Doctors refer abnormal cells growing and developing into a malignant tumor in the tissues of pancreas as pancreatic cancer, which is usually very aggressive. Pancreatic cancer symptoms may stay unnoticed until the cancer is advanced and difficult to treat. Pancreatic cancer treatment includes surgery, chemotherapy, and radiation. In some cases, doctors may also suggest trying targeted therapy (Erlotinib). Below we will review this condition, its symptoms, diagnostic services (ERCP, PTCA, etc) and pancreatic cancer treatment options in more detail.
WHAT IS THE FUNCTION OF THE PANCREAS?
Pancreas is an organ in your abdomen that sits horizontally behind the lower part of your stomach. It works to secrete enzymes that help with digestion as well as hormones that help to regulate the metabolism of sugars. Pancreatic cancer starts in the tissues of your pancreas. This cancer often has a poor prognosis even when it is discovered early. Pancreatic cancer spreads at a great rate and is normally only detected in the later stage which is a big reason why it has a high cancer mortality rate. The symptoms and signs may not appear until the cancer is advanced and surgery is no longer possible.
PANCREATIC CANCER SYMPTOMS
The symptoms and signs normally don’t appear until pancreatic cancer is advanced. When they appear, they include:
- Pain in your upper abdomen that may radiate to your back
- Your skin and the whites of your eyes turn yellow (Jaundice)
- Appetite loss
- Weight loss
- Blood clots
PANCREATIC CANCER TREATMENT OPTIONS
The stage and location of the cancer as well as your age, overall health and personal preferences will play a role in determining the best treatment option for you. If possible, the ultimate goal of the treatment would be to eliminate the cancer. If that is not an option, the focus will be to prevent the cancer from growing or causing more harm. When the cancer is advanced and the treatments aren’t likely to benefit you, your doctor will make you feel as comfortable as possible by relieving your symptoms. Surgery: This may be an option if your pancreatic cancer is confined to the pancreas and hasn’t spread elsewhere. Surgeries performed in people with pancreatic cancer include:
Surgery to remove tumours in the pancreatic head
You may consider an operation called a Whipple procedure (pancreatoduodenectomy) if your pancreatic cancer is located in the head of your pancreas. During the Whipple procedure, the head of your pancreas as well as a portion of your small intestine, gallbladder and a section of your bile duct will be removed. A part of your stomach may have to be removed as well. The remaining parts of your pancreas, stomach and intestines will be reconnected to allow food digestion. The risks of this procedure include bleeding and infection. Some people may experience nausea and vomiting after surgery if the stomach has problems emptying. (Delayed gastric emptying) A Whipple procedure may take a long time to recover. You will have to spend several days at the hospital and several weeks at home to recovery.
Surgery to remove tumours in the pancreatic tail or body
You may consider this option if your pancreatic cancer is in your pancreatic tail or body. This procedure is known as distal pancreatectomy. Your spleen may also be removed. The risks of this surgery are bleeding and infection. Ask your surgeon about their experience with pancreatic cancer surgery as research has shown that the surgery performed by experienced surgeons cause fewer complications. Get a second opinion if you have any doubts.
High energy beams such as X-rays are used in radiation therapy to kill cancer cells. This treatment may be performed before or after surgery alongside with chemotherapy. Your doctor may recommend a combination of radiation and chemotherapy treatments when your cancer can’t be operated on. Radiation is directed to specific point on your body (external beam radiation) from a machine that moves around you. Radiation therapy may be delivered during surgery in specialized centres. (Intraoperative radiation)
Drugs are injected into a vein or taken orally to kill cancer cells. You may receive only one type of chemotherapy drug or a combination of them. Chemotherapy may be combined with radiation therapy also known as chemoradiation. Chemoradiation is normally used to treat cancer that has spread outside of the pancreas. However, this is only used when it has spread near the pancreas and not organ further away. After surgery, this combination treatment may also be used to prevent the cancer from recurring. Chemotherapy is used alone or may be combined with targeted drug therapy in advanced pancreatic cancer patients.
Drugs are used to attack specific abnormalities within cancer cells. Erlotinib (Tarceva) is the targeted drug that blocks the chemicals that promote cancer cells to grow and divide. Patients with advanced pancreatic cancer usually receive Erlotinib and chemotherapy.
DIAGNOSING PANCREATIC CANCER
- History taking and physical examination: Your doctor will ask you questions about your overall health, medical history and symptoms you have. Also he will most probably ask you about your family history of medical conditions, as patients with family cancer history have higher risks of developing cancer in their bodies. After this, your doctor will perform a physical examination.
- CT scan: When pancreatic cancer is suspected, a CT scan or computerised scan of the abdomen will be conducted as the initial diagnostic test. Ninety five percent of the time, a CT scan is able to detect pancreatic mass that is greater than two centimetres. Cancers that are smaller are harder to detect.
- MRI scan: This scan visualizes the pancreas and ducts in the pancreas. This is particularly useful in surgery planning.
- Endoscopic ultrasound (EUS): Visual images of the digestive tract and pancreas are created using the EUS. These images are detailed ultrasound images of the bile duct, digestive tract and pancreas. They will allow your doctor to determine the size and location of a cancerous tumour in your pancreas and whether it has spread to any of the surrounding lymph nodes, blood vessels or other structures. A thin needle is used to painlessly extract tissue samples of the tumour during the endoscopy. This type of biopsy is called Fine-needle Aspiration (FNA). The tissue samples are then examined with a microscope to determine whether they are cancerous or not.
- Endoscopic retrograde cholangiopancreatography (ERCP): A fiberoptic scope is used to look in the stomach and small intestines where the ducts of the pancreas are drained into. These ducts are injected with X-ray dye and X-ray images of the pancreas are taken.Any irregularities of the pancreatic ducts can then be seen. Tissue samples can also be taken during this procedure. A small plastic tube called stent will also be placed during this procedure if there are blockages in the ducts to bypass the obstructions. A stent that is placed will have to be changed three to four monthly as it can become blocked by normal pancreatic secretions. The risks of this procedure include pancreas infection and perforation of the small intestines.
- Percutaneous transhepatic cholangiography (PTCA):This is an X-ray of your bile ducts. These tubes carry bile from your liver to your gallbladder and small intestines. A test will be performed by a radiologist in the radiology department. You will be required to lie on your back on an X-ray table. The upper right and middle area of your tummy will be cleaned by the provider and then a numbing medicine will be applied. Your liver and bile ducts can be located using the X-rays to assist your health care provider. X-ray dye is injected into your liver with a long, thin and flexible needle. Contrast medium is a dye that is injected into your bile ducts. This helps to highlight certain areas so they can be visualized. As the dye flows through the bile ducts into the small intestines, more X-ray images are taken. A video monitor nearby will show the images taken inside your body. Sedation will be given to you to calm for during this procedure.