Pancreatic Cancer and treatment

The most common is cancer of the exocrine pancreas that originates in the pancreatic ducts (figure 1). The ducts are responsible for carrying pancreatic juice to the intestines. This type of pancreatic cancer, called pancreatic ductal adenocarcinoma.

Most people with pancreatic cancer have pain and weight loss, with or without jaundice (yellowing of the skin).

Pain is common. It usually develops in the upper abdomen as a dull ache that wraps around to the back. The pain can come and go, and it might get worse after eating.

Weight loss. Some people lose weight because of a lack of appetite, feeling full after eating only a small amount of food, or have diarrhea. The bowel movements might look greasy and float in the toilet bowl because they contain undigested fat.

Jaundice causes yellow colored skin and whites of the eyes. Bowel movements may not be a normal brown color and instead have a grayish appearance. Jaundice is caused by a block in the flow of bile from the gallbladder, where it is stored, to the intestinal tract where the bile assists in digestion of food. The block is caused by the cancer.

Pancreatic cancer stages range from stage I, the earliest stage, to stage IV, which means that the cancer has spread to distant organs, such as the liver. In general, lower stage cancers require less treatment than do higher stage cancers. Most physicians who care for patients with pancreatic cancer refer to patients as having surgically resectable cancer (stage I and II), locally advanced and surgically unresectable cancer (stage III), and metastatic cancer (stage IV). Sometimes you will hear physicians describe a stage that technically doesn’t exist called “borderline resectable.” This occurs because imaging doesn’t always accurately distinguish between stage I-II and stage III.

Pancreatic cancer can be treated with several approaches. Early stage pancreatic cancer can often be treated and even cured with surgery. After surgery, further treatment, called adjuvant therapy, is often recommended. This might include chemotherapy or radiation therapy.

However, surgery is often not possible; pancreatic cancer is often advanced by the time it is diagnosed. If surgery is not possible, radiation therapy chemotherapy, or both are often used to shrink the cancer, reduce symptoms, and prolong life.

The standard operation for tumors in the HEAD of the pancreas is a Whipple procedure (also called a pancreaticoduodenectomy).

Because tumors in the body or tail of the pancreas do not cause the same symptoms as those in the head of the pancreas, these cancers tend to be discovered at a later stage, when they are more advanced.

If the tumor can be removed with surgery, a laparoscopy is usually done first to make sure the cancer has not spread. If surgery is an option, part of the pancreas is removed, usually along with the spleen.

Adjuvant (additional) therapy refers to chemotherapy, radiation, or a combination of both that is recommended for people who are thought to be at high risk of having cancer reappear (termed a recurrence or a relapse) after a tumor has been removed surgically.

In people with stage II or III pancreatic cancer, there are two ways to give adjuvant therapy after surgery for pancreatic cancer:

●Give chemotherapy alone.
●Give a combination of chemotherapy and radiation therapy. This strategy is called chemoradiotherapy.

For patients who are initially diagnosed with metastatic pancreatic cancer (stage IV), chemotherapy might be recommended to slow the spread of the cancer and relieve symptoms.

Chemotherapy does not cure metastatic pancreatic cancer, but it can relieve symptoms, slow disease progression, and prolong life.

Possible means to reduce symptoms:

Jaundice — Jaundice is caused by a blockage of the flow of bile from the gallbladder into the intestine. The most common treatment is a stent, which is a small tube that is inserted into a duct to keep it open. The stent can usually be placed in a procedure called ERCP (endoscopic retrograde cholangiopancreatography).

Bowel (duodenal) blockage — Some patients with pancreatic cancer will develop a blockage in the upper intestine (duodenum) caused by the tutor. Surgery can be done to create a detour between the stomach and a lower part of the intestine. An alternative to bypass surgery is placement of a stent (a tube) in the duodenum. The stent helps to hold open the blocked area.

Pain — Pain is a common problem in people with pancreatic cancer. In some people, pain medicine alone is all that is needed. Radiation therapy can also help relieve pain by shrinking the tumor.

A procedure called celiac plexus block might also be a good option to control pain. This procedure uses injections of alcohol into nerves that transmit pain signals. The alcohol kills the nerves, preventing them from telling the brain to feel pain.

