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What is pancreas cancer? Know these 8 early warning signs

In February 2018, Vikas turned 62. He decided to retire completely from his work and spend quality time with his family. He was excited thinking about all the future prospects.In April, He took a small trip to Kerala with his wife. He was completely fine. Just after returning, He was experiencing bad itching all over his body. It felt like itching you get when bitten by a midge in the garden.

Day by day it got worse occuring everywhere from head to toe. Sleeping was almost impossible with this itching. He went to his family doctor. It looked like a temporary thing that would go away in a few days. But it did not. Itching persisted despite using creams and tablets. And his skin began to turn yellow.

This time the doctor diagnosed jaundice. He was hospitalized with it. In the endoscopy it came out like there was a blockage in the bile duct. So, the stent was put in a bile opening and it relieved the itching for some days. But not not permanently. Itching came back more severely. 

This time the endoscopy showed that the blockage was larger and it had crushed both the stent and the duct !

Finally biopsy reports solved all the confusions. The location of the blockage was at the opening of pancreas. It was diagnosed as pancreatic cancer. He had two options, one surgery another, do nothing and die.

Everything about pancreatic cancer
location of pancreas is behind stomach

He underwent surgery. In the 10 hours of surgery, the surgeon removed tumour and a large portion of the stomach with 30% of the pancreas and gallbladder. After surgery, he experienced minor uneasiness for some months, and then the doctor recommended chemotherapy. 3 years from that incident, things have gone well. He is stable with no evidence of recurrence of cancer.

Pancreas cancer is hardly detected in the early stage because it often doesn’t have any symptoms. This is the reason we have created this post to help you understand everything about pancreas cancer.

After reading this post you will know about the early symptoms of pancreas cancer and what are the best treatments available in India. So, first of all

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What is pancreas cancer?

Pancreatic cancer is a type of cancer that begins in the pancreas. Cells of the pancreas start growing out of control. There are various types of pancreas cancer as per the location of cancer in the pancreas. That’s why it is important for you to know about the pancreas and its parts

What is the pancreas?

The pancreas is an organ located behind the stomach. As you can see in the image, Its shape is like a fish with a wide head and short tail. In adults, its size ranges from 2 to 6 inches.

There are 2 types of cells in the pancreas

Exocrine cells

Exocrine cells form exocrine glands and ducts. The majority of the pancreas is made up of exocrine glands. Exocrine glands make enzymes that help in digestion in the stomach. Exocrine glands make digestion enzymes that empty in the upper part of the small intestine.

Endocrine cells

Endocrine cells form a small part of the pancreas. These cells make important hormones like insulin and glucagon. These hormones control blood sugar levels in the body.

Pancreatic cancer starts either in endocrine cells of exocrine cells. Based on that there are 3 types of pancreas cancer.

pancreas
pancreas endocrine exocrine
types of pancreas cancer

What are types of pancreas cancer ?

As you know that exocrine cells form the majority of pancreas, it is most likely that you have exocrine cancer when you are diagnosed with pancreatic cancer.

There are 3 types of pancreas cancer.

  1. Pancreatic adenocarcinoma: Almost 95% of pancreas exocrine cancers are adenocarcinoma. It starts in the ducts of the pancreas. Or rarely it occurs in the cells that produce pancreatic enzymes.
  2. Adenosquamous carcinoma: It occurs in the squamous cells layer of the pancreas. It is a very less common type of pancreas cancer.
  3. Ampullary cancer: Cancer occurs in the ampullary. The location where the bile duct and pancreatic duct meet and empties in the small intestine. Ampullary cancers are not considered pancreatic cancer but they are treated the same way as pancreatic cancer.

Now you know about various types of pancreas cancer. The next thing you should be knowing about is the various stages of pancreas cancer.

symptoms

Pancreas cancer symptoms to keep an eye on

Symptoms may vary as per location of the cancer and in which stage cancer is.

These are common symptoms found in pancreas cancer.

 

  • Unjustified weight loss and loss of appetite
  • Itching skin
  • Dark Urine
  • Jaundice symptoms yellowish skin and eyes
  • Pain in abdomen that radiates to back
  • Uncontrolled diabetes
  • Blood clots
  • Nausea and fatigue without any reason

If symptoms remain persistent for long, it is recommended to go through screening.

Now, we will see what causes pancreas cancer, what are the stages of pancreas cancer.

