Where is the pancreas located?

The pancreas is a soft organ located behind the stomach in the upper abdomen. It plays a crucial role in digestion and sugar control. Parts of Pancreas - Head & Uncinate process, Neck, Body, and Tail. Different types of tumors occur in the pancreas. Some of them are benign tumors and most of them are cancers

What are the types of pancreatic cancer?

The most common type of pancreatic cancer is ductal adenocarcinoma which arises from cells lining in the duct, and the head of the pancreas is the most common site. Several other tumors also occur in pancreas like neuroendocrine tumors, cystadenocarcinoma, and functional endocrine tumors.

How does a pancreatic cancer patient present?

Symptoms with which they present are jaundice (yellowish discoloration of eyes and skin), unexplained weight loss and loss of appetite, itching, whitish oily stools with increased frequency, weakness, and sometimes back pain.

Life beyond pancreatic cancer?

The moment a person is diagnosed with pancreatic cancer, he/she gets frightened. There is no need to panic. Many patients diagnosed with the early disease can be treated and are having reasonable survival. Neuroendocrine tumor patients can be cured and there is definitely no need to panic.

How is a pancreatic cancer patient evaluated?

We do certain blood investigations like liver function tests and pancreatic protocol CT to image the lesion and its extent. Certain other investigations like upper GI endoscopy and if needed endoscopic ultrasound-guided biopsy. Once the patient is planned for surgery, we do a surgical profile. Based on the size of the tumor and its contact with the surrounding blood vessels, the surgeon will plan the surgery accordingly.

What are the different surgical procedures?

If a tumor is in the head of the pancreas, the surgery we do is Whipple’s procedure. This is a complex procedure and for the best results, it has to be done in a high volume center. For quicker postoperative recovery robotic surgery is an option for patients. Robotic Whipple's is safe and with good precision. Specimen extracted through a small incision. Some patients who underwent Robotic Whipple's may not need ICU to stay. The conversion rate to open procedure is very less.

If a tumor is in the body and tail of the pancreas, the surgery we do is distal pancreatectomy. This

is a less complex procedure and can be done in open and laparoscopic methods.

Certain endocrine tumors like Insulinoma can be enucleated from the pancreas. Whereas other endocrine tumors and non-functioning tumors, pancreatic resection has to be done.

Does the patient need to worry about the surgery?

Absolutely not necessary, nowadays with streamlined protocols and availability of high volume centers, this surgery is a safe procedure with acceptable morbidity. Robotics is a revolution in the field of minimally invasive pancreatic surgery. In the future, we are anticipating no ICU stay for these patients.

Does the patient require chemotherapy and radiotherapy treatments?

Surgery is the definitive treatment. All the other treatment options like chemotherapy and radiotherapy

are given in addition to surgery or as a palliative treatment. If the tumor is involving the surrounding blood vessels, we plan chemotherapy or chemoradiation initially to assess the tumor response, followed by assessment for surgery. Palliative chemotherapy in metastatic disease.

How fast patient will recover after surgery?

For patients who underwent open surgery, it will take one month to resume their normal life.

Robotic surgery patients can get back to normal life in 10 to 14 days.

The only way to go is early presentation and diagnosis and taking treatment as early as possible. Awareness regarding symptoms is important in society. Nutrition plays a key role before and after surgery.

Dr. Madhu Devarasetty

Consultant Surgical Oncology

KIMS Hospitals, Secunderabad.