Dr Deepak Varma Gastro Surgeon Cochin

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Pancreatic Cancer

The pancreas is a fish-shaped organ present just behind the stomach. It is about 6 to 8 inches in length and 2 inches in width, with a wide head and tapering body ending in a pointed tail. The pancreas consists of endocrine glands and exocrine glands. Exocrine glands release juices containing enzymes into the intestine that helps in the digestion of food. Endocrine glands are found in small clusters or islets that secrete insulin and glucagon hormones.

Types Of Pancreatic Cancer

  • Precancerous growths:
    • Serous cystic neoplasms also known as serous cystadenomas are benign (non cancerous) cysts filled with watery fluid.
    • The mucinous cystic neoplasms are gradually growing tumours in the form of cysts containing jelly-like mucin. These usually start in the body or tail. This is potentially malignant.
    • Intraductal papillary mucinous neoplasms grow in pancreatic ducts and can become cancerous if not removed.
  • Exocrine tumours:
    • Pancreatic adenocarcinomas start in the gland cells. Most exocrine cancers are adenocarcinomas that begin in the pancreatic duct.
    • Ampullary cancer develops in the ampulla of Vater the place where the pancreatic duct and bile duct meet and empty into the small intestine.
  • Endocrine tumours: More commonly known as pancreatic neuroendocrine tumours they can be malignant or benign.

Causes And Risk Factors

  • Obesity
  • Exposure to harmful chemicals
  • Smoking and tobacco use
  • Aging
  • Male gender
  • Family history and heredity
  • Genetic mutations
  • Chronic pancreatitis
  • Alcohol consumption

Signs And Symptoms

  • Jaundice
  • Unexplained and sudden weight loss
  • Fatigue
  • Pain in the upper and middle abdomen in late stages
  • Loss of appetite


  • Computed tomography or CT scan
  • Endoscopic ultrasound (EUS)
  • MRI and MRCP
  • ERCP or endoscopic retrograde cholangiopancreatography


Surgical removal is the only treatment option for curing pancreatic cancer. Generally pancreatic resections are very complex and require a great deal of surgical experitse, experience and a multidisciplinary team. Postoperative complications can cause morbidity to the patient, if they are not treated by experienced surgical team. Pancreaticoduodenectomy or Whipple procedure, distal pancreatectomy and a total pancreatectomy are the surgical options available as curative treatments for pancreatic cancer.

After the detection of cancer, we discuss the treatment modalities with the patient and weighs each benefit carefully before undertaking the surgery. We lead a multidisciplinary team which takes special care on pancreatic cancer patients.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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