Tuesday, March 19, 2019

Manohar Parrikar passed away due to pancreatic cancer: All about pancreatic cancer

Union Minister Shri Ananth Kumar passed away last year due to pancreatic cancer. And, now Manohar Parrikar died of pancreatic cancer on Sunday.

Let us take a quick recap on pancreatic cancers.

·         Cancer of the exocrine pancreas is a highly lethal malignancy.
·         Surgical resection is the only potentially cure but because of the late presentation, only 15-20% of patients are candidates for pancreatectomy.
·         The disease has a poor prognosis, even after a complete resection. Five-year survival after margin-negative (R0) pancreaticoduodenectomy is around 30% for node-negative and 10% for node-positive disease.
·         Pancreatic cancer usually refers to a ductal adenocarcinoma of the pancreas (85% of all pancreatic neoplasms).
·         More than 95% of malignant neoplasms of the pancreas arise from the exocrine elements.
·         The most common presenting symptoms in patients with exocrine pancreatic cancer are pain, jaundice and weight loss.
·         The initial presentation of pancreatic cancer varies according to tumor location. Around 60-70% of exocrine pancreatic cancers are localized to the head of the pancreas, while 20-25% of pancreatic cancers are located in the body/tail and the remainder involve the whole organ
·         Compared with tumors in the body and tail of the pancreas, tumors located in the head present more often with jaundice, steatorrhea and weight loss.
·         Pain is one of the most frequently reported symptoms, even with small (<2 cm) pancreatic cancers
·         The pain associated with pancreatic cancer is usually insidious in onset, and has been present for 1 to 2 months at the time of presentation.
·         Pain has a typical gnawing visceral quality, and is generally epigastric, radiating to the sides and/or straight through to the back.
·         Pain may be intermittent and made worse by eating or lying supine.
·         Pain is frequently worse at night. Lying in a curled or fetal position may improve the pain.
·         Severe back pain should raise suspicion for a tumor arising in the body and tail of the pancreas.
·         Rarely, pain develops very acutely, as a result of an episode of acute pancreatitis due to tumoral occlusion of the main pancreatic duct.
·         Jaundice is a relatively early sign in tumors arising from the pancreatic head and pancreatic tumors that present with painless jaundice have been ascribed a relatively more favorable prognosis compared with those that present with pain and obstructive jaundice. Jaundice secondary to a tumor in the body or tail typically occurs later in the course of the disease, and may be secondary to liver metastases.
·         A recent onset of diabetes mellitus may be noted.
·         Unexplained superficial thrombophlebitis, which may be migratory (classic Trousseau's syndrome) is sometimes present.
·         Metastatic commonly affects the liver, peritoneum, lungs and less frequently, bone.
·         A solid pancreatic lesion is uncommonly found as an incidental finding on CT scans. 

Epigastric pain and weight loss

·         Abdominal CT scan is the preferred initial imaging test in patients presenting with epigastric pain and weight loss, but without jaundice. 
·         In practice, transabdominal ultrasound is commonly utilized as an initial screening technique for a biliary-pancreatic disease.  However, transabdominal USG  has high sensitivity for detecting tumors >3 cm only.
·         But if acute pancreatitis is in the differential diagnosis, transabdominal USG is not the preferred initial test. Contrast-enhanced CT scan is the best option.
·         Most early-stage tumors will be less than 3 cm in size.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

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