Pancreatic Cancer : Stages, Symptoms, Diagnostic & Treatment

What is pancreatic cancer?

Pancreatic cancer occurs when cells in the pancreas grow uncontrollably. The pancreas is situated close to the gallbladder, behind the stomach in your body. It contains glands that are responsible for producing hormones, including insulin and enzymes.

Pancreas may have several kinds of growths that may be cancerous or non- cancerous tumors. Pancreatic ductal adenocarcinoma is generally the most common type of cancer that develops in the cells lining the ducts responsible for carrying enzymes from the pancreas.

Pancreatic cancer does not get detected easily at its early stages when it may be get treated quickly. It shows the signs and symptoms only after it has spread to other parts of the body. We, at Yashoda Superspeciality Hospital & Cancer Institute, Sanjay Nagar, Ghaziabad are dedicated to sharing the essential information you may require to know about pancreatic cancer. This blog will help you know more about pancreatic cancer, its types, risk factors, signs and symptoms, processes through which it may be diagnosed as well as its stages and treatment.

What are the types of pancreatic cancer?

Pancreatic cancer is categorized based on whether it affects the exocrine glands or endocrine glands. The different types of pancreatic cancer are as follows:

Exocrine Pancreatic Cancer

Pancreas consists mainly of the exocrine glands that produce enzymes. These enzymes enter your intestines, helping in digesting fat, proteins and carbohydrates. Most of the pancreatic tumours mainly affect the exocrine functions.

Different types of tumours that may affect the functioning are:

• Adenocarcinomas
• Acinar cell carcinomas
• Cystic tumours

Endocrine Pancreatic Cancer

Small clusters of cells that constitute the endocrine glands are called islets of Langerhans. The endocrine glands produce insulin and glucagon hormones that enter the bloodstream. These hormones assist in managing blood sugar levels. Diabetes may be caused if these glands have any problems.

The name of the cancer is given based on the type of hormone-producing cell where it originates. Some of them are:

• Insulinomas (Insulin)
• Glucagonomas (Glucagon)
• Gastrinomas (Gastrin)
• Somatostatinomas (Somatostatin)

What are pancreatic cancer causes and risk factors?

The risk factors that may increase the chances of having pancreatic cancer may be:

• Smoking
• Personal history of chronic pancreatitis or diabetes
• Family history of pancreatic cancer or pancreatitis
• Certain hereditary conditions such as Multiple Endocrine Neoplasia Type 1 (MEN1) syndrome, Hereditary Non-Polyposis Colon Cancer (HNPCC) or Lynch Syndrome, Peutz – Jeghers syndrome, hereditary breast and ovarian cancer syndrome and Familial Atypical Multiple Mole Melanoma (FAMMM)
• Scarring of the liver or cirrhosis
• Diabetes
• Obesity
• Inflammation of pancreas or chronic pancreatitis

What are pancreatic cancer symptoms and signs?

The symptoms and signs generally do not develop until the pancreatic cancer has reached to its advanced stages. Doctors at Yashoda Superspeciality Hospital & Cancer Institute, Sanjay Nagar, Ghaziabad always advice one to consult a doctor whenever any of the signs and symptoms as illustrated below are witnessed-:

• In case of jaundice or if the skin and whites of the eyes turn yellow in colour
• Pain in the abdominal region and back
• Dark-coloured urine and light-colored stools
• Weight loss for no valid reason
• Itching on the skin
• Fatigue
• Clotting of blood
• Loss in appetite
• Diabetes

Diagnostic procedures for pancreatic cancer

The Gastrointestinal Oncology specialists at Yashoda Superspeciality Hospital & Cancer Institute, Sanjay Nagar, Ghaziabad are well experienced and use the latest & advanced technology to diagnose pancreatic cancer. They are full of compassion and care providing a comprehensive multi-speciality evaluation. The diagnostic procedures used at Yashoda are:

• In order to visualize the pancreas and have a clear image of it, doctors may recommend one to have imaging tests done such as Ultrasound, Computerized Tomography (CT) scan, Magnetic Resonance Imaging (MRI) scan and if needed, Positron Emission Tomography (PET) scan.
• Doctors may also use an Endoscopic Ultrasound (EUS) to obtain the images of the pancreas. In this, an ultrasound device is passed through a thin and flexible tube known as an endoscope, into the stomach to get the images.
• Doctors may also do a surgical biopsy by removing a sample of tissue for examination. The tissue may be collected during the process of EUS (Endoscopic Ultrasound) or may be collected by inserting a needle through the skin.
• Doctors may also test the blood to find specific proteins or tumour markers produced by the pancreatic cancer cells. CA19-9 is one of the tumour marker tests that may be helpful in knowing how the cancer is responding to the treatment.

