The detection of pancreatic cancers is also not easy as there are no specific screening tests and by the time symptoms sets in, it is mostly late though some are lucky to catch it early.
Dr. N. Harimohan
At times people become aware of medical conditions and illnesses due to negative happenings such as the death of celebrities and well known public personalities.
Such tragedies always evoke interest, and people want to know the causes of a medical illness or condition associated with them.
When Apple creator Steve Jobs suffered and died of advanced pancreatic cancer, the world was curious to know more of this fearsome disease.
Recently, our nation witnessed another tragedy when the former Defence Minister of India and Chief Minister of Goa Manohar Parikkar expired due to the same pancreatic cancer there are great interest and anxiety on cancer pancreas.
To know that a 15 cm long soft fleshy organ placed behind our stomach with its head lying ensconced under a duodenal curve, and extending out like a leaf, is the cause for the most disastrous amongst cancers, with a 10-year overall survival rate of around 1 % is surprising!
It’s the 13th most common cancer, through 8th in the fatality scores.
In the Greek language, Pan is all, and Kras is flesh, and pancreas is so called for its fleshy nature,
The pancreas has an exocrine and an endocrine part in for handling its vital functions. The exocrine part produces digestive enzymes which it transfers through the pancreatic duct to the Ampulla of Vater which opens into the bowel to digest our food,
While the Islets of Langerhans are islands of special cells, producing Insulin by the Beta cells, and Glucagon produced by the Alpha cells, these control our glucose metabolism.
Enmeshed with sympathetic and parasympathetic innervation’s the pancreas is a highly vascular structure, it has closely knit anatomical veins and arteries like the inferior vena cava superior Mesenteric vein, portal vein and the common bile duct branching out into the gall bladder.
All these gain importance when it comes to the resection of the organ in cancer.
Pancreatic cancer does have a genetic and hereditary influence to a small extent but it is more of a disease caused in life due to the way of living.
For first degree relatives of patients, the chances of getting it are higher than in the normal population and they do need to be more alert of likely symptoms.
Now take note of the following pointers related to pancreatic cancer:
Pancreatic cancer has an increased incidence in males and with increasing age.
Smoking is one of the prime causes and chances of getting it is definitely higher than in a non-smoker.
Alcohol by causing pancreatitis can also contribute.
A sedentary lifestyle and obesity can all contribute in myriad ways.
Once suspected by symptoms, it is confirmed with a biopsy using an endoscopic ultra-sonogram technique, or by a CT guided biopsy, if surgery is not planned immediately.
The staging is done using imaging modalities, like a contrast CT scan, or an MRI to detect any liver lesions or a PET scan as advised by the medical or surgical specialist.
At times, the Ampulla of Vater, the opening of the pancreatic duct into the bowel, has to be dilated or a stent is to be inserted into the common bile duct to remove the biliary obstruction and reduce jaundice
Surgical removal offers the best chances for a good result,
In surgical lingo RO resection means complete resection and a tumor-free margin of 1 mm with no remnants even microscopic, this has the most minimum chances of recurrences,
The lesser forms being R1 and R2.
It also depends on the part of the pancreas that cancer has affected and how easy it is to remove it surgically as the organ is placed in a not very easy location and surrounded by many structures.
There are strict guidelines to direct every type of surgery.
Keep in mind that the detection of pancreatic cancers is also not easy as there are no specific screening tests and by the time symptoms sets in, it is mostly late though some are lucky to catch it early.
At times, chemotherapy or chemoradiation is given before surgery as it is attempted to downsize the tumor or make it respectable.
In many cases of locally advanced tumor or metastatic (spread to distant organs), no surgery is possible.
In these cases, the prognosis or outcome is bad to poor, though there are several regimes of chemotherapy these days or combination with targeted therapies to improve quality of life
Supportive treatment for pain, loss of weight, and fatigue have to go along all treated as an advanced disease is defeating.
To put it in a nutshell, this is one cancer one could avoid having if there’s an option of making such a choice.
Last but not the least, a big salute to Mr. Manohar Parrikar who displayed remarkable courage and fought this deadly illness, even as he continued working till his last breath as Goa CM.
(Dr. N. Harimohan is a Fellow in Palliative Medicine and Associate Consultant at the Department of Palliative Medicine, VPS Lakeshore Hospital and Research Center, Kerala. The views expressed are the author’s own.)