MUMBAI, 18 NOVEMBER, 2020 (GPN): Although the twelfth most common cancer in the world, pancreatic cancer is the fourth leading cause of cancer-related deaths. According to the ICMR, India has a relatively lower incidence of pancreatic cancer as compared to the West. However, this form of cancer often does not cause symptoms until it has already spread to other organs, which makes it harder to detect at its early stages. With November being marked as World Pancreatic Cancer Awareness Month, it’s important to take a closer look at this potentially deadly cancer and how you can determine whether you are at risk.

Understanding pancreatic cancer

Pancreatic cancer is caused by mutations in the DNA of the cells in your pancreas, which cause them to grow uncontrollably and to continue living beyond their normal course. These accumulating cells can form a tumour. If untreated, the cancerous cells can also spread to other organs and blood vessels. Smoking, diabetes, chronic inflammation of the pancreas (pancreatitis), a family history of genetic syndromes that increase cancer risk including a BRCA2 gene mutation, Lynch syndrome, and FAMMM syndrome, a family history of pancreatic cancer, and obesity can increase your risk for pancreatic cancer. Age is also a factor as most patients are diagnosed after the age of 65. Research indicates that a combination of smoking, long-standing diabetes, and a poor diet increases your risk of pancreatic cancer more than any one of these factors alone.

Testing and treatment

Surgery to remove the tumour, including a part or the entire pancreas, is often combined with additional post-surgery treatments to prevent recurrence. However, only about 20 percent of people diagnosed with pancreatic cancer can undergo surgery because most pancreatic cancers are diagnosed after the disease has already spread. Further, unlike other forms of cancer, even if pancreatic cancer is diagnosed at an early stage, the chances of recurrence after surgery alone are high unless post-surgery treatments such as chemotherapy are also administered. Testing for pancreatic cancer is, therefore, especially important to enable early detection and effective treatment. 

Testing for BRCA1 and BRCA2 mutations can help to determine and monitor your risk for pancreatic cancer. BRCA genes act as tumour suppressors, preventing cells from growing indiscriminately and becoming cancerous. Mutations in these genes could potentially increase the likelihood of tumours, including pancreatic cancer. It has been found that cancer cells with BRCA mutations may respond well to a targeted therapy called PARP inhibition, when combined with chemotherapy. The PARP inhibitor Olaparib has been approved for metastatic pancreatic cancer patients who have BRCA1 or BRCA2 mutations and whose tumour previously responded to platinum-based chemotherapy. Erlotinib (tarceva) is another targeted treatment approved for people with advanced pancreatic cancer, in combination with chemotherapy. Erlotinib blocks the effect of a certain protein that can become abnormal and help cancer grow and spread.

Dr. Rajas B Patel

Medical Oncologist

RH Clinic / Chemotherapy Day Care Center

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