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Pancreatic cancer, this type of cancer ;originates in the pancreas, the organ that lies behind the lower portion of your stomach. Abnormal cells start to grow and divide to form tumours. Over time, the disease may spread to other parts or organs of the body, making it hard to treat.

Knowing all about pancreatic cancer will give you an idea of the signs and risks of the disease. Here are a few facts you probably never knew about this grave illness:



Cancer of the pancreas ranks twelfth in the list of most common cancers across the world


Pancreatic cancer is the seventh most common cause of death worldwide


Pancreatic cancer affects women and men alike


The more you age, the more you are at risk of developing pancreatic cancer. About 90% of people living with this type of cancer are over 55 years of age. The average age of patients is 72 years when the cancer is detected


People who are in the habit of ;smoking regularly for a long period are prone to pancreatic cancer. Studies claim that at least three out of ten such cases are caused by smoking and tobacco use.


Lack of physical activity and ;obesity are the most common factors that put you at risk of pancreatic cancer


Pancreatic cancer signs can be vague, depending on the site of occurrence of the tumour whether it is present in the tail, body, or head of the pancreas


Pancreatic cancer symptoms include yellowing of the eyes and skin (like in the case of jaundice), abdominal pain, fatigue, digestive problems, and unexplained weight loss.


Physical examination, as well as imaging tests like mri and ct scans, are used to diagnose the ailment


Among all types of cancer, pancreatic cancer has the lowest rate of survival only 3-6% of people diagnosed early survive for about five years


Studies show that keeping your body weight in check and abstaining from alcohol and smoking reduces one s risk of developing cancer of the pancreas


Usually, this type of cancer is diagnosed in the later stages with about 80% of the patients having a terminal illness with an average life expectancy of 4-6 months


Although the rate of survival for other forms of cancer may have improved over the years, the same cannot be said about pancreatic cancer



Pancreatic cancer is an aggressive and fatal form of cancer. It often spreads without revealing symptoms, which makes diagnosis difficult. However, if detected early, there are ways to treat the disease.

Treatment of pancreatic cancer mainly involves chemotherapy, radiotherapy, and surgery. Which line of treatment would suit your condition best, depends on your health, the prognosis of the disease, and your doctor s opinion.

Pancreas are a small, but a pretty important part of a person s digestive system. So when it needs to be removed, the reason has got to be quite serious, to say the least, doesn t it? The procedure is known formally as pancreatectomy and it is most often required for people who are suffering from cancer of the pancreas. Ideally, these people would only need the cancerous tumours removed, but things are not always this simple. As a matter of fact, only a little more than a tenth of the people who have pancreatic cancer can have the tumour alone removed. As a result, most need to go for a pancreatectomy, which involves removing the entire pancreas. Whether the pancreas can be kept is usually related to how soon the cancer was detected, with people who have done so in time being a majority of the 10% of people with pancreatic cancer who have not needed pancreatectomies.

If a person does not have cancer, the reason he or she may need a pancreatectomy due to an accident which has injured the area significantly badly. In this case, a procedure which is known as a partial pancreatectomy is carried out on the patient. The good news is that the success rate of this sort of operation is generally quite high and the long-term effects on the body are nil. This is the case in spite of a lot of the normal tissue of the pancreas being removed, pretty amazing, isn t it?

While it may be called a pancreatectomy, it does not always mean that the pancreas is the only thing that is removed. In fact, in a lot of pancreatectomies, the surgeons also remove other parts of the digestive system which are usually the common bile duct, the spleen and the gallbladder.

There is, of course, the case of chronic pancreatitis, which occurs when the organ just swells up repeatedly. The repeated swelling leads to permanent damage to it, which affects the rest of the body, too. In most cases, the cause of this happens to be a sustained addiction to alcohol. When this is the case, it is really hard to perform a pancreatectomy and the utility of the pancreas is greatly reduced. Not a good situation to be in, under any circumstances, at all!

A pancreatectomy is a process which nobody would voluntarily wish to undergo, but there are advantages to knowing what it is, in any case!

Chronic pancreatitis refers to an inflammation of the pancreas the organ that creates enzymes and hormones to manage blood sugar levels and aids in digestion. The condition either does not heal completely and keeps coming back, or persists for months or years at a stretch.

Chronic pancreatitis is a serious, debilitating condition, which can potentially lead to permanent damage and scarring of the organ. The following are the consequences-

Formation of cysts and calcium stones in the pancreas
Blockage of the gastrointestinal tract
Malnutrition
Diabetes

The condition is most likely to develop between the ages of 30 and 40 and is commonly observed in men than in women.

