Pancreatic Cancer

Pancreatic cancer arises when cells in the pancreas, a glandular organ behind the stomach, begin to multiply out of control and form a mass. These cancer cells have the ability to invade other parts of the body.

There are a number of types of pancreatic cancer. The most common, pancreatic adenocarcinoma, accounts for about 85% of cases, and the term “pancreatic cancer” is sometimes used to refer only to that type. These adenocarcinomas start within the part of the pancreas which make digestive enzymes. Several other types of cancer, which collectively represent the majority of the non-adenocarcinoma, can also arise from these cells.

One to two in every hundred cases of pancreatic cancer are neuroendocrine tumors, which arise from the hormone-producing cells of the pancreas. These are generally less aggressive than pancreatic adenocarcinoma.

Types of Pancreatic Cancer

Malignant lesions of the exocrine pancreas:

Most exocrine pancreatic cancers (95%) are ductal adenocarcinomas, a type of tumor that arises from the cells lining the pancreatic duct.

The remaining 5% of exocrine pancreatic cancers arise from acinar cells, the cells that secrete the digestive enzymes.

Common Premalignant lesions:

Intraductal papillary-mucinous neoplasm (IPMN) is a rare form of pancreatic tumor characterized by enlargement (dilatation) of the main pancreatic duct, mucus overproduction, and occasional pain. More than 30% of these tumors have malignant foci within them, but because diagnostic tests cannot distinguish between noncancerous and cancerous forms of this tumor, surgery is the best diagnostic and treatment option for all people suspected of having an intraductal papillary-mucinous tumor. A lesion that appears in the main duct has a higher risk to evolve into cancer and will be resected. However, if a lesion appears in a side branch less than 3 cm, the risk to evolve into cancer is low and the lesion is not resect but its evolution is carefully followed.

Stages of Pancreatic Cancer

Stage is a term used in cancer treatment to describe the extent of the cancer’s spread. The stages of pancreatic cancer are used to guide treatment and to classify patients for clinical trials. The stages of pancreatic cancer are:

Stage 0: No spread. Pancreatic cancer is limited to a single layer of cells in the pancreas. The pancreatic cancer is not visible on imaging tests or even to the naked eye.

Stage I: Local growth. Pancreatic cancer is limited to the pancreas, but has grown less than 2 centimeters across (stage IA) or greater than 2 centimeters (stage IB).

Stage II: Local spread. Pancreatic cancer has grown outside the pancreas, or has spread to nearby lymph nodes.

Stage III: Wider spread. The tumor has expanded into nearby major blood vessels or nerves but has not metastasized.

Stage IV: Confirmed spread. Pancreatic cancer has spread to distant organs.

Prevention of Pancreatic Cancer

Tumor Board Evaluation

All patients who come to Dr. Manish Kumar Singhalfor oncology care start their treatment only after they have been discussed in the Tumor Board and given a Tumor Board Number. In the tumor board, all our specialists (Surgical Oncologists, Gastroenterologists, Medical Oncologists, Radiation Oncologists, Oncopathologist and Radiologists) discuss the findings, and chart out the optimal plan of treatment for each patient, based on established National and International Guidelines and Protocols. This treatment plan takes into account the overall health of the patient, the extent (stage) of the cancer and their preferences. The primary treatments for Osophageal Cancer include surgery, radiation therapy and chemotherapy.

Oncologists at Dr. Manish Kumar Singhal see several thousand patients who have Osophageal Cancer each year. That experience helps them to guide patients toward the most appropriate treatment approach. We take great care to ensure patients understand the benefits and risks associated with each treatment option.


Surgery is the best option for people whose cancer can be safely and effectively removed. This usually means that the tumor hasn’t grown into any of the major blood vessels located near the pancreas or spread to the liver, abdominal cavity or lungs.

Unfortunately, only about 20 percent of pancreatic cancer patients have tumors that can be surgically removed (resected). And although improvements in diagnosis, staging, surgical techniques and postoperative care have led to much better outcomes after surgery, pancreatic resection is still one of the most difficult and demanding operations for both surgeons and patients.

Pancreatic surgeries offered at Dr. Meenu Walia
1. Whipple procedure – This is the most common type of surgery, also known as pancreatoduodenectomy (Whipple procedure) and is potentially curative. The surgery involves removing the “head” of the pancreas along with the duodenum, the gallbladder and the lower end of the bile duct. The bile duct, pancreatic duct and intestine are reconstructed. This is a technically demanding procedure, which our surgeons perform routinely, within an acceptable rate of morbidity.
2. Other surgical procedures – Dr. Manish Kumar Singhaloffer other options for pancreatic cancer, including total pancreatectomy, which removes the entire pancreas, along with the gallbladder, part of the stomach and small intestine, the bile duct, spleen, and nearby lymph nodes; and distal pancreatectomy, in which the body and tail of the pancreas are removed.

Radiation Therapy And Multi-Modality Therapies

Radiation oncologists at Dr. Manish Kumar Singhal have particular expertise in the most advanced therapies, including intensity modulated radiation therapy, which uses hundreds of small radiation beams of varying intensities to precisely target cancer cells, while sparing healthy tissue.

At Dr. Manish Kumar Singhal, radiation is almost always given in conjunction with chemotherapy (chemoradiation) for tumors that can’t be removed. It’s also used before or after surgery to reduce the size of tumors and destroy cancer cells that may have spread beyond the pancreas.

Radiation can be delivered during surgery using intra-operative radiation electron therapy. Intra-operative radiation electron therapy allows doctors to treat tumors with high doses of radiation – the equivalent, in some cases, of 10 to 20 daily radiation treatments – without harming nearby organs.


Inoperable pancreatic cancers require the use of chemotherapy / radiation therapy to shrink / control the tumor growth. Pancreatic cancers with metastatic require chemotherapy. Selection of chemotherapeutic drugs, dosages and schedule depend on the physical condition of the patient and performance status. Patient not fit for injectable chemotherapy may also be offered targeted therapy.

Palliative Care

When cancer is so advanced that treatment options are limited, an experienced, integrated team of palliative care providers serves the social, psychological and spiritual needs of patients and their families. The team may include physicians from a number of fields as well as dietitians, medical social workers, psychologists, pharmacists and pain management specialists.

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