Pancreatic cancer arises when cells in the pancreas, a glandular organ behind the stomach, begin to multiply out of control and form a mass.
Signs & Symptoms:
Pain in the stomach or back
Jaundice
Weight loss
Bowel problems
Nausea and vomiting
Indigestion / Heartburn
Fever and shivering
Diabetes
Other symptoms can include
Extreme tiredness / fatigue
Feeling unusually full after food
Venous thromboembolism (blood clots that form in a vein)
Unexplained acute pancreatitis (inflammation of the pancreas).
Risk Factors:
Smoking
Overweight and obesity
Workplace exposure to certain chemicals
Age
Gender
Race
Family history
Genetic syndromes
Diabetes
Chronic pancreatitis
Cirrhosis of the liver
Stomach problems
Diet
Physical inactivity
Coffee
Alcohol
Common Types:
Exocrine Tumors
Endocrine Tumors
Diagnosis:
Medical history and physical exam
Imaging tests
Computed tomography (CT) scan
Magnetic resonance imaging (MRI)
MR cholangiopancreatography (MRCP)
MR angiography (MRA)
Ultrasound
Magnetic resonance cholangiopancreatography (MRCP)
Somatostatin receptor scintigraphy (SRS)
Positron emission tomography (PET) scan
Angiography
Blood tests
Biopsy
Stages:
Stage 0:
The tumor is confined to the top layers of pancreatic duct cells and has not invaded deeper tissues. It has not spread outside of the pancreas. These tumors are sometimes referred to as pancreatic carcinoma in situ
Stage IA:
The tumor is confined to the pancreas and is 2 cm across or smaller. It has not spread to nearby lymph nodes or distant sites
Stage IB:
The tumor is confined to the pancreas and is larger than 2 cm across. It has not spread to nearby lymph nodes or distant sites
Stage IIA:
The tumor is growing outside the pancreas but not into major blood vessels or nerves. It has not spread to nearby lymph nodes or distant sites
Stage IIB:
The tumor is either confined to the pancreas or growing outside the pancreas but not into major blood vessels or nerves. It has spread to nearby lymph nodes but not to distant sites
Stage III:
The tumor is growing outside the pancreas into nearby major blood vessels or nerves. It may or may not have spread to nearby lymph nodes. It has not spread to distant sites
Stage IV:
The cancer has spread to distant sites
Prevention:
Eating a diet rich in fruits and vegetables
Staying physically active and engaging in daily exercise
Maintaining a healthy weight
Avoid smoking
Avoid alcohol consumption
Management:
Surgery
One of the following types of surgery may be used to take out the tumor:
Whipple procedure: A surgical procedure in which the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct are removed. Enough of the pancreas is left to produce digestive juices and insulin.
Total pancreatectomy: This operation removes the whole pancreas, part of the stomach, part of the small intestine, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes.
Distal pancreatectomy: The body and the tail of the pancreas and usually the spleen are removed.
If the cancer has spread and cannot be removed, the following types of palliative surgerymay be done to relieve symptoms and improve quality of life:
Surgical biliary bypass: If cancer is blocking the small intestine and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine to create a new pathway around the blocked area.
Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin tube) to drain bile that has built up in the area. The doctor may place the stent through a catheter that drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.
Gastric bypass: If the tumor is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally.
Radiation Therapy
Radiation Therapy is the use of high-energy x-rays or other particles to destroy cancer cells. Radiation therapy may be given for pancreatic cancer in the following situations:
After surgery for patients who have a high risk of their cancer coming back in the area of surgery. This includes patients with a tumor that is large or was removed with close or positive surgical margins, meaning that cancer cells are seen up to or very close to the edge of the tissue removed during surgery.
Before surgery to try to shrink a borderline resectable tumor
For patients with locally advanced, unresectable disease
To relieve severe pain for people with metastatic cancer
External-beam radiation therapy is the type of radiation therapy used most often for pancreatic cancer, and treatment usually takes five to six weeks with once-daily doses of radiation. Newer types of radiation therapy, such as stereotactic radio-surgery, are being used for pancreatic cancer because they can provide more localized treatment and require a fewer number of treatment sessions.
Chemotherapy
Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Adjuvant chemotherapy is given after a pancreatic tumor is removed with surgery to prevent the cancer from coming back. Chemotherapy given before surgery is generally used for patients with borderline resectable disease, when shrinking the tumor may increase the chance of removing it with surgery. First-line chemotherapy is generally the first treatment used for patients with either locally advanced or metastatic pancreatic cancer. Second-line chemotherapy is given when treatment does not work to control cancer growth. Sometimes, first-line treatment does not work at all, which is called primary resistance. Or, treatment may work well for a while and then stop being effective later, which is sometimes called secondary or acquired resistance. In these situations, patients may benefit from additional treatment with different drugs if the patient’s overall health is good. Palliative chemotherapy is any chemotherapy regimen discussed above which helps relieve the symptoms of pancreatic cancer, such as lessening pain, improving a patient’s energy and appetite, and stopping or slowing weight loss.
Targeted therapy
Targeted therapy is a treatment that targets the cancer’s specific genes, proteins or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.
Supportive care for people with pancreatic cancer includes:
Relieving bile duct or small intestine blockage
Improving digestion and appetite
Controlling diabetes
Relieving pain and other side effects
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