Causes of Chronic Pancreatitis:

A number of factors are responsible for long-term pancreatitis. The most common ones include-

Alcohol abuse Reportedly, 70% of all cases regarding the condition is related to alcohol consumption
Autoimmune diseases When your body attacks the healthy tissues and cells mistakenly
Genetics
A constrict pancreatic duct The tube that carries enzymes to the small intestine from the pancreas
A blockage of the pancreatic duct by stones
Cystic fibrosis A hereditary disorder that causes mucus to build up in the lungs
Hypercalcemia When the level of calcium in the bloodstream increases abnormally
Hypertriglyceridemia When the level of triglycerides in the blood rises up

Warning Signs of Chronic Pancreatitis:

Symptoms of chronic pancreatitis do not show up at the early stages. They become more evident when inflammation aggravates. However, you should look out for the following signs-

Severe abdominal pain Usually in the upper portion
Loose stool that appears pale and does not flush away easily
Vomiting and nausea
Unintentional weight loss
Fatigue
Excessive thirst
Shortness of breath
Diarrhoea
Jaundice
Pancreatic fluids inside the stomach
Intestinal blockage
Internal bleeding

The above symptoms vary based on the severity of the condition. Painful episodes may last for days. For some people, drinking and eating seem difficult because that makes the pain worse. With the progression of persistent pancreatitis, the pain becomes constant. Seeking treatment at the earliest is necessary for the condition to heal.

Diagnosis and Treatment:

A blood test alone is not sufficient to detect the changes in your pancreas in the initial stages. An imaging test is the most reliable method to confirm the diagnosis. Your doctor may recommend the following tools-

CT Scan
X-ray
Ultrasound
MRI Scan

The objective of the treatment is to reduce pain and improve the functioning of your digestive system. The damage to the pancreas cannot be cured, but your doctor will prescribe necessary measures to manage the symptoms of the condition.

The primary treatment methods include endoscopic therapy, medications, and surgery.

Medication - Pain killers, insulin steroids, and artificial digestive enzymes may be taken as per the doctor s recommendation
Endoscopy - The procedure involves inserting a flexible, long tube (known as an endoscope) through the mouth. It allows the doctor to look at the pancreatic stones formed inside. He/she then removes the stones, places stents to improve the flow, and seals the leakage.
Surgery - The last resort is surgery. The doctor will recommend it only if medications and endoscopy therapy have failed to rectify the painful symptoms. Removing a portion of the diseased pancreas can offer relief. Surgery may also be performed to drain cysts and to unblock or widen the pancreatic duct.

The outlook depends on the underlying causes and the seriousness of the disease. However, immediate treatment and diagnosis can improve the outlook. Consult a doctor as soon as you encounter the above symptoms of pancreatitis.

Exocrine Pancreatic Insufficiency (EPI), also called pancreatic deficiency, is a disorder where the pancreas is unable to produce a sufficient amount of enzymes that are required to digest food. The pancreatic enzymes help to break down and absorb nutrients from the food in the small intestine. So, this disease causes nutritional deficiencies.

Causes of Exocrine Pancreatic Insufficiency

This condition is generally caused as a complication of other diseases because EPI develops only as a result of severe damage to the pancreas. The following reasons can cause EPI:

1. Inflammation of the pancreas
After surgery in the pancreas, stomach or the intestines, there may be inflammation in the pancreas as a post-surgical complication. A high content of triglyceride fat in the blood can also cause pancreatic inflammation and hinder the secretion of the enzymes.

2. Chronic Pancreatitis
In this disease, the pancreatic ducts are swollen and blocked and so the digestive enzymes cannot be passed into the small intestine. This condition is often caused by heavy consumption of alcohol.

3. Cystic Fibrosis
The digestive fluids and enzymes become thick and sticky and block the passageways of the pancreas and other organs like the lungs and the kidneys. This can obstruct secretion and passage of enzymes afterwards.

4. Shwachman-Bodian-Diamond syndrome
This is an autosomal recessive genetic condition where enzyme-producing pancreatic cells are not formed properly. This rare disorder causes a number of associated disorders like bone marrow diseases, skeletal defects and exocrine pancreatic insufficiency.

