DECODING THE PURPLE RIBBON

DECODING THE PURPLE RIBBON

WORLDWIDE NOVEMBER IS OBSERVED AS PANCREATIC CANCER AWARENESS MONTH REPRESENTED BY A PURPLE RIBBON. LET’S DECODE SOME FACTS & MYTHS ABOUT THIS LETHAL CANCER WHICH TAKES APPROXIMATELY > 4.6 LAKHS LIVES EVERY YEAR.

WHAT IS PANCREATIC CANCER

Pancreatic cancer arises from the normal pancreatic cells when there are certain mutations in the regulatory genes & the cells start growing uncontrollably. It is more common in the elderly with most patients being >60 years of age, however there is increasing trend or rise in incidence amongst young individuals. According to the latest data (GLOBOCAN 2020) 4,95,773 patients were diagnosed with this fatal cancer worldwide, making it the 14th most common cancer. This cancer is one of the most lethal with worst prognosis & reported 5 year survival rate of < 9%.

SYMPTOMS

Most of the times, patients do not have any complaints & this cancer grows & spreads silently in the body. Symptoms also depend on the location of the tumor in pancreas for example, tumors located in pancreatic head present with yellowish discolouration of eyes or skin (jaundice), dark urine, or itchy skin.  Some of the patients also have unexplained, unintentional weight loss, loss of appetite, indigestion and pale, clay coloured stools. Recent diagnosis of diabetes with weight loss can be an early presenting symptom of pancreatic cancer. Interestingly, diabetes can be a cause (risk factor) or effect (manifestation) of pancreatic cancer.

CAUSES

Like most cancers, exact reason or cause is not known. However there are certain risk factors which increase the probability/ possibility of person getting pancreatic cancer over the years. The greatest risk factor is strong family history. Other risk factors are smoking, alcohol consumption, obesity, diabetes & chronic pancreatitis.

DIAGNOSIS

Your doctor will ask for CT scan (triple phase, contrast enhanced) of the chest abdomen & pelvis if there is a suspicion of having pancreatic cancer. This CT scan will show if there is any tumor in pancreas & also the local & distant spread of the tumor. CA 19-9 a blood test is also useful as a tumor marker for supporting the diagnosis & probable spread Other tests like endoscopic ultrasound (EUS) & PET CT scan are advised in certain specific situations.

TREATMENT OPTIONS

Whenever possible surgery is the best available option for treating pancreatic cancer, however only 20-30% patients are amenable for surgery when they are diagnosed. Pancreatic cancer surgery is one of the most complex & technically demanding requiring advanced skills. Outcomes of pancreatic surgery are better in the hands of trained surgeons. Remaining patients (60-70%) where surgery is not possible are treated with chemotherapy, radiotherapy or combination of both. Subgroup of patients who are not eligible for upfront surgery at diagnosis may be given chemotherapy & radiotherapy then subjected to surgery if they respond well. Decision making for choosing right treatment for individual patient is crucial & requires thorough understanding & experience for better outcomes.

NEW TREATMENT OPTIONS

The field is continuously evolving & recent time has witnessed significant developments in early diagnosis, better treatment outcomes, extended surgeries, downstaging of locally advanced tumors with neoadjuvant therapies & incorporation of minimally invasive (laparoscopic/ robotic) approaches in surgery.  The availability of newer chemotherapeutic drugs & regimens has made a modest breakthrough in the treatment of advanced pancreatic cancer.

Dr Rajesh Shinde

Consultant, Robotic Surgery, GI, HPB & Colorectal Cancer Apollo Cancer Centres, Navi Mumbai.