Pancreatic Cancer Treatment in India: Whipple Surgery, Costs & Survival Rates

Pancreatic cancers are becoming highly common over the planet. Pancreatic cancer treatment in India for international patients is becoming a talk of the town. This is mainly because of the affordability and convenience in treatment. Pancreatic cancers account for about 1.8% of all new cancer cases throughout the world and roughly about 4.6% of all cancer-related deaths. The pancreatic cancer survival rate in India is around 7 to 9%.

The significance of this content can be understood from the points it will cover including the stages of pancreatic cancers, available treatment and surgery options, and cost comparison for Pancreatic cancer treatment between India and the US. Let us quickly get into the details of this blog. 

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Pancreatic Cancer: Why Early Stage Matters

Pancreatic cancers are dangerous as they are not easily detectable at the early stages. Pancreatic cancers are located deep inside the abdomen and this is one of the most common reasons for their undetectability. Patients often get confused with the symptoms and do not understand the underlying issues. 

Pancreatic cancers should be detected at early stages. This is the most important step in treating these types of cancers. The spread of pancreatic cancer can be restricted efficiently and effectively if it is recognised and detected in its early stages. Let us know exactly why it is difficult to detect pancreatic cancers. 

• There is no visible lump associated with pancreatic cancer. Also no amount of bleeding is seen or experienced in these cases. These are prominent reasons for the undetectability of pancreatic cancers in its early stages.
• There are no obvious or absolute signs of pancreatic cancer in its early stages. This makes it undetectable at earlier stages.
• Pancreatic cancers come with silent growth and this makes them highly undetectable during its earlier stages.

Though pancreatic cancers are undetectable in nature there are certain signs and symptoms that patients should not overlook if they are suspecting a pancreatic cancer growing in their body. Here are those prominent symptoms and signs to look for and be alert thereafter : 

• Yelling of eyes and skins
• Persistent abdominal pain.
• Unexplained weight loss.
• Suddenly hailing diabetes.

Pancreatic cancers are detected at early stages if patients are alert at the signs and symptoms in the earlier stages. After the confirmation of the presence of pancreatic cancers the patients have numerous treatment options including radiation and chemotherapy. 

There are surgeries like Whipple surgeries available to eradicate the growth of pancreatic cancer in the body. There are a number of treatment options for pancreatic cancer treatment in India for international patients. India offers numerous oncological care centres and skilled professionals specialising in treating pancreatic cancers. 

Only 15–20% of patients are eligible for surgery

Surgery is actually the only available cure for pancreatic cancer. Pancreatic cancers don't show any kind of symptoms before it is highly advanced. It reaches all the major blood vessels before it is detected. This is the exact reason why only 15 to 20% of the patients are eligible for immediate surgical cure. There are some determinants that help in determining the eligibility of patients for surgery. Here are those determinants of Pancreatic cancer surgeries : 

The Cruciality of Neoadjuvant Therapy

Around 30% of patients have "borderline resectable" disease. Chemotherapy and radiation can be some curative options available for them. Neoadjuvant Therapy helps in shrinking the tumour and healing the blood vessels making the surgery quite possible. Neoadjuvant Therapy forms an important part of Pancreatic cancer treatment in India for international patients. 

Initial Staging

Initial stages of Pancreatic Cancers are important as these are the stages when the possibility of surgery is the highest. Patients with stage 1 and stage 2 cancers can qualify for the surgical cure. The possibility of surgery is high due to its restriction to the pancreatic area. 

Second Opinions Matter 

Pancreatic cancer treatment in India for international patients should be done after second opinions. A study finds that about half of the patients that are eligible for pancreatic surgery are rejected at first. However, a second opinion can make things clear and allow patients to explore surgical options before it is too late.

Metastatic Cancers

About 50 to 60% of patients are diagnosed with metastatic cancer. If this is the case then cancers cannot be cured. Surgeries cannot be applicable to Pancreatic cancer if Metastatic cancers occur.

Surgical Treatment: Whipple Procedure in India

The Whipple procedure or pancreatectomy in India is a highly complicated surgery to extract tumours from the head of gallbladder, pancreas, bile duct or duodenum to cure cancers. 

The Whipple surgery cost in India for Pancreatic cancer treatment in India for international patients are affordable and normally range from $4,800 to $9,600 based on the type of hospital and infrastructural facilities. The cost of these surgeries differ on the basis of location. The cost of Laparoscopic surgery is anywhere between $ 5,000 to 8,000. The price for Open Surgery varies between $ 4,000 to $ 6,000. 

These operations normally take about 4 to 8 hours under anesthesia. The hospital stays can range between 8 to 14 days including the ICU monitoring period. The procedure becomes highly complex due to the location of the pancreas and its curative nature. Patients should normally go for 5 to 6 meals daily for digestive convenience. 

The recovery period is normally 1 to 3 months in the case of Whipple surgery. You even need to know about the side effects of these surgeries. After effects of these surgeries include nutritional deficiencies, pancreatic leaks and delays in gastric release. Popular metropolitan cities like Hyderabad, Delhi, Mumbai and Chennai have top centres offering these types of surgeries. 

