Pancreas and Periampullary

Pancreatic Cancer
Treatment and surgery in Delhi

Dr. Nikhil Agrawal

What is pancreas?

Pancreas is a flat organ lying in upper abdomen behind your stomach. It is a soft gland, which is divided into head, body and tail. Many vital structures passes through it or very close to it.

What is pancreatic cancer?

Pancreatic cancer arises when cells in the pancreas develops mutations, becomes cancerous (malignant), begin to multiply out of control, form a mass and then spreads.

Pancreatic cancer: do you know?

What are the signs and symptoms of pancreatic cancer?

Signs and symptoms of pancreatic cancer are:
  • Jaundice (yellowing of skin, eyes and urine with pale stools)
  • Abdominal pain
  • Weight loss and loss of appetite
  • Recent onset diabetes

Video on pancreatic cancer

What are risk factors of pancreatic cancer?

Risk factors for pancreatic cancer are:
  • Old age
  • Smoking
  • Family history or hereditary conditions
  • Chronic pancreatitis
  • Obesity

How is pancreatic cancer diagnosed?

Once pancreatic cancer is suspected, it is diagnosed and staged by a high resolution, thin cut, triple phase CT scan. Your surgeon will also do tests to quantify your jaundice, check your kidney function, haemoglobin and blood clotting parameters. A tumor marker called as CA19.9 will also be checked. A chest X-ray or a CT scan of chest will be done to look for any tumor in the chest. Some centres might also do a CT-PET scan.

What are the stages of pancreatic cancer?

Stages of pancreatic cancer are:
  • Resectable: When the disease is picked up at as stage where it can be clearly removed by surgery.
  • Borderline resectable: When the disease has grown to a stage where the cancer is infiltrating some vital vessel coursing through or adjacent to pancreas.
  • Unresectable: When the staging scan shows that disease has reached such a stage where it cannot usually be removed surgically.
  • Metastatic: When the pancreatic cancer had spread to organs beyond the pancreas. This is advanced stage and curative treatment is not possible.

What is TNM staging for pancreatic cancer?

TNM (tumour, node and metastasis) classification developed by the American Joint Committee on Cancer (AJCC) is used for exact classification of stage and it spans from I to IV.
  • The extent (size) of the tumour (T): size and number of the tumour? Has cancer reached nearby structures or organs?
  • The spread to nearby lymph nodes (N): Has cancer spread to nearby lymph nodes? And to how many?
  • The spread (metastasis) to distant sites (M): Has cancer spread to distant lymph nodes or distant organs such as the peritoneum or lungs?

What are the treatment options for pancreatic cancer?

The treatment depends upon the stage of the disease and degree of jaundice.
  • Surgery is the best possible option and can be considered if the cancer is diagnosed at resectable or borderline resectable stage.
  • Chemotherapy uses drugs to destroy cancer cells. For metastatic cancers, surgery is not an option. After FNAC/biopsy and stenting (if jaundiced) chemotherapy is given. Chemotherapy prolongs survival.

What are the surgical options for pancreatic cancer?

Surgery for pancratic cancer:

Which surgery is done for the pancreatic head cancer?

A Whipple procedure, also known as pancreaticoduodenectomy, is a complex operation to treat pancreatic head cancers. In this, the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct are removed. Following this, the intestinal continuity is restored by joining cut end of pancreas, bile duct and stomach to small intestine.

Which surgery is done for pancreatic body and tail cancers?

For pancreatic body & tail tumors surgery is the best option if cancer is diagnosed at a resectable stage.
A distal pancreatectomy or pancreaticosplenectomy is done.
For early tumors, this procedure is done laparoscopically, which results in less pain and faster recovery.

What is the best treatment for pancreatic cancer?

The best treatment for pancreatic cancer is surgery, if it is possible. Surgery should only be considered if the tumor can be completely removed, as partial removal does not improve patients' chances of living longer. In some cases, complete removal of tumour is possible after a few cycles of chemotherapy.

Stay Alert! Stay Healthy!
Wish you a speedy recovery!

About Author

Dr. Nikhil Agrawal
MS, MCh

This site helps you understand the disease process, best treatment options and outcome of gastrointestinal, hepatobiliary and pancreatic diseases and cancers. Dr. Nikhil Agrawal is Director of GI-HPB Surgery and Oncology at Max Superspeciality Hospital Saket, New Delhi and Max Hospital, Gurugram in India.

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