Pancreatic cancer remains one of the most formidable malignancies: relatively rare compared to others, yet disproportionately deadly. In this blog, we’ll explore key facts about this disease, examine what is known about its prevalence in India, and highlight some of the most interesting recent advances in its treatment – moving beyond the standard “what you already know” to what’s coming next.
1. What is pancreatic cancer?
The pancreas is a glandular organ located behind the stomach, with both endocrine (insulin/glucagon production) and exocrine (digestive enzyme) functions. Most pancreatic cancers are Pancreatic Ductal Adenocarcinomas (PDACs), arising from the ductal epithelial cells of the exocrine pancreas. These tumours are aggressive, often discovered at an advanced stage, and have a poor prognosis.
Notably:
- One of the major challenges is its late diagnosis – symptoms are non-specific (weight loss, abdominal pain, back pain, jaundice) until the disease has progressed.
- The tumour’s microenvironment is uniquely complex: dense stroma, extensive fibrosis, immunosuppressive, and poor vascular penetration of therapies.
- Genetic mutation in the KRAS gene occurs in >90 % of PDACs, which has historically been considered “undruggable”. (See section on advances.)
- Five-year survival rates remain low (often in the single digits or low tens of percent) for metastatic disease.
Because of these features, pancreatic cancer is a “hard target” – one where standard approaches (screening, radical surgery, single-agent chemotherapy) have only modest success.
2. Prevalence in India: What do the data show?
The article from the National Cancer Registry Programme (India) published in JAMA Network Open (2025) covers 43 population-based cancer registries across India and gives estimated incidence across all cancers. According to that dataset, the estimated incidence of pancreatic cancer in India for 2024 was about 22,982 cases (with a crude incidence rate 1.6 per 100,000) for both sexes combined.
This shows that, even though pancreatic cancer is still relatively rare, the absolute numbers are not negligible given India’s large population.
Key take-away for India
- While pancreatic cancer incidence in India remains lower than in many Western countries, the prognosis is still poor and the burden non-trivial.
- Given increasing life expectancy, rising prevalence of risk‐factors (obesity, diabetes, smoking, chronic pancreatitis), the upward pressure on incidence must be watched.
- For India, improving registry coverage, early detection pathways, and access to high-quality treatment are essential.
3. Some lesser-known facts of pancreatic cancer:
Beyond the “usual” facts, here are some aspects that are less commonly discussed but highly relevant:
a) New-onset diabetes as a red-flag
It is increasingly recognised that in some patients, pancreatic cancer can present as new-onset diabetes (NOD). Studies show that ~1 in 100 people diagnosed with NOD may be found to have pancreatic cancer within a few years.
This suggests that in certain populations (older age, weight loss, atypical diabetes onset), the new diagnosis of diabetes should prompt careful scrutiny for pancreatic cancer.
b) The tumour microenvironment is a therapeutic barrier
As mentioned, the stroma (the connective tissue around tumour cells) is extremely dense in pancreatic cancer, effectively shielding tumour cells from chemotherapy and immune cells. Researchers refer to it as a “fortress” around the tumour.
This means that simply targeting the cancer cells is not enough, one must also target the supporting cellular and extracellular architecture to improve drug delivery and immune attack.
c) Geographic/regional variation & suspected links
In India, older data suggest some regional variation in incidence of pancreatic (and peri-ampullary) cancers that might link to e.g., tropical pancreatitis, nutritional exposures, environmental toxins, chronic inflammation of the pancreas.
While the data are not conclusive, these observations underscore the need for India-specific epidemiologic studies to understand local risk-factors and pathogenesis.
4. Recent advances & what’s on the horizon:
Recent research is starting to offer new hope for this challenging disease,
a) Targeted therapy and biomarker-driven treatments
- The National Cancer Institute (NCI) highlights that more than 90 % of pancreatic cancers harbour KRAS mutations, once thought undruggable, and now KRAS inhibitors are under investigation.
- A 2024 review emphasises the movement toward “multi-omics” (genomic, transcriptomic, proteomic) approaches to identify novel antigens and vaccine targets in pancreatic cancer.
- A 2025 review highlights “personalised medicine” in pancreatic cancer: treatments tailored by tumour DNA, immune-profiles and molecular subtypes.
b) Immunotherapy, stroma-modulating agents & vaccine approaches
- Because the dense stroma and immunosuppressive environment are major obstacles, researchers are developing stroma-modifying drugs to remodel the tumour microenvironment and enable better drug/immune access.
- Cancer vaccines (‘therapeutic vaccines’) designed to prime the immune system against tumour-specific antigens are in early-phase trials.
- A review in 2024 highlighted new clinical developments combining immunotherapy with chemotherapy, targeted therapy, or stroma-agents in pancreatic cancer.
c) Early detection and diagnostics
- As noted earlier, new-onset diabetes may act as a clinical sentinel for earlier pancreatic cancer detection.
- Emerging imaging and “liquid-biopsy” approaches are under investigation. For example, efforts to detect small pancreatic tumours via advanced CT/AI, protease assays in blood, etc (though mostly in research phase).
5. Closing thoughts:
While pancreatic cancer remains a major challenge, particularly in countries like India where diagnosis is often late and resources may be constrained, there is real momentum in the research world. The next decade may see meaningful improvements: earlier detection, more effective therapies, better outcomes for subsets of patients and if India’s oncology-ecosystem keeps pace (registry data, referral networks, access to multidisciplinary care), the burden could be better mitigated.
References
- National Cancer Registry Programme Investigator Group. Cancer Incidence and Mortality Across 43 Cancer Registries in India. JAMA Netw Open. 2025;8(8):e2527805. doi:10.1001/jamanetworkopen.2025.27805. (JAMA Network)
- Gaidhani RH, et al. An epidemiological review of pancreatic cancer with special reference to India. Int J Med Sci Web. 2021. (Indian Journal of Medical Sciences)
- Jayarajah U, et al. Incidence and age-standardized rates of pancreatic cancer in Sri Lanka. Indian J Cancer. 2021. (Used here to reference regional experience) (Lippincott Journals)
- Shrikhande SV, et al. Indian Council of Medical Research Consensus Document: Pancreatic Cancer. Indian J Med Paediatr Oncol. 2019. (ijmpo.org)
- National Cancer Institute. Advances in Pancreatic Cancer Research. December 4, 2024. (Cancer.gov)
- Ma Y, et al. Recent advances in the treatment of pancreatic cancer. Cancer Reports 2024. (SpringerLink)
- Hayat U, et al. Current and Emerging Treatment Options for Pancreatic Cancer. J Clin Med. 2025;14(4):1129. (MDPI)
- World Cancer Research Fund International. Pancreatic cancer statistics. 2022. (World Cancer Research Fund)
