Understanding Pancreatic cancer

Cancer arising in the head and uncinated process of pancreas, we label as pancreatic cancer. But it includes cancers in the neck, body and tail of pancreas also.

These patients present with loss of weight, loss of appetite, jaundice, pruritus and sometimes with back pain. Jaundice deepens over time, this awareness is very important for the patients.

Your urine will be darker i.e. more yellow coloured. Stools will be whitish or clay coloured and oily. As soon as these symptoms are noticed he or she should immediately consult a clinician.

What are the risk factors involved?

Smoking, alcoholism, diabetes are some of the risk factors. Family history is observed in certain patients. Certain types of pancreatitis like hereditary pancreatitis, tropical pancreatitis which is seen in southern India may predispose to cancer. Chronic pancreatitis is also a described risk factor.

How to diagnose pancreatic cancer?

With the symptoms mentioned above if a patient presents, your consultant advises Pancreatic protocol CT, Upper GI endoscopy, Liver function tests. CT scan will show the location of tumor and its relation to the surrounding vessels describing the extent of the tumor. We will see for any liver metastasis or any fluid in the abdomen. Upper GI endoscopy done to take a biopsy from ampullary lesions. Liver function test to look for Jaundice.

Endoscopic ultrasound guided biopsy may be done for diagnosis in certain circumstances.

Operability will be assessed based on the extent of the tumor and its relation to vessels , tumor considered inoperable if it is stuck to these vessels( Superior mesenteric vessels).

How to proceed after evaluation?

Your consultant will explain to you the chances of surgery if the disease is operable. Surgery done for the head of pancreas cancer is called Whipple's procedure. Technically demanding procedure with certain manageable complications. Surgery for neck tumors is central pancreatectomy. Surgery for body and tail tumors is distal pancreatectomy.

Inoperable cancer - these patients are offered chemotherapy or chemoradiation to prepare them for surgery if possible. Response of the tumor assessed. If the response is good, you may be suitable for surgery. If it's a poor response, the prognosis will be explained. 

What is Whipple’s procedure?

Structures that are removed include head and uncinated process of pancreas, entire duodenum, distal common bile duct and distal stomach. Passage will be created for bile, food and pancreatic juice i.e. reconstruction. Certain complications are described like pancreatic leak, bile leak which lead to sepsis, incidence of these complications comes down with better experienced surgeons. Mortality is very low. These procedures are better done in  tertiary institutes.

This procedure can be done in open, laparoscopic and Robotic approaches. Robotic approach has many advantages - less pain, less blood loss, reduced ICU stay, lesser conversion to open surgery, early work resumption. Better magnification, more precise work enhances recovery of the patients.

Is Robotic Whipple a safe option?

Yes it's safer with experienced hands. Some patients we are not keeping them in ICU. Oncological outcomes are excellent. Patient selection and proper evaluation are very important.

Treatment after surgery?

Most of the patients are discharged around 8 days after surgery. They will be offered a high protein diet and good antibiotic cover. Once the patient is completely recovered based on the biopsy report you will be offered adjuvant treatment. Chemotherapy is planned. This reduces relapse of the disease.

What is palliative chemotherapy?

Inoperable cancer which may not become operable in future and patients with metastatic disease are offered chemotherapy for some benefit or to slow down the disease progression.

This will not enhance survival.

Patients with the above mentioned symptoms should present early to the clinician and take treatment. Early diagnosis and treatment is the key for better outcomes. Pancreatic cancer patients need not be frightened as soon as they are diagnosed. Robotic Surgery helps in early recovery and is a safe for these patients.  

Dr. Madhu Devarasetty

Consultant Surgical Oncology

KIMS Hospitals, Secunderabad.