The pancreas, about 6-8 inches long, is pear-shaped and positioned near to the liver and the duodenum. The primary functions of the pancreas include:
• It helps in the breakdown of fats and sugars in the digestive system by making digestive juices which are mainly enzymes.
• It secretes hormones, like insulin, that affects how the body uses and stores nutrients.
The portion of the pancreas that produces digestive juices is called the exocrine pancreas, while the endocrine pancreas is the other part that produces hormones.
Cancer is a disease where cells divide and grow in an abnormal, poorly controlled manner due to mutation in the DNA of the cell. When the cells in the pancreas grow uncontrollably due to mutations in their DNA, it causes Pancreatic Cancer. Pancreatic cancer can be both exocrine and endocrine depending on their site of mutation in the pancreas. Pancreatic cancer generally affects elderly patients between 60-80-years of age. Identifying pancreatic cancer during its early stage is sometimes difficult as it does not show any symptoms unless it is in an advanced stage.
A major study found that the risk of pancreatic cancer is raised by the combination of smoking, long-term diabetes, and a poor diet. The risk factors which increase the chance of getting pancreatic cancer include:
• Cigarette smoking
• A high-fat and low-fibre diet
• Diabetes mellitus
• Chronic pancreatitis
• A family history of hereditary syndromes that may raise the risk of developing cancer. These include BRCA2 gene mutation, Lynch syndrome, and familial atypical mole malignant melanoma (FAMMM) syndrome.
The symptoms of pancreatic cancer are mainly related to the location of the tumour in the pancreas. The following symptoms can be observed with a patient suffering from pancreatic cancer:
• Jaundice that leads to yellowing of the skin, yellowing of the whites of the eyes, dark coloured urine, and itching
• Nausea, Vomiting, Weight Loss
• Abdominal Pain
• improper digestion of the food leading to diarrhoea
A diagnostic test gives a clear indication to the surgeon on whether cancer is operable or resectable. Patients with symptoms suspicious of pancreatic cancer will undergo the following diagnostic tests.
1. Ultrasound of the abdomen
2. Endoscopy Ultrasonography
3. Endoscopic Retrograde Cholangiopancreatography
4. Computed Tomography
6. Removing a tissue sample for testing (biopsy) under the microscope 7. CA19-9 tumour marker test
Once the diagnosis of pancreatic cancer comes positive, the physician tries to determine the extent (stage) of cancer. Roman numerals ranging from 0 to IV reflect the stages of pancreatic cancer. The lowest stages suggest that the cancer is limited to the pancreas. By stage IV, cancer has spread to other areas of the body. The treatment and management of Pancreatic cancer depend on these stages.
Pancreatic cancer care depends on cancer's stage and its location. General wellbeing and personal interests also come into account. For certain patients, the major goal of treating pancreatic cancer is to eliminate cancer from the body. Surgery, radiation, chemotherapy, palliative or a combination of these can be used in the treatment procedure.
The types of surgery used in treating pancreatic cancer are:
• Pancreatic head surgery
• Pancreatic body and tail surgery
• Surgery is also done to remove the entire pancreas
• Surgery of the blood vessels near the pancreas
Chemotherapy uses drugs to suppress and kill cancer cells. These drugs can be injected into a vein or administered orally. Radiation therapy is also integrated with chemotherapy which is known as Chemoradiation. It is used to treat cancer that has not spread to other organs other than the pancreas.
To kill cancer cells, radiation therapy uses high energy waves or beams, such as those made from X-rays and protons. Standard radiation therapy uses X-rays to cure cancer, but some treatment facilities provide a newer type of radiation that uses protons.
Integrative and Alternative Medicine
Distress is a common symptom found in patients suffering from cancer. Some research suggests that people with pancreatic cancer are in much distress than people suffering from another type of cancer. Integrative medicine and alternative therapies may also help you deal with distress. Examples include:
• Art therapy
• Massage therapy
• Music therapy
• Relaxation exercises
It is requested to take the advice of your physician if you are interested in any of these treatment options.
Palliative medicines are used when cancer patients are in an advanced stage. They are done to improve nutrition and quality of life. Pancreatic cancers frequently are diagnosed in advanced stages where surgery, chemotherapy and radiation are not helpful. They may have a biliary obstruction or gastrointestinal obstruction. Several techniques like Self Expandable Metallic stents may be placed across the obstructed biliary tract or gastrointestinal tract using special techniques like ERCP and EUS.
HOD And Consultant - Gastroenterology
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