Description

Pancreatic Cancer Surgery

Overview

Pancreas is a secretory organ of the digestive system
and it lies horizontally in the upper-mid quadrant of the abdomen at the lower
level of the stomach just behind the duodenum. Pancreas secretes the enzymes
that help the digestion and the hormones that help regulation of the blood
glucose.

The pancreatic juice that has an important role
especially in the digestive system is drained to the duodenum. The pancreatic
juice is involved in production of lipase, amylase and trypsine that are
required to digest protein, fats and carbohydrates, respectively.

Pancreatic cancer starts in pancreatic cells and
tissues. In anatomic terms, the pancreatic gland has three divisions; head,
body and tail. Pancreas cancer most frequently develops in the head and again,
most cases starts in secretory cells of the pancreas.

As is the case for all cancers, early diagnosis of the
pancreatic cancer may increase the success rate of treatment.

Risk Factors

Most cases are men and diagnosed at age >40 years
and smoking is the principal risk factor especially in the long-standing
diabetes mellitus. Other factors that increase the risk of pancreatic cancer
are as follows:

• Chronic inflammation of the pancreas (pancreatitis)
• Diabetes mellitus,
• Genetic predisposition,
• Family history of pancreatic cancer and colon cancer,
• Smoking
• Obesity,
• Advanced age,
• Eating foods with high fat content

Types:

The cancer can start in the head, the body or the tail
of the pancreas. Cancers usually develop in the head of the pancreas.

Exocrine cancers: Exocrine cancers are the most
common type of the pancreatic cancers. Adenocarcinoma is the term used to refer
this type of cancers that develop in the pancreatic canal at the exocrine part
of the gland.

Endocrine pancreatic tumors:  These tumors, also called
neuroendocrine tumors, originate from islet cells and their treatment varies
from that of exocrine tumors.

Pancreatic Lymphoma: It is a rare type of cancer in
pancreas.

Symptoms:

Pancreatic cancer often causes no symptom until the
advanced stage or the symptoms can easily be confused with signs and symptoms
of other diseases. Since it progresses insidiously, they are usually skipped in
early stages. Possible symptoms of the pancreatic cancer are as follows:

• Lack of appetite
• Unintended weight loss
• Pain in the upper abdomen, sometimes referring to the back
• Sudden-onset diabetes mellitus
• Digestive symptoms, such as bloating, indigestion
  and lack of appetit
• Nausea
• Depression
• Fatigue, poor exercise performance
• Jaundice
• Pale-colored stool – similar to putty

Prevention:

As is the case for all other cancers, prevention of
pancreatic cancer is also to eliminate or minimize manageable risks. Healthy
eating, diet rich in fruits and vegetables, regular exercise and avoiding
stressful life are important factors to prevent development of the disease.
Smoking is a risk factor that is proven to play role in the pancreatic cancer.
Another important issue that should not be ignored is to quit smoking or not to
smoke, if already not smoking.

If the family history is significant for pancreatic
cancer and colon cancer, it is necessary to visit a doctor in order to be
informed about necessity of screening and genetic testing.

Diagnosis:

After the disease is definitely diagnosed, some tests
are performed to determine the best treatment modality before a treatment is
actually instituted. Some particular methods are available that are used to
diagnose the pancreatic cancer and to determine the body parts the cancer has
spread after the cancer is diagnosed. These are ultrasound, CT, MRI, PET,
endoscopic ultrasound, biopsy and blood tests.

Treatment:

All data about patient and tumor are collected, the
most appropriate treatment approach is determined. When possible treatment
options are reviewed, it is necessary to weigh possible benefits against
possible adverse effects and risks.

Correct identification of type, stage and grade plays
the major role in determining the best treatment in the pancreas cancer.

Cancer stages are usually symbolized with Roman
numbers I to IV. Stage IV is the most advanced stage of cancer. A personalized
treatment is planned for each patient by considering stage, age, general health
status and personal preferences.

The first step in treatment of the pancreatic cancer
is to remove the tumor located in the pancreas. If this is not possible, the
second objective should be hindering the growth of the tumor to avoid further
damages and enhancing the quality of life.

Treatment options for pancreatic cancer include
radiotherapy, chemotherapy and surgery. In some cases, these methods are used
in combination or sequentially. Your doctor will decide the best treatment for
you by considering type, grade and stage of your tumor as well as your general
health status and your age.

Chemotherapy

Chemotherapy uses drugs to treat the cancer. The
active substances of drugs kill the cancerous cells. Chemotherapeutic agents
can be given into a vein or be taken by mouth. In case of intravenous
administration, a thin tube, called catheter, is inserted into a great vein and
the chemotherapeutic agent is administered through this catheter throughout the
treatment period.

One or more than one chemotherapeutic agent can be
administered depending on the type of cancer and response to treatment. Active
chemotherapy maintained for a particular time is followed by an “off” period.
After the “off” period expires, the treatment resumes. Each of these sequential
active and “off” periods is called a cycle.

Side effects of the chemotherapy are a function of the
chemotherapeutic agent and the dose. Most common side effects of
chemotherapeutics include; fatigue, nausea, vomiting, mouth sores, hair loss
and inflammation of the digestive system. Side effects caused by chemotherapy
will also be treated by your doctor. If these side effects are severe enough to
threaten your health, your doctor may advise to suspend the treatment or to
switch you to another chemotherapeutic agent.

Radiotherapy

Radiation therapy aims to kill cancer cells by using
high-powered energy beams.

If the radiation source is out of the body and the
beams are directed to cancer, this treatment is called external radiotherapy.
 On the other hand, if the radioactive agent is placed at the locus of the
tumor through a needle or a catheter, method is called internal radiotherapy
(brachytheraphy).

Although radiation therapy can be the first-line
treatment, it is usually used to kill cells that cannot be removed operatively.
In the first-line treatment, radiotherapy is mostly combined with chemotherapy
and this modality is also called chemoradiotherapy.  It plays an important
role in relieving or eliminating pain, shortness of breath and chronic cough in
advanced stage cancers.

Radiotherapy has a very wide spectrum of side effects
depending on the body part irradiated. The risks that apply to you will be
explained by your doctor.

Surgery:

In pancreatic cancer surgery, the part of the
pancreas, where the tumor is located) can be removed (head, body and tail) or
the pancreas can be totally removed.

Whipple operation is the principal approach in the
surgical treatment of the pancreatic cancer. While the surgical technique is
relatively easier for tumors located in the tail and the body of the pancreas,
the tumors located in the head of the pancreas require a complex treatment; the
pancreatic head is removed along with the gallbladder, common bile duct,
duodenum and surrounding lymph nodes.

Asking your questions about the treatment of
pancreatic cancer, your life after treatment, rehabilitation, pain management,
clinical studies and all the questions in your mind about the pancreatic cancer
to your doctor will help you for an informed participation to your treatment
and alleviating your concerns.