The Pancreas is a leaf-shaped gland sitting below the stomach extending from the “C” shaped upper part of the intestine called the duodenum in the center to the spleen on the left. Cancer developing in this gland is referred to as Pancreatic cancer. Pancreatic cancer is commonly seen in males in the sixth and seventh decades of life. It commonly presents with abdominal pain and jaundice. The most common variant of cancer encountered is adenocarcinoma. It can arise in the head, neck, body, tail and the uncinate area – various parts of the pancreas. (Areas within pancreas and location) The subset of periampullary tumours are identical in location, behavior and treatment to pancreatic cancer arising in the head region of the pancreas.

The Pancreas is composed of gland tissue and channels that run through it called pancreatic duct, carrying the secretion from the glandular tissue or parenchyma into the intestine, aiding digestion.

When the cells lining the channels (ductal epithelium) start multiplying in an unregulated manner, it results in adenocarcinoma.

In another variant, the lining of the channels exhibits atypical features including the ability to produce mucin – a proteinaceous liquid in excess and such lining can be a precursor to cancerous changes over time (malignant transformation of cystic neoplasm of the pancreas).

The development of cancer is usually a combination of the underlying tendency of native cells within the organ and the irritation caused by extraneous risk factors.

Common risk factors for pancreatic cancer include pancreatic stone disease (referred to as Chronic calculus pancreatitis), hazardous intake of alcohol, familial risk and certain types of cystic neoplasm of the pancreas especially the mucinous variants. A familial condition wherein polyps affecting the colon (large intestine) called Lynch syndrome or Hereditary non-polyposis colorectal cancer is associated with tumours of the ampulla and pancreas.

Throat cancer can also affect the piece of cartilage (epiglottis) that acts as a lid for your windpipe. Tonsil cancer, another form of throat cancer, affects the tonsils, which are located on the back of the throat.

Pancreatic cancer is known to spread fast and commonly blocks the bile duct and the pancreatic duct – the channels draining the liver and pancreas respectively into the part of the intestine referred to as duodenum. This results in jaundice, itching and change in the nature of stools to greasy stools (steatorrhoea). Further, when it spreads towards the nerve plexus behind it, it can produce severe back pain.

When it arises in the head of the pancreas, it is in close relationship to critical blood vessels that directly deal with the liver and small intestine. If cancer encroaches into a significant portion of these blood vessels, it may not be amenable for surgical removal directly and often needs chemotherapy and radiotherapy to shrink the tumour for making surgery feasible.

It is notorious for spread to distant sites like the liver, lung, abdominal cavity and lining (peritoneum) which usually makes it advanced. Hence, it is crucial to detect it early to allow for curative treatment.

Whereas survival rates for advanced pancreatic cancer continue to be dismal lasting for less than 6 months, survival for localized pancreatic cancer has improved significantly over the last 2 decades.

Whereas the overall survival at 5 years for all stages of pancreatic cancer put together is about 10% only, the 5-year survival improves to nearly 40% when detected in the early stage. Unfortunately, nearly half of pancreatic cancers are diagnosed when they have already spread. Hence, there is an emphasis on health checks, cancer screening among high-risk individuals and early detection of pancreatic cancer.

With the advent of newer modalities including precision oncology, proton based radiation, surgical cytoreduction and theranostics, it is possible to manage advanced and recurrent cancer as well with meaningful improvement in survival.

Prior to the availability of multimodality treatment including chemotherapy, radiotherapy, immunotherapy, surgical resection alone resulted in survival of about 3 to 4 years in pancreatic cancer. Now with advances including neoadjuvant (chemotherapy and/or radiotherapy before surgery) and adjuvant (chemotherapy and/or radiotherapy after surgery) strategies have enabled increasing to survival to nearly 6 years overall.

The neuroendocrine variant of pancreatic cancer has a better prognosis and outcome following treatment and in early stages, the 5-year survival is more than 90%. The 5-yr survival drops to around 75% for locally advanced cancer and around 30% for distant spread. The overall 5-year survival for pancreatic neuroendocrine cancer is about 50%.

The most common type of pancreatic cancer is adenocarcinoma arising from the ductal lining. Another type of pancreatic cancer is the neuroendocrine tumour of the pancreas, which can vary from a quiescent presentation (grade 1 neuroendocrine tumours) to sinistral manifestations (neuroendocrine carcinoma) with signs of spread.

Yet another type of pancreatic cancer is cystadenocarcinoma, where longstanding cystic tumours of the pancreas undergo cancerous transformation.

Pancreatic cancer can be picked up early on scanning done for assessment of chronic pancreatitis or incidentally when done for other indications. High-risk individuals identified by cancer risk tools can be screened using scanning methods and tumour marker tests. If detected at the early stages, it is possible to achieve a cure and prolonged survival.

Men above the age of 45 years are at greater risk of developing pancreatic cancer.

Those with a hazardous intake of alcohol, long-standing pancreatic stone disease, long-standing diabetes, family history of pancreatic cancer and colorectal cancer are commonly at risk for the development of pancreatic cancer. A type of familial polyps affecting the colon (large intestine) called Lynch syndrome or hereditary non-polyposis colon cancer is associated with tumours of the ampulla, also referred to as Periampullary tumour as well as tumours of the pancreas.

Familial pancreatic cancer is suspected if 2 or more first-degree relatives or at least 3 members of the family have been diagnosed with pancreatic cancer previously. This needs detailed pedigree chart assessment, genetic counseling and further testing in a hereditary cancer clinic.