Pancreatic Cancer — Overview

Pancreatic ductal adenocarcinoma (PDAC) is the most common type of pancreatic cancer. It has a poor prognosis because it often presents late with vague symptoms. However, surgery offers the only chance of cure, and outcomes are improving with multimodal treatment. Only 15–20% of patients present with resectable disease.

Symptoms

• Painless progressive jaundice — most common presentation for head cancers
• Upper abdominal or back pain
• Unexplained weight loss and loss of appetite
• New-onset diabetes mellitus in older adults
• Pale stools, dark urine
• Steatorrhoea (fatty, floating stools)

Surgical Options

• Pancreaticoduodenectomy (Whipple procedure) — for resectable cancers of the pancreatic head, ampulla and distal bile duct. The only curative option for these tumours.
• Distal Pancreatectomy with Splenectomy — for resectable cancers of the pancreatic body and tail.
• Total Pancreatectomy — for cancers involving the entire pancreas or multifocal tumours.
• Palliative Surgery — biliary bypass (hepaticojejunostomy) and gastrojejunostomy for unresectable tumours causing jaundice or duodenal obstruction.

Neoadjuvant & Adjuvant Therapy

For borderline resectable tumours, neoadjuvant chemotherapy (FOLFIRINOX or gemcitabine/nab-paclitaxel) may downstage the tumour to allow surgery. Adjuvant chemotherapy after surgery reduces recurrence risk. Dr. Ashok Kumar works with the oncology team at Charak Hospital for comprehensive multimodal pancreatic cancer care.