'Pancreatic cancer is stealthy. Strikes with little warning'

By the time the ailing Nigerian, Sun Igho, could reach India, he had lost precious time. The cancer was no more operable. The only thing left for Dr Patta to do was to try and win him a while more to live.

By Shali Ittaman

New Delhi: It had probably not dawned on the Indian embassy officer in Nigeria that the clock would be racing away from someone with pancreatic cancer. So, despite being repeatedly petitioned to let Sun Igho go to India for his treatment, she took a month to say yes.

By then, Igho, 74, who doesn’t want to give his real name here, was critically ill! 

“Pancreatic cancer is an unforgiving disease,” says his doctor, Patta Radhakrishna, the lead surgical gastroenterologist at SRM Institute of Medical Sciences in Chennai, India. “Even those who receive treatment early, don’t always survive for long!” 

According to the data on pancreatic cancer released by the American Cancer Society in 2021, only 11 out of every 100 pancreatic cancer patients get an early diagnosis. Of the 11, only 4 manage to live for 5 years, despite being put through surgery. 

Pancreatic cancer erupts on the pancreas, an organ that secretes insulin, the hormone needed by the body to process sugar. It is commonly spoken of during any discussion on diabetes. 

The pancreas is shaped like a smoking pipe, and is wedged between the stomach and the spine, an area hard to reach. Next to it, are also organs such as the liver, the spleen and the small intestine.

“The problem with pancreatic cancer is that it can’t be diagnosed easily. It also swiftly leeches on to the vital organs in the proximity, at which point little can be done for the patient,” says Dr Patta.

Igho’s family comes from the Edo State in Nigeria, a place where several accomplished doctors live and work. Igho’s son, Dr Elish (pseudonym), a general practitioner working in Australia, thinks highly of them. However, he does rue the state of the hospitals and medical infra in Nigeria — part of the reason why he persuaded his family to move the senior Igho to Chennai, which is home to several high-end hospitals such as SRM. 

Dr Elish suspects his father may have carried the cancer for months before it was detected. “I did notice that he was losing weight — a condition one normally associates with anyone having long-term diabetes. It did not cross our mind that cancer, and not his diabetes, was causing it.”

So, by the time the cancer was called out, and the travel to India confirmed, the ground for treatment had more or less slipped!

“The patient was not in a position to be operated on for the cancer. The best we could do was to put in a stent to drain the body’s digestive juice being stop-corked by the cancer, and to prevent associate conditions such as jaundice from smarting,” says Dr Patta, rather euphemistically. 

“What we did, essentially, was buy him additional months…!” 

Post-script

Sun Igho is now back home in Nigeria, where he will live out the rest of his time with family. “We have to be practical; and accept what is coming,” Dr Elish says of his father.

One thing comes out clearly from the story: Pancreatic cancer is lethal because it can masquerade well! It can appear in the form of jaundice, abdominal pain, back pain, bloating, nausea, vomiting, weight loss, appetite loss, and runaway diabetics. However, the common man often gets tricked into believing that they signal other, less consequential, diseases.

“We, therefore, advise people to let the doctor be the judge of it,” says Dr Patta. “Time is of essence...do not wait; do not hesitate. See a doctor at first hint!”


(Shali Ittaman was formerly the editor at Times of India, at Hindustan Times and at Press Trust of India. Copy written for the Features Division, Guru Daksha Consultancy Services).

Contact Person : Dr. Patta Radhakrishna

Address :SIMS Hospital - Vadapalani, Chennai

(Next to Vadapalani Metro Station)

No.1, Jawaharlal Nehru Salai

(100 Feet Road), Vadapalani

Chennai – 600 026, Tamilnadu, India

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Email : patta_radhakrishna@yahoo.co.in

Polyps in the colon

An overgrowth of cells in the lining of the colon results in the formation of polyps in the colon. Even though they are mostly harmless, some colon polyps have the tendency to develop into colon cancer which can be fatal when found in its later stages. Polyps can develop in any area of the colon where the growth and division of new cells goes unregulated. Being overweight, having a habit of smoking, having a family history of colon polyps and increasing age can increase your risk to get polyps in the colon.

Symptoms

Some of the symptoms that may be suggestive of colonic polyps are:

•     Blood in the stool
•     Pain in the lower abdomen
•     Persistent diarrhea, or constipation
•     Nausea and vomiting

Treatment

Surgical removal of the polyp is the best line of treatment for colonic polyps. Small polyps can be removed during a colonoscopy while large ones would require laparoscopic surgery. Both are minimally invasive procedures that require very less downtime. The polyp tissues which are removed should undergo tissue analysis to rule out cancer. Treatment of colon polyps should not be avoided as it is a preventive measure against the development of colon cancer.

