Pancreatic Cancer

The pancreas is a gland located deep in the abdomen between the stomach and the spine, connecting the duodenum. It is a digestive organ, mainly for the secretion of digestive enzymes to help digestion, and the manufacturing of insulin to monitor the blood sugar level.
 
The pancreas lies deep in the abdomen, behind the stomach and the large and small intestines. Pancreatic cancer is an aggressive cancer. As the malignant tumour within the pancreas hides itself deep inside the abdomen, it is not easy to detect at its early stage. Therefore, pancreatic cancer is usually diagnosed at advanced stage and has poor survival rate. Even the patient is able to undergo a surgery to remove the tumour, the risk of recurrence is higher than other common cancers.

Most patients of pancreatic cancer are over the age of 65, and the other risk factors include:

• Race: The black people have a higher risk.
• Sex: men have higher risk than women
• Smoking: Smokers’ chance of getting the disease is 2 to 3 times higher than that of non-smokers.
• Abnormal sugar metabolism: Those suffering from diabetes mellitus have a higher risk.
• Overweight: Obese people have higher risk.
• Diet: People with a prolonged over intake of animal fat and poor vegetable and fruit consumption are more likely to get the disease.
• Chemicals: Prolonged contacts with pesticides, petroleum or dyes are more vulnerable to the disease.
• Infection with Helicobacter pylori: The risk for people infected with the bacteria is 2 times higher.
• Hereditary pancreatitis: Hereditary chronic pancreatitis will add the risk of getting pancreatic cancer, but it seldom occurs.
• Chronic pancreatitis: Chronic pancreatitis is usually discovered together with pancreatic cancer, but the former may not be the cause of the latter.

 

Although pancreatic cancer cannot be completely prevented, modification of life style can help reduce the risk of getting the disease:

• Quite smoking: cigarette smoke contains cancer-causing substances that can destroy the DNA which monitors the cell growth.
• Maintain a healthy weight: Excessive weight increases the risk of getting pancreatic cancer. Body weight reduction should be gradually and in healthy way.
• Have regular exercise: Suitable amount of exercise may reduce the risk of getting the cancer.
• Have a healthy & balanced diet: To eat more vegetables, fruit and foods with low animal fat.
• Avoid contacting dangerous chemicals or adopt suitable safety measures.

The causes of pancreatic cancer are not known, but mutation and hyperplasia of pancreas cells may be the cause. Most of the pancreatic cancers are adenocarcinoma arising from the pancreatic ductal epithelium.

	Should a patient have the following symptoms, he/she may get the disease:
Sustained pain in the upper abdomen, which is not related to eating or drinking, and the pain may extend to the back. Loss of appetite, nausea, vomiting, indigestion, physogastry, and other intestine and stomach problems Jaundice, itching skin and clay coloured stools Drastic loss of weight in a short time Fixed, hard lumps in upper abdomen Ascites

After taking patient's history and suspected he/she has pancreatic cancer, the doctor will arrange the following tests to explore the size and location of the tumor:

Ultrasound Abdominal computerized Tomography Scan Abdominal magnetic resonance imaging Endoscopic Retrograde Cholangiopancreatography (ERCA) and Biopsy Percutaneous Transhepatic Cholangiogram (PTCA) Biopsy: Using Fine Needle Aspiration (FNA) Cytology, the doctor employs a thin needle to penetrate the skin, with ultrasound or computer tomography guide to reach tumor site. The samples of cells. will be sucked through the needle and the sample tissues will be examined under the microscope to make diagnosis. If pancreatic cancer is diagnosed, other tests will be arranged to check if dissemination has occurred. The tests include laparoscope, lung X-ray, bone scan, positron emission tomography scan and blood test for CA19-9, etc.

     Treatments for pancreatic cancer depend on the stage of the cancer, the age of the patient, the overall health conditions and patient’s preference. The major goal of tumor treatment is to eliminate the tumor. But when this turns out to be impossible, the focus will be to slow down the growth of the tumor wherever possible or to avoid causing further damages. Therefore, under certain circumstances, palliative treatment may be most suitable to individual patient.

Surgery
At present, removing the tumor completely through surgery is the only mean of eliminating pancreatic cancer thoroughly, but this is not applicable to all the patients, especially when the cancer cells have spread beyond the pancreas to other organs and affected the lymph nodes and major blood vessels extensively.
 
Whipple’s Operation: This is the most commonly used surgery technique which includes the removal of the pancreas, duodenum, gall bladder and even part of the stomach, etc. The death rate caused by surgery is lower than 5%.

Around 25% of the patients have pancreatic cancer located in the body and tail of the pancreas and discovered only at advanced stage. They may need to undergo distal pancreatectomy or total pancreatectomy.

Chemotherapy
This is to kill cancer cells by using drugs, and this is usually done through intravenous injection or oral admission. Although cancer cells cannot be completely destroyed simply using chemotherapy, the signs and symptoms of the disease can be relieved and the patient’s quality of life be improved. Meanwhile, chemotherapy may also be used as adjuvant treatment after the surgical removal of pancreas tumor.
    
Palliative Treatment
If the cancer has spread extensively, the primary objective is to mitigate the symptoms and maintain the patient’s quality of life.
 
Palliative shunt: If the tumor blocks the bile duct, a stainless steel or plastic stent is inserted in the bile duct, so as to maintain free flowing in the duct. If the intestine is blocked, by-pass surgery may be deemed necessary.

Pain treatment: This may be the case in the advanced stage when the tumor presses against surrounding nerves, which results in severe pain. Morphine is particularly useful in this stage. When the drug fails to function efficiently, the patient may be consulted on other choices, such as using drugs to stop the pain signals from being transmitted or injecting alcohol into the nerves to destroy the pain reception nerves.

The following complications may occur to patients with pancreatic cancer:

• Jaundice
• Pain: Abdominal pain will intensify as the tumor enlarges and presses the nerves
• Sever loss of weight: Patients having difficulties in eating may need to be fed with an nasogastric tube or through intravenous injection to insert nutrition supplements

Surgical complications: Pancreatic cancer operations are very difficult to perform, but the survival rate has improved a lot. Complications include bleeding, infection and unstable blood sugar level.

Before and after surgery, and during recovery, there are quite a number of things that the patient needs to attend to. The more the patient knows about the disease, the more positive the patient may become.

• Regular follow-ups: Regular follow-ups are arranged for a patient to monitor his /her conditions and symptoms of recurrence. Should there be any new symptom, the doctor must be notified as soon as possible.
• Palliative treatment and caring for other symptoms, such as maintain nutrition and pain killing, etc.
• Food safety: cancer treatment might weaken the immune syste,. Immunocompromised patient is advised to avoid to eat raw or undercooked meat, poultry eggs, raw or unpasteurized diary products, and ready-to-eat raw vegatables.