What are symptoms of pancreas cancer

Stages of pancreatic carcinoma

Stages of the cancer depend on where cancer is located, how much it is spread and whether it is affecting other body parts or not.

Doctors use the TNM system to find the stage of the cancer. TNM stands for 

Tumor : Size of the primary tumor and location of the tumor.

Node : Whether the tumor has spread to the lymph nodes. If yes then upto how much extent

Metastasis :  Whether cancer has spread to the other body parts 

 

Based on this , there are 5 stages of cancer

Stage 0: In this stage cancer has not spread outside the duct in which it has started. It is a very early stage so generally, a person does not feel any kind of symptoms.

Stage I : In this stage the tumor size is larger than 2 cm. But it has not spread outside to any lymph nodes or nearby organs

Stage II: In this stage the tumor grows larger than 4 cm. It spreads beyond the pancreas. In later stage 2 it may spread to nearby lymph nodes but not to arteries or other parts of the body.

Stage III: In this stage tumor spread to nearby lymph nodes and regional arteries but not to distant organs

This is the most advanced stage of cancer and the tumor spreads to the other parts of the body.

Risk factors associated with pancreatic cancer

Causes

We need to know what causes pancreas cancer

There are various risk factors associated with pancreatic cancer. 

  • DNA level mutation in pancreatic cells.
  • Diabetes
  • Smoking
  • Obesity
  • Family history of pancreatic cancer
  • Older age. Majority of pancreas cancer occurs after 65
  • Frequent inflammation of pancreas

Apart from that, long standing diabetes and poor diet also increases risk of pancreas cancer.

Now, we will see an important part, diagnosis and treatment of pancreas cancer.

diagnosis

What methods are in place to screen for pancreas cancer?

Pancreas cancer screening may include the following:

Imaging tests help to develop pictures of internal body parts. With the help of CT scan, PET scan and MRI, doctor visualize internal organs and it’s condition.

Ultrasound

In a transrectal ultrasound, a small tube of this size is inserted into the digestion system. The catheter uses sound waves to create an image of your pancreas.

Magnetic Resonance Imaging (MRI)

In certain situations, your doctor may recommend an MRI of the pancreas for a more detailed image. MRI images can help your doctor plan a procedure to collect tissue from the pancreas.

With the help of endoscopy, Doctors see the inside of pancreas. A small device is inserted in the digestive system with the help of a thin flexible tube.

To determine if cancer cells are present in the pancreas, your doctor may recommend a procedure to collect a sample of pancreatic cells (pancreas biopsy). Pancreas biopsies are often done using a fine needle inserted into the pancreas to collect tissue. The tissue specimen is analyzed in the laboratory to determine the presence of cancer cells.

Doctors prescribe various protein tests as a tumor marker. It helps to understand how cancer is responding to the treatment.

Now we will see various treatments available in India for pancreatic cancer.

treatment

What is treatment for pancreas Cancer?

After diagnosis, if cancer is confirmed, the doctor tries to understand the stage of cancer in order to apply appropriate treatment.

The lower stage of cancer indicates that cancer is just limited to pancreas and the advanced stage indicates that it is spread outside to other body parts.

First goal always remains to eliminate cancer but when it is not possible then doctors do treatment to reduce symptoms and relieve pain. 

Your options for treating pancreas cancer depend on multiple factors, like the rate at which your cancer is growing, if it has spread and your general health, along with the potential benefits or side effects of pancreas cancer treatment.

Surgery is the option in the initial level of cancer to eliminate cancerous cells. There are various types of surgeries available as per location of the cancer in the pancreas.

1. Surgery for tumors in head of the pancreas

For cancerous tumors in the head part of the pancreas, surgeons consider Whipple procedure.

In the Whipple procedure, the head part of the pancreas, gallbladder, first part of the small intestine and nearby lymph nodes are removed. Surgeon then reconnects the remaining parts of the pancreas, stomach and intestine.

2.  Surgery for tumor in head and tail of pancreas

Surgeon removed the left side of the tail and body of the pancreas. Sometimes, the spleen needs to be removed as well.

3. Surgery for tumors in nearby blood vessels

If nearby blood vessels are also affected, then surgeons may remove and reconstruct blood vessels.

After these surgeries, patients may feel nausea and vomiting if they face difficulty in digestion and emptying stomach.

It takes a long time to recover after surgery. Like you may need to spend several days in hospital after surgery and some weeks after that for more to recover.

It is always highly recommended to undergo these surgeries from highly experienced surgeons in this field who have done many surgeries like this.