What is Whipple surgery?

Before getting into the other important details you need to understand the details regarding the actual meaning of Whipple Surgery. Whipple surgery or pancreaticoduodenectomy is a complex surgery used to do away with tumors in the bile duct, pancreas, or small intestine. It extracts the head of the bile duct, pancreas, gallbladder,and part of the small intestine. Later it realigns the other organs of the digestive system.

The surgery is mainly used to treat Pancreatic cancer, benign tumors/cyst, Chronic pancreatitis, Bile duct cancer or cholangiocarcinoma, and Neuroendocrine tumors. This surgery is not a common surgery at all. There is a proper chronological order that a surgeon follows while performing the Whipple surgery. As the pancreas is stuck between all the important organs of the digestive system, it is quite natural for the surgery to be highly complex in nature. Let us know about the process of the Whipple surgery : 

• Firstly the head of the pancreas as this is the location where the cancer normally starts to grow.
• Nextly the duodenum or the first part of the small intestine is extracted.
• Now it is for the bile duct to be extracted.
• Later the surgeon extracts the lymph nodes. This helps in knowing the depth of the cancer spread.
• Now the surgeon joins back the important organs of the digestive including the small intestine and the stomach. 

Cost: $12,000–$18,000 in India vs. $70,000+ in US

A standard Whipple surgery in India costs between $ 12,000 and $18,000. This amount is about 80% less than the US. This process is about $ 70,000 in the US. India is quite affordable for cancer treatment and it is internationally popular for being so. Pancreatic cancer treatment in India for international patients is quite cheaper in India for foreign patients. The quality of cancer care is not lesser than at western locations including Germany and the US. 

The labour and other overhead costs in India are quite less than in the US. Other factors including the exchange rates, technological expenses and government support too reduces the financial burden. Let us have a quick glance at the points of differences between the cost of Whipple surgery in India Vs in the US. 

EXPENDITURE	COST IN INDIA	COST IN US
OP SCANS AND PRE/POST	Less	Normally high
HOSPITAL STAY	Included in package	Billed differently
ENTIRE PROCEDURE	$ 12,000 to $ 18,000	$ 70,000 and above

Determinants of Cost Difference 

Surgical Methods: The surgical methods available for Whipple surgery in India are quite affordable and budget friendly in India. Robotic surgeries normally cost more.

Hospital Reputation: Hospitals like Apollo Hospitals and Kokilaben Dhirubhai Ambani Hospital at Mumbai and have high class hepatopancreatobiliary (HPB) surgery units reducing the cost in an efficient manner. 

Length of Stay: A lot of foreign patients need to plan for a 3 to 4-week stay for the surgery, recovery, and a doctor's approval for travelling back. This has an actual impact on the cost. 

Surgeons performing 50+ Whipple procedures annually

The Pancreatic Cancer Action Network and the American Cancer Society suggest selecting hospitals, doctors and surgeons performing a minimum of 15 to 20 Whipple surgeries per year. This provides you an advantage of staying away from the possible risks and complications arising out of the complex procedure. Pancreatic cancer treatment in India for international patients is widely available in major metropolitan cities. 

The following surgeons and institutions consistently meet or exceed high-volume benchmarks (50+ cases annually):

Popular Centers & Surgeons in India

Dr. Savio George Barreto/Dr. Shailesh Shrikhande : Associated with Tata Memorial Hospital or TMH in Mumbai, these experts offer some of the most essential cancer care treatments in India. This hospital is popular for performing a lot of pancreaticoduodenectomies every year. 

Dr. S.P.S. Yadav / Dr. Mohit Bhandari: These doctors are available at Medanta - The Medicity in Gurgaon at Delhi NCR. This hospital offers some of the most advanced gastrointestinal surgeries in India.

Dr. G.V. Rao / Dr. P. N. Rao: The Asian Institute of Gastroenterology (AIG) in Hyderabad, offers a huge number of robotic Whipple surgeries and HPB surgeries.

Apart from these centres other globally popular institutions for the treatment of Pancreatic cancer include Duke Health at Durham, NC, Johns Hopkins Medicine at Baltimore, MD and Mayo Clinic at Rochester, MN; Jacksonville, FL; Phoenix, AZ.

Chemotherapy for Pancreatic Cancer in India 

Chemotherapy for pancreatic cancer in India is available at a number of oncology centres in India. Two important regimens used in the treatment procedure are Gemcitabine generally combined with nab-paclitaxel and FOLFIRINOX. The Chemotherapy treatment in India is available as Neoadjuvant Therapy, Adjuvant Therapy.

There are also some other treatment facilities available in India including Proton Beam Therapy. Pancreatic cancers require a high level of palliative care and it is greatly available at a lot of oncology centres in India. Let us have a quick look at the cost breakdown for chemotherapy for Pancreatic cancer in India : 

FOLFIRINOX: FOLFIRINOX costs $ 1,000 to $ 1,800 per cycle.

