What Is Pancreatic Cancer Treatment And Surgery?
Pancreas is an oblong tubular structure which lies horizontally below the stomach. It helps in the digestion of food via the digestive enzymes it produces and also regulates the blood sugar levels. An abnormal growth in the body or the tail of pancreas is known as pancreatic cancer. A variety of treatment modalities are available which fall under the group of treatment approaches.
Causes of Pancreatic Cancer:
- Pancreatic cancer almost always have a genetic history, if one member of the family has cancer of the pancreas, their off springs or grand children are quite prone for cancer of similar type
- Excessive smoking, alcohol may also lead to cancer mass in the pancreas
- Exposure to UV radiation may trigger an abnormal growth of cells
- Consumption of steroids may also cause an imbalance in the production of pancreatic cells
Signs and Symptoms Of Pancreatic Cancer:
The early stages of pancreatic cancer never go noticed since there are no obvious symptoms. It is only when the following symptoms begin to appear that a cancer of the pancreas can be suspected. These are as follows:
- Abdominal pain and discomfort
- Distress and discomfort in the middle back region
- Pale colored stools, dark viscous urine
- Altered blood sugar levels
- Nausea, vomiting, general weakness
- Jaundice, pale appearance of the sclera and conjunctiva
- Thrombophlebitis in the arms and legs
- Tenderness on palpation in the postero-inferior part of the stomach
- Unexplained weight loss
- Reduced appetite
Diagnosis of Pancreatic Cancer:
- Liver function tests: These are done to know the levels of alkaline phosphatase, conjugated bilirubin and gama-glutamyl transpeptidae. A pancreatic tumor marker known as carbohydrate antigen 19.9 is also tested for its presence.
- Ultrasound: This is done to help in the location of the cancer mass and study its extent, whether in the head, neck, body or tail of the pancreas.
- Computed tomography CT and magnetic resonance imaging MRI: These imaging studies are done to study each and every minute detail associated with the cancer mass. This will include its exact location, borders of the lesion whether they are well or ill defined, whether it is a solid mass or a cystic cavity. A CT in addition also gives idea about the bony components around the pancreas both in cross and longitudinal sections. MRI on the other hand well defines all the glandular and ductal system of the pancreas since it is used for focusing on the soft tissue organs.
- Biopsy: This is needed to study the mass of cancer and decide a surgical plan. In an excision biopsy, a part or the entire mass of cancer if small, is removed with scalpels and surgical knives and sent to labs where it is stained and studied under microscope to determine the type of cancer and plan the treatment accordingly.
- Fine needle aspiration cytology: A long tubular needle is inserted into the pancreatic cavity where the cancer mass is located and the contents of the mass are aspirated into the needle. The contents are examine for the presence of any type of atypical cells, pus, blood or other specific contents.
Types of Pancreatic Cancer:
- There are many ways in which a pancreatic cancer can be classified. As for example, 90 percent of pancreatic cancers are known as adenocarcinomas, the rest 10 percent are the small epithelial growths.
- Pancreas has two major types of cells. The exocrine cells secreting the digestive enzymes and the neuroendocrine cells regulating the blood sugar levels. Thus tumors of the pancreas can broadly be classifies as:
- Exocrine tumors: These include adenocarcinoma, cystadenocarcinoma, pancreatoblastoma, adenosquamous carcinoma
- Neuroendocrine tumors: Commonly known as panNEt, pancreatic neuroendorcrine tumor
- TNM classification is applied for pancreatic cancers, which is based on size of tumor, number of lymph nodes involved and the degree and potential of metastasis.
- Depending on whether surgical removal can or cannot be an option, these are classified as:
- Borderline resectable
Stages of pancreatic cancer
- Stage I: In this stage the cancer may be large but is limited to pancreas and not spread to lymph nodes. This is called resectable stage.
- Stage II: In this stage the cancer spreads to nearby tissues and organs but has not spread to lymph nodes in the area.
- Stage III: In this stage the cancer has reached a size of any dimension and has entered the tissues and may have entered organs situated away like liver, lungs and abdomen.
- Stage IV: In this there are two stages IV A and IV B. In IV A stage the cancer has affected the nearby organs like spleen, stomach and large bowels and to large blood vessels of the nearby area. In stage IV B the cancer reaches organs situated away like lungs and liver.
Treatment Procedures For Pancreatic Cancer:
A pancreatic cancer is mostly always a metastatic one which requires a complete removal of the pancreas, if not removal of the part of pancreas affected with cancer. Surgical procedures followed are as follows:
- Potentially curative surgery: This is the choice of surgical approach for exocrine pancreatic tumors. It can be done in three major ways as follows:
- Whipple procedure: In this method, a large abdominal incision is made. The head and a part of the body of the pancreas is removed. Along with this are removed parts of the adjacent tissues such as the bile duct, stomach, small intestine and the lymph nodes only if they happen to be infected with cancer cells. Otherwise it’s just the head and body of pancreas that needs to be removed. Once the procedure has been done, the remaining part of the pancreas and the small intestine are tied together so that the digestive enzymes and juices can be directly poured into the small intestinal areas. Also, lower end of the stomach and the small intestine are tied together so that food can directly pass into the small intestine.
