Pancreatic cancer is one of the most prevalent cancer in India and has an unusual mortality rate. According to Conservative reports, not only this cancer is more prevalent among men than women but less than 29% of people are able to outlive this cancer for more than a year without receiving any interventional procedure. The increasing number of fatalities under pancreatic cancer are majorly being caused due to the detection of the disease at a later stage. This makes the early detection, timely treatment and identification of high-risk people extremely important.

Many leading personalities such as Alan Rickman, Steve Jobs and Joan Crawford have suffered from pancreatic cancer and have succumbed to this condition. A recent research conducted by the University of South Carolina in the US found that the onset of diabetes was associated with a 2.3-fold greater increase in the risk of pancreatic cancer than long-standing diabetes. This research further highlights that 80 percent of pancreatic patients have either a new-onset of type 2 diabetes or impaired glucose tolerance at the time of their diagnosis. Hence, according to the study if someone has type 2 diabetes then they are at an increased risk of getting pancreatic cancer also. Based on the evidence from this study, it is extremely important for diabetic patients to take additional care.

How Type 2 diabetes can cause pancreatic cancer 

Type 2 Diabetes requires a higher level of insulin than normal diabetes. This increases the pressure on one’s pancreas to generate more insulin and hence, this is considered as one of the primary reasons for how diabetes can increase the risk of pancreatic cancer among diabetic patients.

Furthermore, pancreatic cancer too can not only lead to insulin resistance by increasing the amount of insulin produced by the pancreas but can also simultaneously lead to a loss in insulin production capacity. In either case, this can increase the risk of type 2 diabetes.

What is the role of duration of diabetes in pancreatic cancer risk?

The duration of diabetes can play a critical role in increasing the pancreatic cancer risk. Many experts have suggested that the longer a person has had diabetes the higher is their risk of pancreatic cancer. People who have had diabetes for more than 5 years are at a much higher risk of pancreatic cancer compared to an average person.

Importance of early diagnosis and treatment 

As both the conditions have a cause and effect relationship, early detection and diagnosis becomes extremely crucial and can enable the clinicians to better manage the conditions.

How can pancreatic cancer be detected? 

Diagnosis for pancreatic cancer usually begins when someone visits a doctor after experiencing symptoms for weeks or months. Symptoms of pancreatic cancer frequently include abdominal pain, weight loss, itching, or jaundice (yellow skin).

A doctor will then embark on a search for the cause, using the following lab tests and techniques that may show evidence or other abnormalities –

• Liver Function Test (LFT)
• CT scan of the abdomen and pelvis
• Magnetic resonance cholangiopancreatography (MRCP)
• Endoscopic ultrasound (EUS)
• Biopsy for histology confirmation
• Pet CT scan of the whole body to detect the spread
• Tumour marker test to measure to amounts of certain substances – like CA 19-9 and carcinoembryonic antigen (CEA) – linked to specific types of cancer when found in increased levels in the body

How can diabetes be detected?

The symptoms of type 2 diabetes can often appear suddenly and therefore for people who are above the age of 45 years or more, anyone who has a BMI (Body Mass Index) of more than 25, women who have had gestational diabetes and anyone who has been diagnosed with prediabetes it becomes important for them to check their blood sugar levels.

The following tests are used for the diagnosis of diabetes –

• A fasting plasma glucose test – It measures the blood glucose levels after someone has fasted for at least 8 hours
• An oral glucose tolerance test – It measures the blood sugar after someone has gone for at least eight hours without eating and two hours after drinking a glucose-containing beverage.
• A random plasma glucose test – In this a doctor will check your blood sugar levels randomly without considering when you had your last meal. This test, along with an assessment of symptoms, is used to diagnose diabetes, but not prediabetes.
• Glycated Hemoglobin (HbA1c)- The American Diabetes Association (ADA) recommends to begin A1c testing at age 45 for overweight or obese people; if the result is normal, the testing should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results and risk status, or when classical signs or symptoms of increased blood glucose levels are observed. People who are not diagnosed with diabetes but are determined to be at increased risk for diabetes (prediabetes) should have their A1c level tested at least yearly.

What are the treatment options for pancreatic cancer? 

