Pancreas Cancer Research and Referral Clinic

Pancreas cancer can encase the nearby key arteries. The three arteries that can be involved are hepatic artery (The one that takes blood to the liver), the celiac axis (The artery to the stomach and nearby organs) and the superior mesenteric artery (the artery to the small intestine). Till recently, the approximation of the tumour mass to any of these vessels was considered incurable and not suitable for surgery. These patients were provided palliative chemotherapy and radiation therapy along with pain control measures. These lesions were considered too advanced. NCCN guidelines call these lesions as locally advanced pancreatic cancer. The diagnosis of locally advanced pancreatic cancer is no longer made on the surgical table. With standardised imaging   (1)  being available in most places, pancreatic surgeons make this diagnosis after imaging evaluation. The obvious next step in evaluation is to look for disease in other major organs like liver, lungs and bone. A diagnosis of...

In 2012, Sasha Muller from Switzerland published a review article in the Recent Results in Cancer Research *   (Please click on the * for references)  on the bird's eye view of developments in pancreatic cancer surgery. We want our reader to recognise that the fact that surgery is the mainstay of curative treatment in pancreatic cancer, while at the same time recognise the limits of such an unimodal approach. In a country with accessible health for most of the population, 4 0% of patients with resectable disease were not offered surgery * . We do not have similar statistics with regard to the situation in India, but we believe that situation may be worse from additional factors like affordability . At best, the 5 year probability of surviving pancreatic cancer remains at a dismal 10% * . The fact that the survival has reached double digits has been a source of joy for the pancreatic surgical community.  If we look at the SEER database 1998 - 2003, the drop in the proporti...

Many developments have happened in pancreatic cancer surgery in the last decade. For the first time, we are having long term survivors and in Chennai, in our group, we are seeing patients with disease spread to the liver, living for more than one year and in good health. These experiences vindicate our protocol. Today, we discuss how we provide excellent results in Whipple's operation for pancreatic cancer. These techniques are developed for removing the pancreatic cancer with excellent margins. The principle of complete mesopancreas dissection:  If you want best results in Whipple's surgery, the key margin is the retroperitoneal margin, which lies along the margin of the superior mesenteric artery. The longer margin you give, the better the results will be. (The following stuff is highly technical. Please skip it, if it is too much to digest) In 2011, we standardised the artery first approach to pancreatic cancer and since 2016, we use it as a standard process. The next approa...

In Chennai, we have many CT scan centers. It is common for our patients to come and see us with CT scan reports of scans done outside. Sometimes, we are unable to look at the CT films and give a genuine opinion. So we end up asking for a second imaging to the dismay of our patients. Imaging standards for pancreatic tumour imaging has been standardized by many radiologic societies and only a standardized evaluation will give us appropriate decision making. Using the wrong scans to decide will lead us into confusion. So what are the established standards for CT scan of the pancreas? Here we go. Before we deal with pancreatic CT, I will explain what constitutes a normal CT scan protocol.  Normal CT scans are done in different formats. Plain CT scan refers to CT scan done without giving contrast agents. Plain scan will not show the blood vessels and cannot accurately define the relationship of the lesion or even clearly define the lesion. It is useful to pick up very large lesions, cal...

CA 19.9 is an essential part of the evaluation of pancreatic cancer. CA stands for Carbohydrate antigen. This CA19.9 is normally produced in two sources in the human body - pancreatic parenchymal cells and the biliary epithelial cells. We still don't know the connection points between the tissue production of CA19.9 and the blood levels. This protein was discovered in the research for large intestinal cancers, but we have found that it is very useful in pancreatic malignancies. A level of > 1000 has a very high chance (around 99%) of pancreatic cancer. The normal level is around 37 U/L and usually the other cutoffs that pancreatic surgeons remember is 100 U/l and 500 u/L, to assess cancer diagnosis and features of advancing disease. It is important to check your CA 19.9 levels after the jaundice is relieved by ERCP and stenting. High levels in the presence of jaundice or cholangitis (infection of the bile ducts) is not useful to assess advanced disease. At PCRRC, we keep 500 u/L...

 The first step to good cancer treatment is to establish the correct diagnosis. Every diagnosis is made by looking at certain changes in the human body. We, doctors have tools like asking questions to learn more about your symptoms, an examination of suspicious looking changes in your body (by touching and pressing, large sized changes can be felt), blood tests, different scans which can examine the particular organ from multiple angles. 1. Obstructive jaundice Jaundice is a medical term for yellowing of the eyes. (Point to remember: This is not a diagnosis. Jaundice is a symptom) There are many causes of jaundice. When a person has jaundice with itching all over the body, or white colored stools, then the possibility of having a mechanical problem arises. Mechanical problems in the human body need a surgeon to correct them.  2. Dilated bile duct Normal human bile duct is less than 6 mm in diameter. Aged people and sometimes, after removal of the gall bladder, the bile duct m...

 NCCN stands for National Comprehensive Cancer Network. In this blog, you will find a lot of reference to NCCN guidelines. This is a resource that we, as cancer surgeons have come to respect and depend on for providing state of the art cancer management. NCCN is a non profit organisation. It is conglomerate of 30 cancer hospitals in the United States. This group consists of experts who treat cancers in high volume dedicated research centers. We, at PCRRC have been using NCCN guidelines to provide care for our patients since 2007. Though as clinicians, we find that leading research journals like Journal of gastrointestinal Surgery, Surgical Oncology Clinics and many such expert resources also provide information on cutting edge technologies, NCCn guidelines for cancer provide the appropriate bedside tool for the management of patients. Though we develop expertise, by using self developed tools, NCCN gives a good framework with which we can take the patient through the entire treatme...