- Distal pancreatectomy: In this procedure, a part of the body and the entire tail of the pancreas is removed. This is the best choice of surgical approach for a neuroendocrine tumor. In such procedures, it becomes mandatory to remove the spleen too.
- Total pancreatectomy: In this procedure the entire mass of pancreas is removed along with gall bladder and a part of small intestine and stomach. In such individuals insulin shots can be the only option to regulate the blood sugar levels.
- Palliative surgery: When pancreatic cancer spreads to the adjacent masses, it becomes difficult to resect all the masses since inevitably a chance of recurrence always persists. Hence, a palliative surgery removes only the affected parts and leaves behind a major part of the organ. A palliative surgery may be done multiple times, however the overall health of the patient should be taken into consideration.
- Stent placement: When pancreatic cancer invades the bile duct, it causes a partial or a total obstruction to it. This may lead to accumulation of the bile salts and juices within the duct and a rise in the intra ductal pressure leading to its distention and disintegration. For this purpose, a plastic or a metal tube can be inserted in the duct to prevent it from collapsing. This is done as a part of palliative treatment where first the cancer mass from the duct is removed and then a rod or tube is placed within it.
- Bypass surgery: In people who are healthy enough, another option for relieving a blocked bile duct is surgery to reroute the flow of bile from the common bile duct directly into the small intestine, bypassing the pancreas. This typically requires a large incision in the abdomen, and it can take weeks to recover from this. Sometimes surgery can be done through several small cuts in the abdomen using special long surgical tools. This procedure is known as laparascopic or keyhole surgery.
- Enucleation: This is the only procedure in which only the cancer mass is removed from the pancreas leaving behind a small vaccum cavity in the pancreatic mass. Affected lymph nodes are also removed. It does not require removal of any parts of stomach, small intestine or spleen.
Other non surgical treatments include:
- Radiation therapy: Irrespective of the stage at which the cancer in pancreas is, a radiation therapy RT can be done. However it may or may not be effective in killing the cancer cells and may cause more harm to the normal cells than it does to the cancer mass. In a curative type of RT, ionizing radiations are targeted over the cancer cells which bring about their disintegration. Adjunctive type of RT can be used along with chemotherapy sessions. The palliative type of RT aims at providing symptomatic relief from the tumor symptoms and does not cure the disease.
- Chemotherapy: It is the method used for the treatment of pancreatic cancer in which drugs are administered timely in various combinations instead of using radiations. These drugs are cytotoxic in nature, lethal to the tumor masses and ultimately bring about the death of cancer cells. RT and chemotherapy can be used alternatively in order to cause the complete eradication of the tumor mass in the pancreas
Complications And Risk Factors Associated With Pancreatic Cancer:
- Existing diabetic conditions always complicate the cancer treatment, especially the ones in which surgical removal is the option. In such cases timely and additional shots of insulin need to be administered
- Smoking and alcohol are tremendous risk factor for pancreatic cancer
- Jaundice may occur as a major side effect owing to damage to the bile duct at the time of surgical intervention
- Improper digestion may persist for a few weeks following a surgical approach owing to reduction in the levels of digestive enzymes
Am I Good Candidate for Pancreatic Cancer treatment:
If you belong to the age group of 35 to 60 years, of any gender and experience any of the following symptoms, you surely are an ideal candidate for pancreatic cancer. The symptoms are:
- Extreme pain and discomfort in the abdomen and back region
- Unexplained weight loss and high blood sugar levels
- Unexplained occurrence of jaundice, sudden pale appearance, dark colored stools, pale yellow urine
- A surgical approach be it a palliative treatment or an enucleating procedure require about 4 to 6 weeks for recovery
- Also, the blood sugar levels need a continuous monitoring and may require administration of insulin shots.
- Radiation and chemotherapy sessions tend to cause hair loss which may or may not be permanent. However soreness in throat and skin rashes disappear within 4 weeks after these treatments have been discountinued.
Post-surgery care and follow up is very important in treatment for pancreatic cancer. The tests used for diagnosis like X-ray, MRI, CAT scans, etc. are used to check the recovery of the patient. The patient needs to be monitored for on-going treatment. Patient needs support for physical, emotional and social needs.
- It is found largely that radiation and chemotherapy have about 15.34 and 18.89 percent success rate effects respectively on any type of pancreatic cancer
- Surgical approaches have at a maximum 25 percent chance of being successful.
- However the overall life expectancy can be increased to roughly about 10 to 12 years by using medications and palliative surgery
Benefits of Pancreatic Cancer Treatment:
A treatment intervention done at the correct time for a pancreatic cancer will help in the following ways:
- Firstly it will prevent the metastasis of the disease into the adjacent areas
- A more conservative approach can then be taken and thus the other tissues can be spared
- Blood sugar levels can be regulated at the correct time before any major side effect such as diabetic foot arises
- Regulate the overall digestion process
Cost Comparisons: India VS Other Countries:
The cost of pancreatic cancer treatment and surgery is much less in India as compared to USA, UK and also Thailand and Singapore.
Why choose India?
Team MedcureIndia has been striving ever since its establishment towards the well being of its clients. Be it the diagnosis or the selection of treatment modality of any disease, we believe in exposing our clients to the most appropriate one in our knowledge. We also firmly believe in enhancing our status regarding the recent treatment trends. The topmost hospitals offering this procedure are places where we direct out clients, assuring treatment results best suited for them.