World Cancer Day (Feb 4)Bengaluru: While head and neck, lung, breast and cervical cancers are frequently discussed due to their high incidence, doctors are increasingly flagging a quieter but concerning trend — a steady rise in pancreatic cancer cases over the last decade. Once considered a rare form of cancer, pancreatic cancer is now being diagnosed more often, usually at advanced stages, with lifestyle-related risk factors playing a key role.
“There has been a clear paradigm shift in the incidence of pancreatic cancer over the last several years. At present, in a tertiary cancer centre like ours, we see approximately 10 to 12 new cases of pancreatic cancer every month. In the past, this was closer to 5 or 6 cases per month,” said Dr Basant Mahadevappa, senior consultant and liver transplant surgeon at HCG Cancer Hospital, KR Road.He attributed this increase largely to metabolic disorders. “The incidence of pancreatitis has increased significantly, and this is closely linked to factors such as gallbladder stones, alcohol consumption, and a diet high in saturated fatty acids. An increased incidence of pancreatitis leads to a higher risk of pancreatic cancer,” he said.Doctors are also seeing a shift in the age profile of patients. While pancreatic cancer was earlier considered a disease of those in their 60s or older, it is not unusual for clinicians to now diagnose patients in their 30s and 40s as well.“The exact reasons for this shift are still not clearly understood. However, lifestyle factors are thought to play a significant role. The quality of food, including higher exposure to pesticides and processed foods, is also suspected to play a role, although definitive evidence is still lacking. Overall, this trend mirrors the general increase in cancer incidence seen across multiple organs, including colorectal, stomach, liver, and now pancreatic cancers,” said Dr Adithya V Naragund, senior consultant, GI and HPB surgery, Cytecare Hospitals.He added that improved detection could be contributing to the rising numbers. With better imaging and wider use of diagnostic investigations, more cases — including early-stage disease that may have gone undetected earlier — are now being identified.A major concern with pancreatic cancer remains late diagnosis. Unlike many other cancers, it often does not produce noticeable symptoms until stage 3 or stage 4, when prognosis is usually poor.“One of the greatest challenges in pancreatic cancer is its silent and non-specific early course. Symptoms often appear only when the disease is advanced. Pancreatic cancer is not screened routinely like breast or cervical cancer because it is uncommon, and current tests are not reliable for mass screening,” said Dr Vijay Kumar Srinivasalu, senior consultant in medical oncology at Sakra World Hospital. He recommended that high-risk individuals — such as those with a strong family history, genetic risk, or long-standing chronic pancreatitis — undergo screening at specialised centres using MRI or endoscopic ultrasound.Cut down on alcohol; women too at riskDoctors are urging preventive action, by reducing alcohol intake and avoiding tobacco products, both of which are established risk factors.While pancreatic cancer continues to be more common among men, women are increasingly being diagnosed as well. Doctors note that outcomes for women are similar to men, especially when the disease is detected at an advanced stage.Treatment outcomes have improved in recent years. Surgical mortality has come down significantly, from nearly 10% a decade ago to about 2 to 3% in large, high-volume centres.“Recent advances in molecular and genetic diagnostic tools have significantly improved treatment outcomes. These tests help identify specific mutations, allowing for personalised therapy. Patients with BRCA (Breast Cancer gene) mutations can be treated with PARP (Poly ADP-ribose polymerase) inhibitors, while those with Kirsten Rat Sarcoma (KRAS) viral oncogene homolog mutations may benefit from KRAS inhibitors. These targeted therapies have contributed to improved outcomes. At present, immunotherapy has shown limited benefits in pancreatic cancer, but its role may expand in the future,” said Dr Vinayak Maka, consultant in medical oncology at Ramaiah Institute of Oncosciences, Ramaiah Memorial Hospital.Inset: Warning signsPainless jaundice (yellowing of eyes and skin, dark urine, pale stools)Unexplained weight loss and loss of appetitePersistent upper abdominal pain, often radiating to the backSudden onset or worsening of diabetes, especially in people over 50Unexplained fatigue or itching **Combination of risk factors**Tobacco and alcohol useLong-standing diabetes mellitus, and in some cases sudden-onset diabetes in older adults Chronic pancreatitis, especially alcohol-relatedObesity and sedentary lifestyle, most common in urban IndiaFamily history and genetic syndromes.
