Posted on 20th February, 2024 at 7:26:12 AM
Pancreatic tumour is a tumor that forms in the cells of the pancreas. The two main types of pancreatic tumors are pancreatic exocrine tumors and pancreatic neuroendocrine tumors. Most pancreatic cancers are exocrine tumors, which form in cells that make enzymes to help the body digest food and they are commonly know as pancreatic cancer. Pancreatic neuroendocrine tumors form in neuroendocrine pancreas cells (such as islet cells). These cells make hormones that help control sugar levels in the blood. Pancreatic neuroendocrine tumors may be benign (not cancer) or malignant (cancer). They are much less common than pancreatic exocrine tumors and have a better prognosis.
What is the global burden of Pancreatic cancer?
According to Globocon 2018 data, there were there were 10860 new cases of pancreatic cancer diagnosed in 2018 in India with 10528 death.
What are the risk factors for developing Pancreatic cancer?
Age- The risk of developing pancreatic cancer increases with age. Most people who develop pancreatic cancer are older than 45. In fact, 90% are older than 55 and 70% are older than 65. However, adults of any age can be diagnosed with pancreatic cancer.
Gender- More men are diagnosed with pancreatic cancer than women.
Race/ethnicity- Black people are more likely than Asian, Hispanic, or white people to develop pancreatic cancer. People of Ashkenazi Jewish heritage are also more likely to develop pancreatic cancer .
Smoking- People who smoke tobacco are 2 to 3 times more likely to develop pancreatic cancer than those who don’t.
Obesity, diet, and alcohol- Regularly eating foods high in fat is a risk factor for pancreatic cancer. Research has shown that obese and even overweight people have a higher risk of being diagnosed with and dying from pancreatic cancer. Chronic, heavy alcohol use can also increase the risk of pancreatic cancer, most likely by causing recurrent pancreatitis, which is repeated inflammation of the pancreas..
Diabetes. Many studies have indicated that diabetes increases the risk of developing pancreatic cancer, especially when a person has had diabetes for many years. In addition, suddenly developing diabetes later in adulthood can be an early symptom of pancreatic cancer. However, it is important to remember that not all people who have diabetes or who are diagnosed with diabetes as adults develop pancreatic cancer.
Family history. Pancreatic cancer may run in the family and/or may be linked with genetic conditions that increase the risk of other types of cancer. This is called familial pancreatic cancer. You and your family may be at risk if 2 or more first-degree relatives or at least 3 members of the family have been diagnosed with pancreatic cancer. First-degree relatives include parents, children, and siblings.
Rare inherited conditions. Members of families with specific, uncommon inherited conditions also have a significantly increased risk of pancreatic cancer, as well as other types of cancer. These conditions include the following:
Chronic pancreatitis. Pancreatitis is the inflammation of the pancreas. Some research suggests that having chronic pancreatitis may increase the risk of developing pancreatic cancer.
Chemicals. Exposure to certain chemicals such as pesticides, benzene, certain dyes, and petrochemicals may increase the risk of developing pancreatic cancer.
Bacteria. A common bacterium called Helicobacter pylori, also called H. pylori, causes inflammation and ulcers in the stomach. Infection with H. pylori increases the risk of stomach cancer and pancreatic cancer. However, the risk of developing pancreatic cancer is not as high as the risk of developing stomach cancer.
What are the symptoms of Pancreatic cancer?
Pancreatic cancer is a “silent disease” because there are not many noticeable symptoms early on. As the cancer grows, symptoms may include:
What are the investigations done in a patient with Pancreatic cancer?
Biopsy or cytology to confirm the diagnosis- Can be done under Endoscopic Ultrasound guidance (EUS), Endoscopic retrograde cholangiopancreatography (ERCP) guidance or CT guided.
Pancreatic cancer patients often presents with jaundice. Often stent need to be placed under ERCP or PTBD to relieve the jaundice.
What are the stages of oesophageal cancer?
Stage I- When the cancer is confined to submucosa of oesophagus and/ or spread to 1-2 lymph nodes
Stage II- When the cancer is confined within the muscle layer (muscularis propria) of oesophagus and/or spread to 1-2 lymph nodes. When cancer has spread beyond the muscle layer without any lymph nodal spread.
Stage III- When cancer has spread beyond the muscle layer with spread to 1-2 lymph nodes. Cancer confined to oesophagus with 3-6 lymph nodal spread is also included in stage III.
Stage IVA- When cancer has spread outside oesophagus to surrounding organs or has spread to 7 or more lymph nodes.
Stage IVB- When cancer has spread to distant organs.
What is the treatment of oesophageal cancer?
Treatment of oesophageal cancer patients depends on various factors e.g., stage of the disease, age of the patient, other medical comorbidities, and general fitness.
Treatment of Stage I- Very early stage oesophageal cancer can be cured with endoscopic mucosal resection (EMR). Other wise, most patients at this stage is treated with surgery. If there is spread to 1-2 lymph nodes, then chemotherapy or chemo radiotherapy can be considered before surgery. If a patient is not fit for surgery then Radical Radiotherapy or Chemo-radiotherapy would be the preferred option.
Treatment of stage II & Stage III- The standard treatment for this stage is to start with chemotherapy or chemo-radiotherapy to shrink down the cancer followed by surgery. If a patient is not fit for surgery then Radical Radiotherapy or Chemo-radiotherapy would be the preferred option. When radiotherapy is used alone, then a Hypofractionated radiotherapy schedule is used over 3-4 weeks. Surgery is usually not possible when oesophageal cancer is present in the upper part of the food pipe. This patient are usually treated with Radical Radiotherapy or Chemo-radiotherapy. When Radiotherapy is used, Intensity Modulated Radiotherapy (IMRT) is preferred over other conventional techniques or 3D conformal radiotherapy. IMRT technique has been shown to reduce the dose to heart & lung and thereby reduces the side effects of treatment. 4D-CT scan is used in some cancer centres to precisely treat the oesophageal cancer patients with radiotherapy, when cancer is involving the lower part of food pipe.
Treatment of stage IVA- Surgery is usually not possible for this stage of patients. They are usually treated with combination of chemotherapy and Radiotherapy or Radiotherapy alone.
Treatment of stage IVB- Patients with stage IVB cancer is usually incurable. This group of patients are usually treated with palliative chemotherapy. Selected group of patients where Her2neu is positive can be benefitted by targeted therapy with Trastuzumab. Selected group of patients may benefit from Immunotherapy. Palliative radiotherapy can be used in some patients for symptom control. Oesophageal stent is sometimes done to open up the food pipe in patients with severe swallowing problem.
What is the prognosis of Oesophageal cancer?
Stage I & II patients can be cured with available treatment. Stage III patients can also be cured but the chance of cure is less. Stage IV patients are usually incurable. The aim of treatment in stage IV is to try to control the cancer, control symptoms from cancer, maintain a quality of life and try to prolong the survival.
