A LEARNING  OF PANCREATIC CANCER WHICH KILLED UNION MINISTER MANOHAR PARIKKAR & ANANT KUMAR 

Prof.Dr.Dram,profdrram@gmail.com,Gastro Intestinal,Liver Hiv,Hepatitis and sex diseases expert 7838059592,943414355    www.blogspot.com/drnakipuria     www.bhartiyanews24x7.com    www.bhartiyanews24x7.net      www.Bharatiyanews24x7.com

Union Minister Shri Ananth Kumar passed away last year on 12th Nov 2018due to pancreatic cancer. And, now 02 Days before Shri Manohar Parrikar died of pancreatic cancer on Sunday and Steve Jobs, the visionary co-founder of Apple Inc. who revolutionized the way we use technology, died  5th oct 2011 after fighting advanced pancreatic cancer since 2004.

Let us take a quick recap on pancreatic cancers:-----

               Pancreatic cancer patients in starting phase mostly present with mild upper abdominal pain or discomfort or dysphagia or bloating,belching or gas formation which is mostly not taken careof by patient as they think it is due to simple indigestion or acidity,they took simple acidity or anti gas formation medicine and continue with their usual daily activity without consulting a Doctor.

                     In later period when Disease is much advanced as lump or tumor formation or swelling in upper abdomen or loss of appetite or marked weight loss or vomiting with blood in vomitus or blood as meleana in stool or jaundice which is gradually increasing.Now most patient consult their Doctor and during that as alump or swelling or by a simple ultrasound or ct scan or MRI or EUS  it is easily diagnosed but when it is diagnosed then usually it is much advanced and then this tumor cant be resected completely as it has spread to nearby organs or lymph nodes or distant organs as liver,lung or brain and so even surgery is done it is mostly palliative ad patient submitted to chemotherapy which doesnot give good long term survival as in lukaemia or lymphoma or other cancers. 

      Cancer of the exocrine pancreas is a highly lethal malignancy.Surgical resection is the only potentially cure but because of the late presentation, only 15-20% of patients are candidates for pancreatectomy.The disease has a poor prognosis, even after a complete resection. Five-year survival after margin-negative (R0) pancreaticoduodenectomy is around 30% for node-negative and 10% for node-positive disease.Pancreatic cancer usually refers to a ductal adenocarcinoma of the pancreas (85% of all pancreatic neoplasms).More than 95% of malignant neoplasms of the pancreas arise from the exocrine elements.

The initial presentation of pancreatic cancer varies according to tumor location. Around 60-70% of exocrine pancreatic cancers are localized to the head of the pancreas, while 20-25% of pancreatic cancers are located in the body/tail and the remainder involve the whole organ.Compared with tumors in the body and tail of the pancreas, tumors located in the head present more often with jaundice, steatorrhea and weight loss.

           Pain has a typical gnawing visceral quality, and is generally epigastric, radiating to the sides and/or straight through to the back.Pain may be intermittent and made worse by eating or lying supine.

Pain is frequently worse at night. Lying in a curled or fetal position may improve the pain.Severe back pain should raise suspicion for a tumor arising in the body and tail of the pancreas.Rarely, pain develops very acutely, as a result of an episode of acute pancreatitis due to tumoral occlusion of the main pancreatic duct.

              Jaundice is a relatively early sign in tumors arising from the pancreatic head and pancreatic tumors that present with painless jaundice have been ascribed a relatively more favorable prognosis compared with those that present with pain and obstructive jaundice. Jaundice secondary to a tumor in the body or tail typically occurs later in the course of the disease, and may be secondary to liver metastases.

          Weight loss and marked weakness usually signify advanced disease as patient doesnot have appetite and secondly whatever patient takes is not digested so muscle wasting and marked weakness or asthenia is seen 

      Rarely it may present as a recent onset of diabetes mellitus may be noted.Unexplained superficial thrombophlebitis, which may be migratory (classic Trousseaus syndrome) is sometimes present.Metastatic commonly affects the liver, peritoneum, lungs and less frequently, bone.

                 Therefore it is advisable to common people or even doctors that if simple upper abdominal pain,loss of appetite or voming or belching,bloating,heartburn,abdominal distension or gas formation in laymen language one should consult a good doctor and get examined and to conduct basic investigations of different blood tests,ultrasound or endoscopy as if pancreatic cancer can be diagnosed in early stage by EUS at 3mm in diameter swelling ,pnacreatectomy or removal of part of pancreas with few organs accompaying as spllen or duodenum till it spreads to near by organ or lymph nodes then survival is very good about 61% survive 05 yrs but in last stage only 1% 05 yrs survival.

              What to talk of our country even each year more than 50,000 people in the United States (and double this number in Europe) are now diagnosed with pancreatic cancer (adenocarcinoma). The prognosis is such that most of these people will have passed by the end of the first year. In the U.S., pancreatic cancer is 9th or 10th most commonly diagnosed cancer (depending on gender), but the fourth leading cause of cancer death in men and women.

              The prognosis of pancreatic cancer (adenocarcinoma of the pancreas) is a very tough, though the survival rates have been incrementally improving particularly over the past ten to fifteen years. It is important to realize that each person is individual; each cancer is different. Statistics can only indicate what tends to happen in the aggregate, and not in the case of an individual person.The median survival duration from diagnosis with chemotherapy medical treatment in locally advanced cancer of the pancreas has been reported as 6 to 12 months.This is the reason we lost an Apple  great technocrat and scientist and our two honest,dyanamic and young ministers.