Frequently asked questions about Pancreatic Cancer

1. What are the types of pancreatic cancer?

Pancreatic Cancer can be of my types including Pancreatic Neuroendocrine tumors which can be locally resectable, Pancreatic cystic neoplasms, out of which only a very few are malignant and finally the most dangerous of them all, Pancreatic Adenocarcinomas which mostly occur in the Head of the Pancreas.

2. How is pancreatic cancer different from other cancers?

Pancreatic cancer is different from the other cancers mainly due to the location of the organ itself. This does not cause much symptoms in the initial disease timing but instead causes symptoms like Obstruction, Diabetes, Jaundice, Indigestion later when it has progressed locally or to other parts of the body.

3. What are the main risk factors for pancreatic cancer?

The main risk factors of Pancreatic Cancer includes Smoking, Alcohol intake along with Chronic Pancreatitis and recurrent inflammation of the pancreas.

4. Does family history affect the risk of pancreatic cancer?

Yes absolutely. Pancreatic Cancer is caused by multiple hereditary syndromes including BRCA 2, and others. A careful history of breast cancer, ovarian cancer, pancreatic cancer and even is to be carefully asked for during the history taking. If family history is positive, further genetic testing can be conducted to find out a specific genetic anomaly.

5. Is pancreatic cancer hereditary?

Yes, Pancreatic Cancer can be hereditary.

6. What are the symptoms of advanced pancreatic cancer?

This includes jaundice along with pain, radiating to the back, and severe vomiting. There can also be buildup of fluid in the abdomen and along with disease spread to the lungs, which can cause difficulty in breathing and spread to the brain can cause loss of consciousness along with headaches.

7. How is pancreatic cancer diagnosed?

Pancreatic Cancer diagnosis can be divided into Imaging and Endoscopic procedures.

The Imaging can include a Contrast Enhanced CT Scan, a MR Cholangiopancreatography or a PET-CT to rule out metastasis. Sometimes an Angiogram may be needed to understand the proximity of the tumor to the vessels.

The Endoscopic procedures include either and Endoscopic Ultrasound or an ERCP to place a Stent to relieve Jaundice.

8. What are the main treatment options for pancreatic cancer?

The main treatment options for Pancreatic Cancer include Surgery, Chemotherapy and Radiotherapy. If the disease is confined to the Pancreas itself, then an operation known as Whipple's Surgery is carried out in which a part of the pancreas along with the adjoining small intestine known as the duodenum, gall bladder, part of stomach and surrounding lymph nodes if required. Chemotherapy and Radiotherapy can be used both after and before surgery.

9. Can surgery cure pancreatic cancer?

Surgery has the highest cure for Pancreatic Cancer. But operability or the ability to do surgery is highly dependent on the spread of the pancreatic Cancer to the surrounding structures. Cancer confined to the Pancreas can be treated upfront with surgery while locally advanced cases might require Chemotherapy and Radiotherapy before surgery while Metastatic cases can only be treated with Chemotherapy or new age Immunotherapy.

10. What is a Whipple procedure, and when is it used?

Whipple Surgery is used for Pancreatic Cancer. In this surgery, a portion of the pancreas along with the adjoining small intestine known as the duodenum, gall bladder common bile duct, part of stomach and surrounding lymph nodes are removed. This complex surgery can be associated with life threatening complications if not managed properly.

11. What are the complications associated with my surgery?

Whipple's Surgery or Pancreaticoduodenectomy is a long and complex procedure which should be carried out by experienced surgeons trained in the procedure as it can be associated with life threatening complications if not managed adequately in a Tertiary Care setting. The major complications include leakage of Pancreatic juices (Pancreatic Fistula), Bleeding (Haemorrhage), delayed bowel movements (Delayed Gastric Emptying) along with Pain and other complications included with major Abdominal surgeries. It is essential to note that complications can arise in approximately ¼ th of patients and death can also occur in approximately 5% of patients.

12. Are chemotherapy and radiation effective against pancreatic cancer?

Chemotherapy and radiation therapy are both used in the adjuvant or the neo adjuvant setting.

13. What are the chemotherapy related complications associated with Pancreatic Cancer?

As 3 drug regimens are considered for Pancreatic Cancers, these can be quite toxic and lead to many side effects including diarrhoea, vomiting, nausea, decreased blood counts which make you susceptible to severe life threatening infections and bleeding. There can also be loss of appetite along with generalised weakness. Approximately 40% of patients are not able to tolerate their Chemotherapy fully and drugs or dosages have to be reduced to complete the Chemotherapy. Again, it is important to be associated with a Tertiary Care centre to manage the complications appropriately.

14. What are the latest treatments for pancreatic cancer?

The latest treatment for Pancreatic Cancer involves intra-operative Radiation Therapy. It involves a specialised Radiation therapy machine which can be applied in the Operating theatre after the surgery. It can help in decreasing recurrences after the surgery.

15. Is immunotherapy an option for pancreatic cancer?

Immunotherapy remains one of the last treatments usually reserved for metastatic cases where other specific targets have not been found and can be used to prolong life.

16. What are the survival rates by stage?

Pancreatic Cancer is a notorious cancer with high chances of recurrence. Localised Pancreatic Cancer 5yr survival is 44%, locally advanced Pancreatic Cancer is approximately 10-20% and metastatic Pancreatic Cancer patients do not usually survive beyond a year. With that being said, it is essential to attend a Tertiary Care Cancer clinic which leads to an overall better surgical approach on the first attempt itself.