Carcinoma Pancreas (Pancreatic Cancer)

Carcinoma of the pancreas — pancreatic ductal adenocarcinoma (PDAC) — is one of the most aggressive malignancies, with a 5-year survival rate of less than 12% overall due to its propensity for late presentation and early systemic spread. It accounts for the majority of pancreatic malignancies, arising from ductal epithelial cells, and is distinct from less common tumours such as pancreatic neuroendocrine tumours (pNETs), solid pseudopapillary neoplasms (SPN), and intraductal papillary mucinous neoplasms (IPMN). Risk factors include chronic pancreatitis, diabetes mellitus, obesity, smoking, family history of pancreatic cancer, and hereditary syndromes such as BRCA2 mutation, hereditary pancreatitis, and Peutz-Jeghers syndrome.

The classic presentation of pancreatic head cancer is painless obstructive jaundice with pale stools and dark urine, accompanied by weight loss and new-onset diabetes. Body and tail tumours often present later with back pain and cachexia. Diagnosis is established with CECT abdomen (pancreatic protocol), MRI/MRCP, endoscopic ultrasound (EUS) with FNA for tissue confirmation, and staging PET-CT. CA 19-9 serves as a tumour marker, though it is not specific. Tumours are classified as resectable, borderline resectable, locally advanced, or metastatic — a distinction that governs treatment strategy.

Surgical resection remains the only potentially curative treatment. Pancreaticoduodenectomy (Whipple's procedure) is performed for tumours of the pancreatic head, uncinate process, or periampullary region, while distal pancreatectomy with splenectomy addresses body and tail tumours. Total pancreatectomy is reserved for diffuse or multifocal disease. For borderline resectable tumours, neoadjuvant chemotherapy (FOLFIRINOX or gemcitabine/nab-paclitaxel) followed by restaging and resection is the contemporary standard. Adjuvant chemotherapy is recommended after resection. Our surgical team at Ahmedabad Liver Surgeons works within a multidisciplinary oncology framework to offer every operable pancreatic cancer patient the best possible surgical and oncological outcomes.