Cancer of Pancreas
The pancreas is a gland, which is located in the back of the abdomen, lying almost on the spine. It produces Insulin, the hormone that controls the blood sugar, as well as many enzymes that are needed for digestion of food.
Cancer of pancreas is now the fourth most common cause of cancer-related death in United States. The 5-year relative survival rate of patients with this cancer is only 3 to 5%. Roughly 28,000 new cases are diagnosed each year in the United States. This type of cancer is found most frequently in men and African-Americans. The average age at the time of diagnosis being 65 years. Unfortunately, most patients are diagnosed in advanced stages when cure is not possible.
Cause
The actual cause of pancreas cancer is unknown. However, some environmental factors, especially cigarette smoking, play a role in the development of this cancer.
Signs and symptoms
Cancer of the pancreas can grow for a long time without causing any problems. Most patients are diagnosed in advanced stages and present with any of the following signs:
- Abdominal pain
- Weight loss
- Nausea, vomiting
- Jaundice, as a result of obstruction of bile ducts
- Anemia
- Back pain due to invasion of nerves
Diagnosis
When suspected, CT scan or Ultrasound examination of the abdomen may establish the diagnosis. A Fine needle aspiration of the pancreas may confirm the existence of the cancer. This cancer can also be detected by an endoscopy-assisted study of the pancreas, which allows taking a biopsy at the same time.
Staging
Endoscopic ultrasound is a very sensitive study that should be done to determine the depth of invasion of the cancer into the tissues around the pancreas, as well as evaluation of the local lymph glands. CT scan of abdomen, as well as bone scans, may have to be done to complete the staging workup.
Treatment
Surgery: Management of this disease relies on surgery in an attempt to remove most or all of the Pancreas and to reconstruct the continuity of the bowels. This is a rather difficult procedure and carries a very high risk, even in the best hands. Indications for surgery are limited to younger patients with very small size tumors.
Chemotherapy: Is appropriate for patients in whom the disease is not cured with surgery. Gemcitabine, VP-16, Cisplatinum, Mitomycin, Taxol, Taxotere, 5-FU and Leucovorin are among the most commonly used drugs for Pancreas cancer. These drugs are used in combination and can have moderate to severe toxic effects. A newer drug that has now become available is
Radiation: For the most part, it is used to control the symptoms of the advanced disease. Radiation at the time of surgery, referred to as intra-operative radiation, has not proven to be more effective than external radiation, which can also be combined with chemotherapy.
Pattern of Spread
If left untreated, or if it fails to respond to treatment, Pancreas cancer can spread to the liver, lymph glands in the abdomen, lungs and almost anywhere else.
Prognosis
In most Americans, this cancer carries a very poor prognosis, which is due to the advanced stage of the illness at the time of diagnosis, and in such cases, survival is short. The disease can be cured only if it is caught very early.
Special Situations
Patients with advanced pancreas cancer may develop any of the following complications.
- Pleural effusion
- Bone metastasis
- Para neoplastic syndromes
- High calcium level
- Blood clots in the legs and other organs
- Pain: Most patients with this cancer experience substantial pain, which can be debilitating. Control of pain is central to care of patients with this illness. Neurolytic Celiac Plexus Block can control the pain in great majority of such patients.
Survival
Survival of patients with this cancer depends on the type and extent of the cancer at the time of initial diagnosis. One-third of patients with early stages may be cured with surgery alone. In the majority of patients in whom cure is not possible, survival could vary from months to years, depending on the extent of cancer, overall condition of the patient, as well as response to treatment and duration of the response.
Follow-up
After completion of treatment, and in any combination that might have taken place, the patient needs to remain under surveillance for the possibility of recurrence of cancer. Follow-up should be scheduled on a regular basis (initially every one to three months for one to two years). The frequency of follow-up will depend on the condition of the patient and his disease. In each follow-up visit, the patient is examined and, normally, a CT scan of the abdomen is obtained at intervals.
Treatment of advanced or recurrent disease will depend on the stage and extent of the recurring disease. Most patients are then treated with chemotherapy using the same agents mentioned above. Radiation therapy may be helpful in managing painful or symptomatic areas to which the cancer has spread. If patients experience pain, different pain medications may be used to alleviate the pain. For patients with advanced disease, where most treatments have failed, one could consider assistance from hospice.
Ca. Pancreas
Ca. Pancreas
Ca. Pancreas