Immunotherapy: Immunotherapy costs $ 1,500 to ₹5,000 per month. 

Gemcitabine-based regimens: It costs $ 20,0 to $ 60,0 per cycle. 

Total Adjuvant Course : The Adjuvant course normally costs between $ 2,500 and $ 5,500.

Chemotherapy is available in India at popular hospitals like ⁠Tata Memorial Hospital and ⁠Nanavati Max Super Specialty Hospital, Apollo Hospitals and ⁠Gleneagles Global Hospitals, Max Super Specialty Hospital, Saket and ⁠HCG Cancer Centre across various metropolitan cities like Delhi and Mumbai. 

FOLFIRINOX & Gemcitabine-nab-Paclitaxel regimens

FOLFIRINOX India and Gemcitabine plus nab-Paclitaxel are the two important, popular chemotherapy regimens. These regimens are used to treat highly advanced pancreatic cancer. FOLFIRINOX (FFX / mFFX) is an integral part of Pancreatic cancer treatment in India for international patients. Gemcitabineo/nab-Paclitaxel is a doublet therapy and FOLFIRINOX is a mix of high powered, four-drug therapy. The choice of the drug is based on the health, liver condition and the overall health of the patient. 

1. FOLFIRINOX (FFX / mFFX)

FOLFIRINOX India  is an adequate mix of four different chemotherapy drugs: Fluorouracil (5-FU), Folinic acid (Leucovorin), Oxaliplatin and Irinotecan. It is used after every fortnight. Patients get numerous drugs in the clinic, after a continuous infusion of 5-FU by a portable pump for a period of 46 hours. FOLFIRINOX (FFX / mFFX) is mainly for younger patients with good and satisfactory liver function. This treatment comes with side effects like diarrhea, hair loss and severe fatigue. 

2. Gemcitabine + nab-Paclitaxel (Gem/nabPTX, Abraxane)

Gemcitabine + nab-Paclitaxel (Gem/nabPTX, Abraxane) is a regimen that mixes albumin-bound paclitaxel with Gemcitabine. It should be used after a cycle of every 4 weeks. It is normally provided by IV once every week for three continuous weeks. A week that follows is for a rest. Gemcitabine + nab-Paclitaxel (Gem/nabPTX, Abraxane) best suits the older patients having other health related issues. The side effects are not as severe as in the case of FOLFIRINOX (FFX / mFFX). 

Cost of 6-month chemo course in India

A 6-month chemotherapy course for pancreatic cancer in India normally costs between a range of $1,800 and $6,600. The entire price depends on the medication quality and type chosen like advanced FOLFIRINOX Vs standard Gemcitabine. 

It even depends upon the type of hospital chosen for treatment. The cost of treatment at affordable oncological care centres is lesser than private out of budget hospitals. Pancreatic cancer treatment in India for international patients is highly affordable at certain hospitals.

Cost Breakdown 

Cost Per Cycle : Standard treatments  range between $ 200 to $ 600 per cycle. However expensive regimens can cost anywhere between $ 700 and $ $ 1,800 per cycle.

Hospital Type : Private hospitals normally charge higher than affordable oncological care centres in India. There are a number of high end hospitals that charge higher than other general hospitals at the same locations.

Regimen Kind : Pancreatic cancer chemotherapy cycles are normally after every 2 to 3 weeks. A comprehensive 6-month period normally contains 6 to 8 treatment cycles.

Diagnostic Imaging: Biopsies and PET scans can cost about $ 400 to $ 1000 in addition to the cost. 

Targeted/Immunotherapy: Targeted therapy and Immunotherapy can cost about $ 1,500 to $ 5,000 per month. The cost of chemo includes this cost too. 

Other Expenses : The cost of chemo course for Pancreatic cancer treatment in India for international patients include a number of miscellaneous expenses like supportive medications, drugs, infusion bills and many more. 

How can you efficiently manage the cost ?

Exploring Options : There are certain generic versions of branded chemotherapy drugs that can bring the cost of the treatment down by about 30 to 40%. 

Government Schemes: Government schemes like PM-JAY can offer numerous monetary benefits and relieves. Government subsidies can help in the cost of Pancreatic cancer treatment in India for international patients.

Insurance Coverage: An adequate health insurance cover will highly decrease the financial burden and ultimately reduce the entire cost of a chemo course.

Frequently Asked Questions

1Q: Is Whipple surgery available in India? 

Ans: Yes, Whipple surgery or pancreaticoduodenectomy is conveniently available at popular cancer treatment centres in India. Whipple surgery is a complicated procedure performed by expert cancer surgeons at famous multi-specialty hospitals all throughout the country.

2Q: What is the survival rate for pancreatic cancer treated in India?

Ans: The entire 5-year survival rate for pancreatic cancer in India is about 8% to 10%. The rate of survival mainly depends upon the stage at which it is diagnosed. Early detection and diagnosis can help in increasing the chances of survival.