Symptoms of Exocrine Pancreatic Insufficiency

The symptoms appear in the middle stages of the disease when the process of absorption of nutrients has already been affected. The common warning signs are:

1. Digestive problems like gas, diarrhea and indigestion because the food remains mostly undigested.
2. Severe and frequent stomach pain in the lower abdominal region
3. Greasy stools due to the excretion of undigested fat
4. Rapid loss of weight and body mass due to mal-absorption of nutrients
5. Constantly feeling bloated and full even if you have not eaten anything
6. A general sense of fatigue and exhaustion
7. Excessive bleeding from small wounds because protein deficiencies hamper blood clotting
8. Pain in the muscles and bones
9. Increased susceptibility to infections of the body systems
10. Anemia
11. Joint pains
12. Abnormal swelling of the limbs or edema

An inflammation of the pancreas is known as pancreatitis. The pancreas is an organ that produces digestive enzymes. Pancreatitis might start any day and continue for long period and it requires immediate medical attention. It is of two types- acute pancreatitis and chronic pancreatitis. Although the treatment usually requires hospitalization, pancreatitis can be easily stabilized and the underlying cause can be treated thereafter.

CAUSES:

Pancreatitis may be caused due to various reasons:

1. Gall bladder stone: The pancreatic duct lies next to the bile duct. The gallstones enter the small intestine after passing through the common bile duct. Often the stones that remain in the common bile duct have a negative effect on the pancreas, which causes a hindrance to the normal flow of the pancreatic fluids, causing pancreatitis. Also a back flow of the bile into the pancreas can cause pancreatitis.
2. Alcohol: Long time alcohol use also causes pancreatitis. Alcohol can damage the pancreas tremendously causing it to get inflamed.
3. Other causes: Hereditary disorders in the pancreas, cystic fibrosis, high level of triglycerides, and a few medicines may also cause pancreatitis.

Symptoms:

1. The first symptom of pancreatitis is abdominal pain: The pain may be sudden or gradually increasing, but is usually aggravated after eating. It is severe and constant, and may continue for a few days. If you are suffering from pancreatitis, you will feel very sick after a sudden attack and you might require medical assistance immediately.
2. Swollen abdomen: Pancreatitis my cause your abdominal area to swell up and become tender.
3. Nausea: If your abdomen suddenly starts paining due to the onset of pancreatitis, you tend to feel extremely nauseous. You might end up vomiting and may also have violent heaves.
4. Fever: The inflammation will cause you to run a temperature, along with a searing pain in your stomach, which will make you feel extremely uncomfortable.
5. Rapid pulse: Pancreatitis affects the rate at which the heart beats, causing a rapid increase in the pulse rate.

Exocrine Pancreatic Insufficiency (EPI), also called pancreatic deficiency, is a disorder where the pancreas is unable to produce a sufficient amount of enzymes that are required to digest food. The pancreatic enzymes help to break down and absorb nutrients from the food in the small intestine. So, this disease causes nutritional deficiencies.

Causes of Exocrine Pancreatic Insufficiency

This condition is generally caused as a complication of other diseases because EPI develops only as a result of severe damage to the pancreas. The following reasons can cause EPI:

1. Inflammation of the pancreas
After surgery in the pancreas, stomach or the intestines, there may be inflammation in the pancreas as a post-surgical complication. The high content of triglyceride fat in the blood can also cause pancreatic inflammation and hinder the secretion of the enzymes.

2. Chronic Pancreatitis
In this disease, the pancreatic ducts are swollen and blocked and so the digestive enzymes cannot be passed into the small intestine. This condition is often caused by heavy consumption of alcohol.

3. Cystic Fibrosis
The digestive fluids and enzymes become thick and sticky and block the passageways of the pancreas and other organs like the lungs and the kidneys. This can obstruct secretion and passage of enzymes afterwards.

4. Shwachman-Bodian-Diamond syndrome
This is an autosomal recessive genetic condition where enzyme-producing pancreatic cells are not formed properly. This rare disorder causes a number of associated disorders like bone marrow diseases, skeletal defects and exocrine pancreatic insufficiency.

Symptoms of Exocrine Pancreatic Insufficiency

The symptoms appear in the middle stages of the disease when the process of absorption of nutrients has already been affected. The common warning signs are:

1. Digestive problems like gas, diarrhea and indigestion because the food remains mostly undigested.
2. Severe and frequent stomach pain in the lower abdominal region
3. Greasy stools due to the excretion of undigested fat
4. Rapid loss of weight and body mass due to mal-absorption of nutrients
5. Constantly feeling bloated and full even if you have not eaten anything
6. A general sense of fatigue and exhaustion
7. Excessive bleeding from small wounds because protein deficiencies hamper blood clotting
8. Pain in the muscles and bones
9. Increased susceptibility to infections of the body systems
10. Anaemia
11. Joint pains
12. Abnormal swelling of the limbs or edema

Pancreatic cancer is an aggressive form of cancer. The disease shows no early symptoms and often spreads to other organs long before it is properly diagnosed. Due to such poor prognosis, only around 6% of the pancreatic cancer patients are healthy and alive 5 years after the first diagnosis.

