The 11th most widely prevalent cancer in India, pancreatic cancer has an extremely low survival rate if undetected and unoperated at a very early stage. The pancreas is an extremely delicate pear-shaped organ that makes pancreatic juices called enzymes. These enzymes break down sugars, fats, and starches. Pancreatic cancer is a silent killer but extremely potent and lethal. 

As we spread awareness about this disease during Pancreatic Cancer Awareness Month, TC46 got in touch with Surgical Oncologist Dr Anil Heroor, Head at Fortis Hospital in Mumbai. He talks about the types and stages of this cancer, and some common causes and the side effects of the treatments.

1. What is pancreatic cancer? What are the types and stages of pancreatic cancer?

There are various types of pancreatic cancer are:

  • Adenocarcinoma
  • Carcinoid GIST

The most common one is Adenocarcinoma.

Cancer of the pancreas is a relatively uncommon but deadly cancer. There are 4 stages of this cancer. Cancer limited to the pancreas is early-stage cancer. When cancer spreads beyond the pancreas and goes to other organs, most commonly the liver and lungs, it is called stage 4 cancer.

2. What causes pancreatic cancer?

It is caused majorly by lifestyle choices, including alcohol consumption, smoking, and in some cases obesity. Chronic swelling (inflammation) or pancreatitis is also one of the causes. Some cases are hereditary in origin.

3. Who is at high risk for pancreatic cancer? How does Adenocarcinoma affect women?

The incidence of pancreatic cancer in India is low—about 0.5-2.4 per lakh in males and 0.5-1.8 per lakh in females. The incidence is highest in the state of Mizoram.

4. What are the signs of pancreatic cancer you should never ignore?

Symptoms are pain which is often severe and radiating to the back. Loss of appetite, dyspepsia (indigestion), and white coloured stools are some of the other key symptoms.

5. What are some common risk factors of pancreatic cancer among women?

Smoking, including passive smoking, is the only significant risk factor, other than the other usual risk factors like increasing age and alcohol intake. In general, the incidence is less in women.

6. What tests do doctors use to diagnose pancreatic cancer?

Pancreatic cancer is diagnosed by doing a CT Scan, or an MRI, Endoscopic Retrograde Cholangiopancreatography (ERCP) which is an endoscopic procedure. Pet CT may be required to diagnose the spread. A biopsy is done if the cancer is advanced and requires upfront chemotherapy. It is also classified as resectable, borderline resectable and unresectable.

7. How does pancreatic cancer affect the body?

It depends on the location of origin: The head, body, or tail of the pancreas. The most common being the cancer of the head pancreas; this is a deadly cancer and affects the body in various ways.

8. Can pancreatic cancer be prevented? Share some preventive measures.

Whilst it cannot be prevented, one can definitely reduce the incidence further by changing one’s lifestyle and adopting healthy habits.

9. What are some treatment options for resectable, metastatic and locally advanced unresectable pancreatic cancer?

The best treatment for pancreatic cancer is surgery. Complex procedures like Pancreaticoduodenectomy (Whipple Surgery) and Distal Pancreatectomy are done. Minimal access and robotic surgery are now making rapid inroads in treatment. Surgery is minimal access and recovery is faster than conventional. But these are highly complex procedures with a steep learning curve because of all the important structures around it; bleeding or Pancreatic Fistula following surgery are potentially lethal complications. Hence, these surgeries are best performed by surgeons with a good volume of these procedures, and hospitals which are capable of delivering multispecialty services.

10. What are the side-effects of pancreatic cancer treatment?

There are certain side effects that would occur after pancreatic surgery namely malabsorption, lack of digestion, and rarely Diabetes Mellitus.

Common Cancer Symptoms Women Shouldn’t Ignore

1. Abnormal Vaginal Bleeding: More than 90% of women diagnosed with endometrial cancer experience irregular bleeding. If you have already undergone menopause, any bleeding — spotting included — should be evaluated. Haven’t gone through menopause yet? See your doctor if you experience bleeding between periods, heavy bleeding or bleeding during sex. This can also be a sign of cervical or vaginal cancer.

2. Unexplained Weight Loss: If you’re overweight or obese, losing weight by exercising and making healthier food choices can actually help curb your cancer risk. But if you suddenly lose more than 10 pounds without changing your diet or exercise habits, talk to your doctor.

3. Vaginal Discharge Colored With Blood: Bloody, dark or smelly discharge is usually a sign of infection. But sometimes, it’s a warning sign of cervical, vaginal or endometrial cancer.

4. Constant Fatigue: A busy week can wear anyone out. But in most cases, a little rest should cure your fatigue. If fatigue is interfering with your work or leisure activities, stop blaming your hectic life and see your doctor.

5. Loss Of Appetite Or Feeling Full All The Time: Never hungry? Appetite changes may be symptoms of ovarian cancer or other cancers not related to the reproductive system.

6. Pain In The Pelvis Or Abdominal Area: Ongoing abdominal pain or discomfort — including gas, indigestion, pressure, bloating and cramps — can signal ovarian or endometrial cancer.

7. Changes In Your Bathroom Habits: Suddenly need to urinate all the time or feel constant pressure on your bladder? Unless you’ve started drinking more liquids or you’re pregnant, this may be a sign of cancer.

8. Persistent Indigestion Or Nausea: Occasionally, persistent indigestion or nausea can signal gynecologic cancers. Play it safe, and see your doctor if you feel queasy more often than usual.

9. Change In Bowel Habits: These may be a sign of something externally pressing on the colon. This could be an advanced stage gynecologic cancer or other cancers.

10. Changes In Your Breasts: Most breast cancers are detected by women themselves during routine daily activities like bathing, shaving or even scratching. Be alert for lumps in the breast or armpit. Also be on the lookout for changes to the skin on your breasts, changes in the look and feel of your breasts, and abnormalities in the nipples.

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