Pankaj Udhas suffered from pancreatic cancer, all about the disease

Singer Pankaj Udhas passed away on Monday reportedly due to pancreatic cancer. Pancreatic cancer occurs when malignant (cancerous) cells in your pancreas change and grow out of control, forming a tumour.

What is pancreatic cancer?

“Pancreatic cancer occurs when malignant (cancerous) cells in your pancreas change and grow out of control, forming a tumour. Your pancreas is a 6-inch-long, spongy, tube-shaped organ stationed between your spine and stomach. Its main function is to make digestive juices (known as enzymes) and hormones including insulin that play a key role in keeping blood-sugar levels, starches and enzymes in check aiding in digestion. Most pancreatic cancers develop in the ducts of your pancreas. It’s hard to detect and treat pancreatic cancer at an early stage. Hence this type of cancer turns fatal because it is often diagnosed at an advanced stage when treatment options are limited. Early detection and treatment is key,” says Dr. Bir Singh Sehrawat, Director and HOD-Gastroenterology, Marengo Asia Hospitals, Faridabad.

“Pancreatic cancer is one of the most aggressive and deadly cancers, affecting more than 4 lakh people in India every year. It occurs when abnormal cells grow in the pancreas, an organ that produces enzymes for digestion and hormones for metabolism. Pancreatic cancer often does not cause symptoms until it reaches advanced stages, making it difficult to diagnose and treat,” says Dr Pushpak Chirmade, Consultant, Medical Oncology at Kokilaben Dhirubhai Ambani Hospital Navi Mumbai.

Causes of pancreatic cancer

Pancreatic cancer may develop due to lifestyle causes from smoking, drinking too much alcohol to being overweight and eating excess processed foods.

“The exact cause of pancreatic cancer is unknown, but some factors that may increase the risk include smoking, diabetes, chronic pancreatitis, obesity, and family history. The most common type of pancreatic cancer is pancreatic adenocarcinoma, which starts in the exocrine cells that produce digestive enzymes. A rarer type is pancreatic neuroendocrine tumour, which starts in the endocrine cells that produce hormones,” says Dr Chirmade.

“Exact cause of this disease is still unclear. However, there are some factors that may raise the risk of pancreatic cancer. These include tobacco use (smoking cigarettes or in any form), heavy alcohol consumption, chronic and hereditary pancreatitis, having overweight or obesity (particularly in early adulthood), consumption of a diet containing red and processed meats, fried foods, sugar, or cholesterol. Men are more prone to developing pancreatic cancer than women. People working with certain chemicals, particularly used in metal working and pesticides, having type 1 or type 2 diabetes, having hepatitis B and having personal or family history of the condition may be at high risk of developing pancreatic cancer,” says Dr Sehrawat.

Diagnosis and treatment

“Treatment options may include surgery (such as tumour resection or pancreaticoduodenectomy), chemotherapy (commonly using drugs like gemcitabine or FOLFIRINOX), radiation therapy, targeted therapy, immunotherapy, or a combination of these approaches. The goal of treatment is often to control the cancer, alleviate symptoms, and improve the patient’s quality of life. However, pancreatic cancer is often diagnosed at an advanced stage, which can limit treatment options and make it challenging to achieve long-term survival. Therefore, early detection and prompt intervention are crucial in managing this disease,” says Dr Dipanjan Panda, Senior Consultant, Medical Oncology, Indraprastha Apollo Hospitals.

“To diagnose it, symptoms and medical history of the patients is investigated. The patient is recommended to undergo CT scans, blood tests and two specialized procedures that can help to identify pancreatic cancer accurately such as endoscopic retrograde cholangiopancreatography (ERCP) assisted cholangioscopy and endoscopic ultrasound (EUS),” says Dr Sehrawat.

“The diagnosis of pancreatic cancer is based on imaging tests, such as ultrasound, CT scan, MRI scan, and PET scan, that can show the size and location of the tumour. A biopsy, which involves taking a small sample of tissue from the pancreas, is done to confirm the diagnosis and to look for genetic changes in the cancer cells. Blood tests can also measure the levels of tumour markers, such as CA19-9, that pancreatic cancer cells produce,” says Dr Chirmade.

Main treatment options as per Dr Sehrawat are:

Radiation therapy: To treat pancreatic cancer, patients are advised to undergo Radiation therapy. X-rays and other high-energy beams are used to destroy cancer cells.

Chemotherapy: Here, anti-cancer medications are used to kill cancer cells and help prevent their future growth.

Targeted therapy: To target cancer cells without harming other cells, Medications and antibodies are used.

Dr Chirmade says the treatment of pancreatic cancer depends on the stage of the disease and the overall health of the patient and the main options are surgery, chemotherapy, radiation therapy, or a combination of these.

“Surgery is done to remove the tumour and some surrounding tissue, but it is only possible for about 20% of patients whose cancer has not spread to other organs. Chemotherapy is the use of drugs that kill cancer cells or stop them from growing. Radiation therapy is the use of high-energy rays that damage cancer cells or make them more sensitive to chemotherapy,” says the expert.

Recent advances in pancreatic cancer research have led to the development of new therapies that target specific features of the cancer cells, such as genetic mutations, immune system, or tumour environment. Some examples are:

• Neoadjuvant chemotherapy: This is chemotherapy given before surgery, with the goal of shrinking the tumour and improving the chances of complete removal.
• Immunotherapy: This is a type of therapy that boosts the body’s natural defences against cancer. One example is pembrolizumab, a drug that blocks a protein called PD-1 that cancer cells use to evade the immune system.

Lifestyle changes to lower pancreatic cancer risk

Dr Sehrawat suggests some lifestyle modifications to lower the risk of pancreatic cancer:

• Quit or limit smoking: Refrain from excessive consumption of alcohol as heavy drinking may raise risk of chronic pancreatitis and possibly pancreatic cancer.
• Try to maintain your weight healthy by doing regular exercise, yoga and eating a well-balanced diet
• Avoid consumption of red meat, processed meat, sugar and fried foods. Instead, you should incorporate fresh fruits, vegetables, whole grains and lean proteins in your daily diet.

“Pancreatic cancer is a challenging disease that requires a multidisciplinary approach and personalized care. Patients and their families should consult with their doctors about the best treatment options and the latest clinical trials available for them. Early detection, prevention, and awareness are also key to improving the outcomes and quality of life of pancreatic cancer patients,” concludes Dr Chirmade.

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