In radiation therapy, a high energy beam is used to eliminate growth of cancer cells. It is often used before or after surgery to reduce cancer growth.

High radiation beams like x-rays and protons are used for treatment.

Nowadays protons are used to eliminate cancer cells. Proton beams cause lower side effects than traditional x-ray beams.

External beam radiation for pancreas cancer

External radiation is an option for treating pancreas-related cancer. It can also be used after surgery to kill cancer cells that may remain if the cancer is at risk of spreading or returning.

Radiation positioned inside your body (brachytherapy). 

Brachytherapy refers to placing radioactive sources in your pancreatic tissues. Most commonly, radiation is contained in radioactive seeds the size of rice that is inserted into the tissues of the pancreas. The seeds produce a low radiation dose over a prolonged period. Brachytherapy is an option to treat cancer that did not extend past the pancreas.

Chemotherapy is used to eliminate cancer cells. It is used in advanced stages of cancer or after surgery to eliminate growth of cancerous cells.

In chemotherapy, drugs are used to kill cancerous cells. It is either given orally or in vain.

Chemotherapy is often combined with radiation therapy to eliminate recurrence of cancerous cells. or reduce cancer tumors.

Supportive care is used to provide relief from pain and other symptoms. It helps to improve the quality of life of the patient.

Supportive care is provided by doctors , nurses and various NGO.

Supportive care is combined with other treatments to help patients feel better and live longer.

Targeted drug therapies focus on specific abnormalities in cancerous cells. By blocking these abnormalities, targeted medication treatments can cause the death of cancer cells.

 If hormone therapy is not effective, targeted therapeutic medications may be recommended for advanced or recurrent prostate cancer treatment.

A cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells.

Fiberoptic tubes are then used to carry the laser light to the cancer cells, where the drug becomes active and kills the cells. Photodynamic therapy causes little damage to healthy tissue. It is used mainly to treat tumors on or just under the skin or in the lining of internal organs.

pancreas cancer treatment cost in India

How much does pancreas cancer treatment cost in India?

The cost for pancreas cancer treatment in India varies on the size of the tumor, stage of cancer, and also the treatment option is chosen according to the condition of the patient. A cancer evaluation will reveal the extent of the spread and the best-suited treatment to restrict and cure it. The cost for cancer evaluation starts from 500 USD.

After the initial evaluation, the oncologist will be able to gauge if cancer can be treated by therapy alone or if surgery is recommended. The cost for pancreas cancer surgery in India starts from 5000 USD. Thanks to advancements in technology and innovation, newer and safer surgical options are also possible.

Advanced cutting-edge surgery like Whipple’s  procedure is also available in India. However, it is to be noted that not every patient is eligible for this treatment option. The onco-surgeon will suggest the best-suited treatment plan based on the patient’s case.

In certain cases, surgery is also to be combined with other treatments like chemotherapy and radiation therapy and supportive care to ensure a complete cure.

The cost of chemotherapy starts from 400 USD / cycle.

Whipple’s procedure cost starts from 7200 USD in India

Total pancreatectomy cost starts from 5000 USD in India  

Radiation therapy cost starts from 3000 USD in India.

Treatment cost
prostate cancer survival rate

Success Rate

What is the survival rate of pancreatic cancer treatment in India?

Survival rate of pancreatic cancer depends on the stage of the cancer.

5 year survival rate of pancreas cancer in 

  • In localized cancer survival rate is 39%
  • In regional cancer survival rate is 13%
  • In distant cancer 5 year survival rate is 3% 

Conclusion

A lot of people survive their pancreas cancer, even those with advanced illness. Pancreas cancer often develops slowly, and effective pancreas cancer treatment options now exist that prolong life.

 

Frequently Asked Questions and patient concerns:

1. Are there any early warning signs of pancreatic cancer?

When a tumor grows in an early stage , you may face jaundice, yellowish skin and eyes. Sudden weight loss is another common early symptom.

How do you cope with pancreatic cancer?

Pancreas cancers are treated with surgery, chemotherapy, radiation therapy. It depends on what stage of cancer you are having. In more advanced stages of cancer, cancer may not be completely cured but can be treated to provide relief from symptoms.

3. What age group get pancreatic cancer?

Risk of developing pancreatic cancer grows with ageing. The average age of diagnosis of pancreatic cancer is 70 years. Almost all reported patients of pancreatic cancer are older than 45 years, 66% of all patients are older than 65 years of age.

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