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Inguinal Hernia

Inguinal Hernia is a common condition where the contents of the abdomen like intestines or fat, bulge through a weak area in the lower abdominal wall into the groin area. This condition is not life-threatening but it may cause pain while lifting, bending, straining with a bowel movement, or coughing. Some of the symptoms that may suggest that you have Inguinal Hernia are:

•     A bulge in the groin area that disappears while lying down
•     Pain when coughing, exercising, or bending over
•     Weakness, heaviness or burning sensation
•     Swollen scrotum in men

Weak areas in the abdominal and groin muscles are responsible for hernias to occur. When extra pressure falls on this part of the body, it can eventually cause hernia. The following factors increases your chance to develop this condition:

•     If the condition runs in the family
•     Having a previous episode of inguinal hernia
•     Men are at more risk than women
•     If your birth is premature
•     Being obese
•     Pregnancy
•     Having cystic fibrosis, chronic cough or constipation

Inguinal hernias that increase in size, cause symptoms, or become incarcerated must be treated immediately. In infants and children, inguinal hernias should be treated as soon as it is detected to prevent incarceration. Surgery is the primary treatment for this condition and there are several options of open and laparoscopic surgeries are available now. Inguinal hernias can be treated successfully with quick recovery when done by an expert gastro surgeon.

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Pancreatic Cancer

Pancreas is an important endocrine organ which is located behind the stomach. It plays a vital roe in the process of digestion as it produces ‘enzymes’. The enzymes help the body in digestion of fats, proteins and carbohydrates.

What is Pancreatic Cancer?

An abnormal growth of the cells in the pancreas can lead to pancreatic cancer. It occurs within the pancreas tissues and because of this, it can be a little difficult to detect pancreatic cancer. In most cases, the patients do not show any serious symptoms, but just some subtle signs that include:

•  Pain in the stomach
•  Loss of appetite
•  Blood clots
•  Unexplained loss in weight
•  Depression
•  Jaundice

What are the Causes of Pancreatic Cancer?

The exact reason that can lead to pancreatic cancer is still unknown, however it has been established that when cells in the pancreas start to grow at an unusual rate, it can lead to cancer of the pancreas.

All cells have a life circle and the grow and expire in proportion, but sometimes over production of cells makes the old and damaged cells take over the healthy ones leading to infections and thus cancer.

What are the Treatments Available for Pancreatic Cancer?

A great deal of the treatment depends on the stage of cancer as well as the condition the patient is in. However, every treatment has two main objectives:

• Getting rid of the cells that are cancerous
• Preventing the spread of this disease

The available options for treatment are:

• Radiation Therapy

X-rays and high-energy beams are used to kill the cancerous cells, and stop their spread to the rest of the body.

• Chemotherapy

Using cancer-killing medications the future growth of cells can be contained.

• Targeted Therapy

Certain drugs that are specially designed to destroy only the cancer cells, work very well without harming the healthy cells.

• Surgery

Though a surgery is generally taken as the last option, it depends on the stage at which the cancer has reached. With a surgical procedure a part or parts or the whole pancreas may be removed. There are many factors that your doctor and surgeon will bear in mind before advising a surgery.

Is Pancreatic Cancer Curable?

Yes, it is. However, it largely depends on the stage at which the cancer was detected. An early diagnosis can prove very beneficial for the patient, as with time and age cancer becomes very complex to treat and may return even after a surgery.

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What causes gastrointestinal perforation?

Gastrointestinal Perforation, a.k.a., Ruptured Bowel, a.k.a., Discontinuity of the Bowel Wall, is a potentially devastating medical condition where a hole or rupture forms in the wall of the gastrointestinal tract, which includes the large and small intestines; the stomach and the esophagus. 

Symptoms include tenderness to touch and severe constant pain. Increased breathing and heart rate, acute mental confusion, fever and sepsis may also occur.

Causes of the condition:

1. Ischemia (inadequate blood supply): This can be Bowel Obstruction or Necrosis. Bowel obstruction is where enlargement of the bowel walls lead to the reduced blood supply and Necrosis; which is the death of cells due to lack of blood supply. Both of which can lead to rupture or perforation. This is more common among the elderly, specifically, among those with clotting disorders, coronary disease and a history of smoking.
2. Infection: 2 main causes are: Appendicitis, where the finger-shaped pouch projecting into the colon on the lower right side of the abdomen becomes inflamed; and Diverticulitis, where the small pouches that form on the side of the intestines become inflamed. It is believed that both these are due to entrapment of fecal matter, causing internal pressure and infection leading to perforation.
3. Erosive Diseases: These are those that wear out the body structure over a period of time in many ways, like ulcerous disease or invasive tumours. An ulcer directly damages the bowel wall due to infection, overproduction of acid or lack of acid protective mechanism. Tumours can form on the entire wall of the bowel leading to perforation.
4. Physical: This can be either external or internal trauma. External or mechanical injury can be caused by either blunt or penetrating trauma to abdomen during say, an accident or a fight. Internal are usually medical in nature, often caused by instrumentation, like during an endoscopy. 