One of the most common surgeries to remove tumours from the pancreas is Pancreaticoduodenectomy, that is commonly called Whipples surgery. The primary aim of the procedure is to cure cancers or disorders that are identified in the pancreas, bile duct or the duodenum. Here, the tumour is removed to prevent it from spreading to other organs, thus improving the life expectancy of the patient.

Whipple's Procedure

Before the surgery, an intravenous line will be injected to your arm, to provide you with the necessary medication. Medicines may be passed through this line to soothe your nerves. A spinal injection or an epidural catheter may be placed. This helps you to recover painlessly after the surgery.

The surgery can be carried out in different ways

Open surgery

Here, the surgeon makes a small incision in your abdomen to access the pancreas and other organs. This is the most common method. This is a complicated operation where the tip of the pancreas, the gallbladder, the bile duct and the initial portion of the small intestine are removed. It is performed to treat cancers that are present on the head of the pancreas.

Laparoscopic surgery

Here several small incisions are made in your abdomen to insert a camera that transmits the live video of the abdomen to a monitor. According to the live feed, the surgeon performs the operation by using surgical tools. It is a common form of minimally invasive surgery.

Robotic operation

This is another type of minimally invasive surgery where the surgical tools are attached to a special robot. Here, the doctor uses a console to control the robot to perform the surgery. This is used because surgical robots can reach and operate in spaces and corners where the human hands may not reach during surgery.

The Whipples surgery can take 4 to 12 hours depending upon the approach being used and the complexity of the process. During the surgery, you will be given general anaesthesia, so you will be asleep.

In some cases, a part of your stomach or nearby lymph nodes may be removed to treat the cancer growths. After the process, the doctor will reconnect the other organs so that you can digest food normally.

After the procedure, you may face problems while emptying your bowels. The condition improves around 7 to 10 days after the surgery. Most patients are able to return back to their normal life usually around 6 weeks after the procedure.

It is recommended that you follow the doctor s instructions after the surgery and stick to the diet prescribed. Additionally, keep the incision protected from sunlight and remove the bandages only after consulting the doctors.

The diagnosis, as well as management of pancreatic cystic lesions, is a general problem. Nearly 1% of the patients in the chief medical centers have been observed to have pancreatic cystic lesions on cross-sectional imaging. It has also been observed that a quarter of all pancreas scanned in an autopsy series contain pancreatic cysts. Earlier, these cystic lesions were regarded as benign but with increasing evidence made available from the cystic lesions, they are regarded as origin of pancreatic malignancies.

Information on Asymptomatic Neoplastic Pancreatic Cysts

The most vital medical tools that are used in the diagnosis and management of pancreatic cystic lesions include the endoscopic ultrasound and cross-sectional imaging. These are used to distinguish non-mucinous cysts from mucinous cysts. The identification of pancreatic cysts creates a lot of anxiety for the clinicians as well as the patients related to the probable presence of a fatal tumor. The findings of a macro cystic lesion that enclose viscous fluid loaded in CEA are helpful in the analysis of a mucinous lesion.

The most common pancreatic cysts are the non-neoplastic inflammatory pseudo cysts, and they can be detected easily by imaging. The identification of pancreatic irregularity with probable association with malignant cells is a vital source of referral for the specialist. The set of guidelines that have been proposed for the management and diagnosis of patients with asymptomatic neoplastic pancreatic cysts are based specifically on the analysis of the quality of the data. It is also designed to address the most important and frequent clinical scenarios. The diagnostic suggestions are provided based on the clinical problem as well as the risk of malignancy.


Imperative Guidelines to Follow

To achieve accurate diagnosis of asymptomatic neoplastic pancreatic cysts is indeed a great challenge. It is all the more important to find the reproducible methods that can be used to stratify the threat of cancer for the patients. The main guidelines include a two-year screening interval of cysts that can be of any size as well as stopping observation after 5 years, in case there is no change. The new guidelines, for the most part, recommend surgery if more than one concerning feature is confirmed on the MRI by use of endoscopic ultrasound. The new guidelines even suggest discontinuation of inspection after the surgery if no dysplasia or invasive cancer is identified. The guidelines have mainly been developed by use of Grading of Recommendations Assessment, Development and Evaluation.

