A condition that occurs due to changes or mutations in the pancreatic cells, causing them to grow and multiply uncontrollably and resulting in the formation of a mass of tissue or tumor is known as pancreatic cancer.

The pancreas are small glands that are shaped like a hockey stick and located behind the stomach.

The function of the pancreas is to help in the digestion of food. It also makes the insulin and glucagon hormones, which are responsible for maintaining blood sugar levels.

There are two main types of pancreatic cancers:

1. Pancreatic adenocarcinoma: This is the most common type of pancreatic cancer. They begin in the exocrine cells of the pancreas, which are responsible for the production of enzymes that help in digestion.
2. Pancreatic neuroendocrine tumors: These types of tumors are rare and start in the endocrine cells of the pancreas, which are responsible for releasing hormones that affect everything from a person’s mood to his/her metabolism.

The exact cause of pancreatic cancer development is not known. The condition occurs when the pancreatic cells develop certain changes or mutations in their DNA. These mutations instruct the cells to grow and multiply in an uncontrollable way. The accumulation of these abnormal cells leads to the formation of a mass of tissue known as a tumor. If left untreated, these cancer cells can spread to the other parts of the body.

Some factors increase the risk of developing pancreatic cancer and may include:

• Smoking
• Obesity
• Diabetes
• Increase in age (most cases of pancreatic cancer are diagnosed after 65 years of age)
• Family history of pancreatic cancer
• Pancreatitis (long-term or chronic inflammation of the pancreas)
• Family history of certain genetic syndromes that increase the risk of developing cancer, like the Lynch syndrome, BRCA2 gene mutation, and familial atypical mole-malignant melanoma syndrome

Pancreatic cancer normally shows no symptoms in the early stages. As the disease is advanced, the following symptoms may be noticed:

• Abdominal or stomach pain that may radiate to your back
• Loss of appetite
• Unintentional weight loss
• Light-colored stools
• Jaundice (yellowing of the skin and whites of the eyes)
• Dark-colored urine
• Light-colored stools
• Itchiness of the skin
• Diabetes, or pre-existing diabetes that becomes even more difficult to control
• Fatigue
• Blood clot formation

The doctor may recommend the following to diagnose pancreatic cancer:

1. Physical examination: The doctor will check your overall health, and ask you about your medical history and family history.
2. Imaging tests: CT scans, MRI scans, PET scans, ultrasounds are the different types of imaging tests that are done to obtain clear images of the internal organs of the body.
3. Endoscopic ultrasound: A thin, flexible tube known as an endoscope is passed down the food pipe or esophagus into the stomach to obtain images of the pancreas from inside the abdomen using an ultrasound.
4. Blood tests: Specific tumor markers like CA 19-9 are shed by the pancreatic cancer cells. These can be detected by doing a blood test.
5. Biopsy: The doctor removes a sample of the suspected tissue mass and sends it to the laboratory for examination. This tissue can be removed by passing special medical tools through the endoscope or by the insertion of a needle through the skin and into the pancreas (fine-needle aspiration).

The type of treatment done for pancreatic cancer depends on the stage and location of cancer, the severity of the condition, and the overall health of the patient. The various treatment modalities for the treatment of pancreatic cancer are:
1. Surgery:
This procedure involves the removal of the cancerous part of the pancreas.
The lymph nodes present near the pancreas may also need to be removed.
The surgical procedure of the removal of the pancreas, or a part of the pancreas is called pancreatectomy.
In case of a tumor that is located in the head of the pancreas (the widest part of the pancreas near the small intestine), the doctor may recommends surgery called the Whipple procedure.
The Whipple procedure includes removing the head of the pancreas surgically, along with the gallbladder (a small pouch present just under the liver), duodenum (the first part of the small intestine), a part of the bile duct (small tubes which carry bile, which is a fluid made and released by the liver, outside the liver), and the adjacent lymph nodes.

2. Radiation therapy:
This therapy includes the use of high-powered energy beams like x-rays and protons for killing cancer cells.

3. Chemotherapy:
This therapy includes the use of some drugs for killing cancer cells.

4. Immunotherapy:
Some drugs boost the body’s immune or disease-fighting system so that the cancer cells can be killed.
This therapy is not very effective against pancreatic cancer.

5. Targeted therapy:
This therapy includes the use of certain drugs that kill the cancer cells by attacking specific characteristics of the cancer cells.

The complications associated with pancreatic cancer include:

• Loss of weight
• Extreme pain
• Jaundice
• Obstruction of the bowel

The side effects of the different types of pancreatic cancer treatments are:
1. Surgery:

• Bleeding
• Infection
• Fatigue
• Pain
• Digestion of food is difficult
• Nausea
• Vomiting
• Diabetes

2. Radiation therapy:

• Skin reactions
• Diarrhea
• Upset stomach
• Nausea
• Tiredness

3. Drug treatments (chemotherapy, immunotherapy, targeted drug therapy):

• Nausea
• Vomiting
• Diarrhea
• Loss of appetite
• Rashes
• Gastrointestinal disorders
• Mouth ulcers
• Fatigue
• Loss of hair
• Increased risk of infections
• Easy bruising
• Anemia
• Peripheral neuropathy (nerve damage) causing numbness or tingling

The risk of developing pancreatic cancer can be diminished in the following ways:

• Quit smoking
• Alcohol consumption should be in moderation
• Control your blood sugar levels
• Eat a healthy and well-balanced diet
• Maintain a healthy weight
• Exercise regularly

Pancreatic cancer is usually diagnosed at an advanced stage because it normally shows no symptoms in the early stages. Therefore, it is one of the leading causes of death caused due to cancer. Cancer survival rate is approximately 20% after one year. Cancer survival rate is approximately 6% after five years. If surgery has been performed and a section of your pancreas has been removed, the average survival rate is 18 to 20 months. The five-year survival rate, in this case, can increase to 10 to 25%.

The cost of Pancreatic Cancer Treatment in India varies across different cities and hospitals-