This is a life-threatening medical emergency requiring immediate medical care, and early diagnosis and treatment lead to highly improved chances of recovery.

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Medical care & Management of Appendicitis

A small-pouch shaped organ on the right side of the abdomen that is connected to the colon is called an appendix. Usually, appendicitis is caused due to the swelling of the appendix, which will be inflamed and pus-filled. A stomach infection, blockage in the lining of the appendix could lead to appendicitis. The infection or the bacteria would multiply quickly, causing inflammation and pus in the appendix. Timely treatment is a must, or else it would rupture and lead to further complications.

Appendectomy 

An appendectomy is a process of surgically removing the appendix. This is considered to be a common procedure performed under emergencies. It is considered to be an emergency as the infected appendix might rupture or burst, allowing the infectious contents to enter the abdominal cavity. This surgery can help prevent complications.

Abdominal testing, blood test, urine test, and CT or ultrasound would be used to diagnose the issue. Sometimes, doctors would prescribe certain medications that could reduce the infection and pain, but severe conditions cannot be controlled with medications; hence, appendectomy is highly recommended. 

Procedure 

Using keyhole surgery or laparoscopy, doctors would perform an appendectomy. The procedure is less invasive than open surgery and performed under general anesthesia. Tiny incisions would be made in the abdomen into which a special tool called a port would be inserted. Carbon dioxide would be pumped through this port so that the stomach would get inflated and make the organs in the abdomen easier to examine. A laparoscope would be inserted through one of the incisions, and using other tools; the doctor would identify the position and remove the appendix. Sterile fluid will be instilled to remove the remaining infectious materials. The surgical instruments would then be removed so that the carbon dioxide would escape, and then the doctor would close the incisions with sutures or bandages. 

Recovery time 

Based on the severity of the infection, the recovery period would vary for each individual who has undergone an appendectomy. If the appendix has ruptured, then the hospital stay would be longer. Specific steps, when followed, help in faster recovery such as:

• Avoid driving 
• Avoid alcohol 
• Follow a healthy diet plan and drink plenty of fluids 
• Refrain from lifting heavy objects at least for 10-14 days post-surgery
• Wash the hands thoroughly after touching the area close to an incision site 
• Follow the instructions given by the doctor divinely 
• Check the bandages to make sure there are no infections
• Avoid wearing tight clothes 
• Take pain killers and other medications as prescribed by the surgeon
• Advised to hold a pillow over the tummy while sneezing or coughing to minimize the strain on the incision site

If there are any issues after the surgery, it is suggested to have an immediate follow-up. Follow-up care is a must as it is the central part of the treatment and safety.

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The link between obesity & stomach cancer

Obese would be titled for people whose body mass index is greater than 30. Excess fat and being overweight can be termed as obesity. This excess of body fat can be harmful and cause a lot of health issues and complications as well. 

The most common causes of obesity would be too much intake of food, alcohol, certain medications, lack of sleep, and no physical activity. These could cause certain types of cancer, and women are at higher risk of developing cancers of the endometrium, breast, colon, kidney, and gallbladder.

Obesity & stomach cancer

Stomach cancer is considered to be a malignant ulcer in the lining of the stomach. It is also known as gastric cancer. One of the causes that leads to stomach cancer is the excess of fat or obesity. The chronic inflammation associated with obesity increases the risk of gastric cancer. Obesity can produce more insulin and leptin, which would lead to increased cell proliferation, promoting the growth of cancerous cells. People who are obese are more prone to develop H. pylori or Helicobacter pylori infection, which is considered to be a risk factor for peptic and gastric cancer. And the abdominal fat can be a risk factor as it produces oesophageal reflux, which in turn causes gastric cancer. 

Medical care 

Obesity would become a hindrance to a lot of treatments or treatment protocols. It affects the dosage of chemotherapy. Obesity is just one factor, but it layers on top of all the other factors that would trigger stomach cancer. A healthy lifestyle and diet can be the best way to prevent cancer, plus lowering the risk of obesity and other complications. 

Gastroscopy, CT scan, and upper GI series would be used to diagnose stomach cancer. Gastric surgery can be performed to help treat obesity when other treatments and methods fail. Usually, gastric cancer would require surgery in the form of partial or total gastrectomy or bypass.

Even though there are various methods and treatments for gastric cancer, it is better to prevent the issue initially. It is always suggested to maintain a proper diet to stay fit and healthy.

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