Weight loss — Weight loss is common in people with pancreatic cancer. Taking a pancreatic enzyme replacement can help your body to absorb fat. Enzyme replacements are usually taken in a capsule on a daily basis. more  

Jaundice is caused by a blockage of the flow of bile from the gallbladder into the intestine. The most common treatment is a stent, which is a small tube that is inserted into a duct to keep it open. The stent can usually be placed in a procedure called ERCP (endoscopic retrograde cholangiopancreatography). Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that uses X-ray to view the patient's bile and pancreatic ducts. The functions of the common bile duct and the pancreatic duct are to drain the gallbladder, liver, and pancreas; the two main ducts convey the bile and the pancreatic juice through the papilla into the duodenum (the first part of the small intestine). The most common reason why someone would need an ERCP is because of a blockage of one of these ducts (often due to gallstones). Generally, prior to ERCP blood tests and noninvasive imaging tests such as ultrasound, computed tomographic (CT) scan or magnetic resonance imaging (MRI) were performed. The endoscopist (a doctor who has special training in the use of endoscopes) will examine the bile and/or pancreatic ducts, looking for abnormalities such as blockages, irregularity in the tissue, problems with the flow of bile or pancreatic fluid, stones, or tumors. If a problem is found, the endoscopist can often perform a procedure to repair or improve the condition; as a result, ERCP has replaced surgery in most patients with common bile duct and pancreatic disease. Many patients who need ERCP are hospitalized, but ERCP can also be performed as an outpatient procedure, depending on the patient's condition and on the complexity of the required procedure. After ERCP, you will be monitored while the sedative medications wear off. The medicines cause most people to temporarily feel tired or have difficulty concentrating, so it is usually advised not to return to work or drive that day. The most common discomfort after the examination is a feeling of bloating as a result of the air introduced during the examination. This usually resolves quickly. Some people also have a mild sore throat. Most people are able to drink clear liquids shortly after the examination. In some cases, blood tests may be done the same day following ERCP. Gallbladder removal is surgery to remove the gallbladder. This surgery is also called “cholecystectomy.” There are 2 main ways to remove the gallbladder: ●Laparoscopic surgery – This means the surgeon uses a “laparoscope,” a long, thin tube that has a light and a tiny camera on the end to see inside the body. (The laparoscope is sometimes called a “scope” for short). For this type of surgery, the surgeon makes a few small incisions. Then he or she inserts the scope through one of the incisions and other specials tools through the other incisions. Next the surgeon uses the scope and the tools to do the operation. Most gallbladder removals in the US are done using laparoscopic surgery. Sometimes, though, open surgery is necessary because the gallbladder and bile duct are too infected or scarred to do laparoscopic surgery safely. ●Open surgery – This means the surgeon makes an incision in your belly big enough to do the surgery directly. The risks of the surgery are low, but they can include: ●Damage to other bile ducts near the gallbladder ●Bile leaks ●Bleeding ●Damage to the bowels ●Infection Recovery is a little different depending on whether you have laparoscopic or open surgery. ●If you have laparoscopic surgery, you will probably be able to leave the hospital the same day you have surgery. But there is some chance you will need to stay overnight. Even though the cuts on the belly are small, the operation inside was the same as if you had open surgery. Your doctor will want you to rest and avoid heavy lifting, sports, and swimming for at least a week. ●If you have open surgery, you will probably stay in the hospital for 1 to 2 days. While there, do your best to start walking as soon as possible. Also, do the breathing exercises that your nurse recommends. After you go home, you should be able to do most of your normal activities, but you should avoid heavy lifting, sports, and swimming for a few weeks. If you develop any the following symptoms in the weeks after surgery, call your doctor: ●Fever or chills ●Redness or swelling around the cuts from your surgery ●Nausea or vomiting ●Cramping or more severe belly pain ●Bloating (feeling like your belly is full of gas) ●Yellow skin or eyes Biliary leakage should be suspected when patients present after cholecystectomy with fever, abdominal pain, and/or bilious ascites. If a patient with a bile leak continues to have severe abdominal pain from bile peritonitis or evidence of progressive intraabdominal sepsis, operative exploration and washout is indicated. Patients with bile leaks usually present within the first postoperative week, although presentation may be delayed for up to 30 days. more  
Dr. Chandna, if Jaundice is caused by a block in the flow of bile from the gallbladder, then what are the risks a person faces, whose gallbladder has been removed? The lucid description of the ailments and causes, is sure to bring a greater awareness among the members of the group about the impending dangers of licentious living; thanks for your time more  
Mr. Anil Vij Ji, Thanks. It may be a preventive measure and not a treatment after onset of cancer in pancreas. However, if you know somebody who has been cured or got substantial relief after onset of cancer in pancreas, members would be happy to know the story. more  
Dear Puneet Thanx a lot. With due respect- Few healthy habits may also ward off / reverse by taking: NUTRITIOUS FIBER FOR CURATIVE & TOXICITY REMOVAL ACTIONS Juices INCLUDING their fibers (smoothies!) : Fresh fruit (mixed but more of citrus: Mosambi/ Orange) & Vegetable (mixed but more of green) Most households have/ can afford Juicer/ Mixer. SUPPLEMENTS Triphala & Chyawanprash HYDRATION Lots of Water Thanx. more  
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