, still shows better survival rates of patients with pancreatic cancer, even though it is rarely detected.

Yashoda Superspeciality Hospital & Cancer Institutes, Sanjay Nagar, Ghaziabad, is equipped with world-class technology and has a highly skilled network of some of the best oncologists from the Indian Army to treat patients with pancreatic cancer.

Best Hospital/Doctors for Pancreatic Cancer

Dr. (Brig.) A.K. Tyagi is the Director of Surgical Oncology at Yashoda Hospital, Sanjay Nagar, Ghaziabad. With over 35 years of experience as a Cancer Surgeon and several decades in the Indian Army, Dr. Tyagi is an expert when it comes to any type of cancer. Trained at both laparoscopic and robotic surgical systems, Dr. (Brig.) A.K. Tyagi has treated over thousands of patients successfully, helping them lead cancer free lives.

Dr. (Maj. Gen.) B.N. Kapur is the Director of Medical Oncology at Yashoda Hospital, Sanjay Nagar, Ghaziabad and is one of the best oncologists in Delhi NCR. He is skilled in treating solid organ cancer using latest evidence-based therapies and specialises in Hematolymphoid malignancy, paediatric tumour, bone marrow transplantation, and all solid tumours.

Dr. (Maj.Gen.) Dharmesh S. Swaroop comes with an experience of over three decades in the field of medical oncology. Currently serving as the Director of Medical Oncology at Yashoda Hospital, Sanjay Nagar, Ghaziabad, his specialisations include – gynaecological malignancies, GI malignancies, and malignancies of the breasts.

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