In the early stages, as the cancer is of small size, it can be removed surgically as it has not spread outside or pancreas to nearby tissues or lymph nodes. However, in the advanced stages, there are various treatment options which are used –

• Chemotherapy
• Immunotherapy
• Radiation Therapy

Why one should also seek a second opinion? 

For effective management of pancreatic cancer, a multidisciplinary team approach is required which can help the patients and their families in understanding the complexity of managing the disease. Therefore, patients and their family members can seek a second opinion to expedite the process of treatment decision as further delay in treatment can put the patient’s health in jeopardy and can rapidly progress cancer to an advanced stage.

As the incidences of pancreatic cancer are growing at an alarming rate it has now become a major health challenge. We need to understand that cancer is curable if timely detection and treatment is provided. Therefore, spreading awareness about this disease has now become imperative and people are now required to be aware about the possible therapeutic solutions.

Dr Aditi Gupta
Lead Consultant –Biochemistry
Aster Labs, Bengaluru

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Bangalore, November 06, 2020 – Aster Labs, the diagnostics arm of Aster DM Healthcare, a leading healthcare service provider in the country, has introduced US FDA approved digital pathology solution by Philips Intellisite Pathology Solutions for primary diagnosis at its state of the art reference lab located at Queens Road in Bangalore and at Aster Medcity in Kochi. With the inclusion of this cutting-edge technology, Aster Labs is looking to completely digitize its histopathology workflow and will be taking a step towards building a networked pathology system in the country. The decision to implement digital pathology solutions at its centers is an important milestone for the brand as it further strengthens its commitment towards making world-class diagnostics accessible to every Indian.

As the incidences of chronic and complex diseases such as cancer have been on the rise in recent years, the need and demand to revamp the pathology industry in the country is now being realized more than ever before. Technology, both in the field of scanning and IT, has now finally met the necessary standards for digital pathology, in terms of software maturity and network, computing, and storage capability. Digital pathology, thus, now has the potential to provide solutions to the immediate implications of our patient care as well as the digital workflow. It can efficiently eliminate issues with handling material and could detect abnormalities as they occur. Hence, with digitization, Aster Labs will be looking to streamline its workflow, sharpen its diagnostic processes and facilitate greater partnerships, and collaboration among all its stakeholders regardless of location.

Speaking on this initiative, Dr. Harish Pillai, CEO, Aster Hospitals and Clinics, India, said: “The COVID-19 pandemic has had a significant impact across industries and healthcare in particular. Currently, every aspect of the industry from diagnosis to treatment is undergoing tremendous change. This has created an urgency in the healthcare industry, to look for innovative solutions and efficient application of technologies like Artificial Intelligence (AI) and Deep Learning. Pathology is one such area that stands to greatly benefit from the inclusion of disruptive technologies. Therefore, with Digital pathology, we are taking a step towards the future on a digital cockpit that will enable precision diagnostics at Aster Labs. Our ultimate clinical objective with digitization is to ensure the right patient case reaches the right subspecialty histopathologist all the time, at the fastest possible time.”

Sharing his views, Mr. K.R. Jayaprakash, Chief Operating Officer, Aster Labs, said: “This advanced technology platform, will not only improve our Turn Around Time (TAT) and bring in efficiency in the reporting system but will also aid our histopathologist in accessing the traditional cases like Appendix and Hysterectomy, etc. irrespective of their location. The best advantage of this technology is that several people can review the slides at the same time, in separate geographies, and through a combination of expert opinions, the team can arrive at the best conclusion that would benefit the patient and will assist them with accurate diagnosis. This will also ease the concern of collateral implications which is often faced by the patents due to human errors. ”

Along with the implementation of digital pathology solutions across all its centers, Aster Labs also plans to build a value-based pool of talent of general histopathologists and aims to become a CoE (Centre of Excellence) for sub specialty FTR (First Time Right) reporting and other advanced sub specialties like transplant pathology, dermatopathology, neuropathology, and renal pathology, etc.

Aster Labs also plans to bring in digital storage of images that can be stored for a period of 24/48/72 hours and will be charged as a premium service to patients and referral clinicians. It will offer this service, as part of our “We will Treat you well “mission. Furthermore, R&D activities including AI-based algorithms on Whole Slide Images ( WSI )  and promotion of academic events are also on the cards of Aster Labs for expanding the capabilities of its digital pathology platform.

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