Inflammation of the pancreas is known as pancreatitis. The pancreas is an organ that produces digestive enzymes. Pancreatitis might start any day and continue for a long period and it requires immediate medical attention. It is of two types- acute pancreatitis and chronic pancreatitis. Although the treatment usually requires hospitalization, pancreatitis can be easily stabilized and the underlying cause can be treated thereafter.

CAUSES:
Pancreatitis may be caused due to various reasons:

1. Gall bladder stone: The pancreatic duct lies next to the bile duct. The gallstones enter the small intestine after passing through the common bile duct. Often the stones that remain in the common bile duct have a negative effect on the pancreas, which causes a hindrance to the normal flow of the pancreatic fluids, causing pancreatitis. Also, a backflow of the bile into the pancreas can cause pancreatitis.

2. Alcohol: Longtime alcohol use also causes pancreatitis. Alcohol can damage the pancreas tremendously causing it to get inflamed.

3. Other causes: Hereditary disorders in the pancreas, cystic fibrosis, high level of triglycerides, and a few medicines may also cause pancreatitis.


Symptoms:

1. The first symptom of pancreatitis is abdominal pain: The pain may be sudden or gradually increasing, but is usually aggravated after eating. It is severe and constant, and may continue for a few days. If you are suffering from pancreatitis, you will feel very sick after a sudden attack and you might require medical assistance immediately.

2. Swollen abdomen: Pancreatitis may cause your abdominal area to swell up and become tender.

3. Nausea: If your abdomen suddenly starts paining due to the onset of pancreatitis, you tend to feel extremely nauseous. You might end up vomiting and may also have violent heaves.

4. Fever: The inflammation will cause you to run a temperature, along with a searing pain in your stomach, which will make you feel extremely uncomfortable.

5. Rapid pulse: Pancreatitis affects the rate at which the heart beats, causing a rapid increase in the pulse rate.

The pancreas has an important role in the body. It releases enzymes for digestion and hormones for managing blood sugar. Pancreatic cancer hampers these functions and starts to affect the health of the patient even before cancer spreads to nearby organs. However, the real concern with pancreatic cancer lies in its rapid spread. In fact, it typically spreads to nearby organs quite fast. Moreover, it is quite difficult to detect it in the early stages.

Symptoms of Pancreatic Cancer-

Jaundice: Jaundice symptoms like yellowing of skin and eyes may appear in the primary stages of cancer if it begins near the common bile duct. However, if it begins at the opposite end, it would manifest only in the advanced stages. Pancreatic cancer spreading to the liver can also cause jaundice.

Back or Belly Pain: Back pain or abdominal pain is common in patients suffering from pancreatic cancer. The cancerous part of the pancreas can grow large and start impinging upon the nearby organs. This causes pain. If cancer spreads to surrounding nerves it may also cause pain.

Weight loss: Weight loss accompanied by poor appetite is a very common symptom of pancreatic cancer.

Nausea and Vomiting: If cancer spreads to the stomach, it can create a partial blockade for food resulting in nausea and vomiting.

Liver Enlargement: Pancreatic cancer may lead to enlargement of the liver if cancer has spread to that organ. The doctor can detect an enlargement by palpating the edge of the liver.

Indeed, there may also be other symptoms of pancreatic cancer, but none of these is definitive. In fact, by the time the symptoms begin cancer might have spread far and wide. However, for the fortunate one, pain or jaundice symptoms may start early. In their case, treatment can be started early.

Treatment of Pancreatic Cancer-
Though pancreatic cancer is hard to cure, a complex surgical procedure known as the Whipple procedure can extend the life of patients significantly. It is also called as Pancreaticoduodenectomy. In this procedure, doctors remove the wide part of pancreas lying adjacent to the duodenum. However, it is not only the pancreas portion that is removed, but other parts like the duodenum, the gallbladder, a part of the bile duct, and also a part of the stomach is also removed. After the surgery, the surgeon reconnects the rest of the intestine, bile duct, and the pancreas.

Who Can Undergo Surgery for Pancreatic Surgery?
Everybody is not fit for pancreatic surgery. It is estimated that just about 20% of patients can undergo this procedure. In most of these patients, cancer has not yet spread to major blood vessels and organs like lungs, liver, stomach, etc. To identify candidates for this procedure, doctors may even resort to testing. Among those eligible for the Whipple procedure, some can undergo laparoscopic procedure while others may need to go through an open procedure.