Once the doctor confirms the presence of pancreatic cancer, he or she will inspect the extent of the cancer in order to know the stage of cancer.

Stages of pancreatic cancer

Pancreatic cancer may be categorized from Stages 0 to 4. These are as follows:

Stage 0- Carcinoma in situ is another name given to this stage. In this stage, the lining of the pancreas contains abnormal cells that may become cancerous and travel to other closer tissues.

Stage I- In this stage, the cancer that has formed is confined to the pancreas. Depending upon the size of the tumor, this stage is further classified into Stage IA and Stage IB. Stage IA- The size of the tumour in this stage is smaller or equal to 2 cm. Stage IB- The size of the tumour in this stage is larger than 2 cm but less than 4 cm.

Stage II- Depending upon the size of the tumour and where the cancer has spread, this stage is categorized into Stage IIA and Stage IIB.

Stage IIA- The size of the tumour in this stage is larger than 4 cm.

Stage IIB- The size of the tumour in this stage may be of any size and may have travelled to 1-3 closer lymph nodes.

Stage III- In this stage, the tumour may be of any size and may have spread to 4 or more closer lymph nodes or to the major blood vessels near the pancreas.

Stage IV- In this stage, the tumour may be of any size while the cancer has travelled to other parts of the body such as lungs, liver or the peritoneal cavity, the cavity that contains most of the organs in the abdomen.

After the stage is determined by the doctor, the treatment of pancreatic cancer is designed.

What are treatment options for pancreatic cancer?

Treatment of pancreatic cancer depends on the type of cancer one has, its stage and size. Specialists at Yashoda Superspeciality Hospital & Cancer Institute, Sanjay Nagar, Ghaziabad, use top-class technology and advanced machines to treat cancer. They have years of experience and are always present to guide and help the patient throughout the treatment. Some of the types of treatments that may be used to treat pancreatic cancer are:

Surgery- Whipple procedure is used to remove the head of the pancreas, the gallbladder and parts of the stomach, bile duct and small intestine. Doctors may also recommend total pancreatectomy in which the whole pancreas and parts of stomach, small intestine, bile duct and nearby lymph nodes are removed. Distal pancreatectomy is the surgery to remove the body and tail of the pancreas.

Doctors may also recommend palliative surgery when the cancer cannot be removed and has travelled to other parts. This may include biliary bypass that is done when bile keeps building up in the gallbladder because the bile duct is blocked by cancer or may include endoscopic stent placement in which surgery is done to place a thin tube, known as stent, to extract the bile that has developed in the area while the bile duct is blocked by the tumour.

Palliative surgery may also include gastric bypass when the flow of food from the stomach is blocked by the tumour.

Radiation Therapy- In this treatment, high doses of energy waves are targeted to the site of cancer in order to destroy the cancer cells or prevent their growth. This may include external radiation therapy that is done from outside the body using advanced machines or may include brachytherapy in which radiation is placed inside the body through a source. Chemotherapy- In this treatment, drugs are used to hinder the growth of cancer cells, aiding in their destruction. Drugs may be given via veins in the arm or through pill form or both. This therapy may be used in combination with radiation therapy to increase the impact of the treatment known as chemoradiation therapy.

Targeted Therapy- In this treatment, drugs are used to attack specific genes or proteins of the cancer cells causing them to die. Signals that are required for the tumours to grow are blocked by targeted therapy drugs known as Tyrosine Kinase Inhibitors (TKI). One of the Tyrosine Kinase Inhibitors, known as Erlotinib, is used to treat pancreatic cancer.

Looking for Specialists or Doctors of Pancreatic Cancer in Delhi NCR?

The Gastrointestinal Oncology Team at Yashoda Superspeciality Hospital & Cancer Institute, Sanjay Nagar, Ghaziabad, is fully aware of the need and co-operation you may require throughout the process of diagnosis and treatment of pancreatic cancer. With years of experience and use of highly advanced and technologically sound machines, we are among the best hospitals of Delhi NCR. Our specialists are highly trained, having mastered their skills with years of experience. Our doctors perform a range of surgeries with advanced robotic technology including gastric and liver resections, esophagectomies and radical pancreatic surgeries.

Dr. (Brig.) Arvind Kumar Tyagi, Director, Surgical Oncology, has completed his training in surgical oncology from the Tata Memorial Hospital, Mumbai. With more than 30 years of medical experience, he has been practicing as a surgical oncologist across different Armed Forces Hospitals all over India. He has received various awards and has many publications as his achievements.

Dr. Manish Kumar Gupta, is one of the leading gastroenterologists in Delhi NCR with years of experience in dealing with pancreatitis, chronic liver disease and Inflammatory Bowel Disease (IBD). He is also well versed in diagnostic and therapeutic endoscopy.