|Pancreatic Cancer (Carcinoma of the Pancreas)|
The goal of any surgical treatment is the complete removal of the cancer. Doctors use the term 'curative surgery'. If surgery is performed primarily to relieve symptoms (e.g. to reduce pain or to remove blocked passages), the term 'palliative surgery' is used. Cancer cells may remain in the body even if curative surgery is performed, as some cancerous cells may have spread (or "metastasised") to surrounding tissue or other organs undetected. These cells often remain concealed during surgery. If doctors suspect that cancerous cells have escaped detection, chemotherapy or radiotherapy is recommended. This will usually suppress any such cells. This is known as 'adjuvant therapy'.
If a tumour cannot be completely removed, chemotherapy or radiotherapy may also be recommended to slow malignant growth or to reduce the symptoms caused by remnants of the tumour. Serious side effects, such as nausea, vomiting and hair-loss, once quite common, are now much more infrequent. This was achieved by breakthroughs in chemotherapy and radiotherapy.
Clinical research must be conducted to achieve further advancement in cancer treatment. Patients are separated into groups according to form of treatment (i.e. traditional vs. experimental treatment). Thus results can be evaluated as to their success. The best care for the patient will always have the highest priority.
is pancreatic cancer?
Cancerous growth depends on many factors. Some cells are very aggressive and fast growing, some have clearly identifiable characteristics and grow much more slowly. The patient's age, general health and immune system (which can be damaged by smoking and excessive drinking) play an important role. Usually pancreas cancer patients are 60 and over, however in rare cases younger people can be affected.
A tumour in the head of the pancreas can also block the main pancreatic duct, preventing the digestive enzymes which are normally produced in the pancreas from reaching the intestines. This leads to poor digestion, weight loss and diarrhoea. These symptoms can be relieved by taking pancreatic enzyme supplements in tablet form, or by clearing the obstruction in the main pancreatic duct. Often the symptoms of diabetes mellitus appear before pancreatic cancer is diagnosed. Diabetes mellitus can however appear both after the diagnosis of cancer and after a pancreas operation. The most common form of pancreatic cancer arises in the duct cells in the head of the pancreas. Most patients are over the age of 60, but younger people may also develop the disease.
The disease takes a similar course if the cancer does not originate in pancreatic tissue, but in the deep-seated bile duct (which also traverses the pancreas head), or in the papilla (draining channel for pancreatic fluid and bile leading into the duodenum). These cancer forms have one redeeming factor: they can be detected early through icterus (typical eye discoloration indicating the presence of jaundice). Finally we need to mention the cystic forms of pancreatic cancer. They are not easily differentiated from benign tumours or pseudo cysts, which can be observed with chronic pancreatitis patients. Considerable experience before and after surgery is required to determine the appropriate therapy.
does pancreatic cancer develop?
Scientists have increasingly observed the presence of growth stimulating factors (growth factors), as well as alterations (mutations) of certain hereditary genes. These would control cell growth and cell death (apoptosis) under normal circumstances. However, when mutation occurs, pancreatic cancer cells tend to grow more rapidly than healthy tissue. These changes are probably responsible for the resistance of the tumour to chemotherapy and radiotherapy. Further research into pancreatic cancer is necessary to pinpoint the exact character of those changes that could serve as basis for the development of new therapies. This research will develop improved methods to combat pancreatic cancer.
are the symptoms?
Often patients complain about unusual pains in the upper abdomen, these can sometimes spread to the back; and gradually increase in intensity as the disease advances. Tumours located in the pancreas head can disrupt bile flow. This leads to jaundice, which can be accompanied by colourless stool, dark urine and itchy skin. Absence of pain and fever with this type of jaundice must be interpreted as a clear danger signal. Diabetes mellitus developing for the first time is another common sign of pancreatic cancer.
are the causes?
can pancreatic cancer be detected at any early stage?
treatments exist for pancreatic cancer?
At an advanced stage of the disease, complete
removal of the tumour is often impossible. Therapy will then aim to
relieve the patient's symptoms. The flow of bile must be restored if
the bile duct is blocked and the patient is suffering from jaundice.
This can be done endoscopically by inserting a tube into the bile duct,
or by a surgical procedure, known as biliodigestive anastomosis, during
which a piece of the intestine is sewn on to the bile duct, to ensure
the flow of bile.
If the tumour grows into the duodenum, it will obstruct the passage of food, i.e. food cannot pass easily or not at all from the stomach into the intestine. To bypass this predicament, surgery known as gastroenterostomy, will be performed (this procedure joins the stomach to the small intestine).
The benefits of radiotherapy and/or chemotherapy in the treatment of pancreatic cancer have not been convincing. Efforts are being made to develop new and more effective forms of treatment for pancreatic cancer. A range of new procedures is undergoing clinical tests at present.
are the permanent consequences of pancreatic cancer and what form of
after-care is given?
The removal of a part of the pancreas will lead
to a reduced production of digestive enzymes, which in turn will cause
weight loss, bloating or diarrhoea. This condition can be treated quite
easily with medication containing pancreatic enzymes.
After surgery, patients must be regularly monitored by medical checks, lab tests and medical imaging (ultrasound, CAT, MRT). Problems arising from surgery can thus be corrected and resurging tumours can be detected early. Further therapy can be applied if necessary.
These tests are conducted in consultation with the GP. Often, additional therapy, e.g. chemotherapy, can be carried out as part of clinical studies and organised on a case-by-case basis with patient, surgeon, oncologist (cancer specialist) and family doctor.
are the chances for a cure?
Genetic therapies are of special interest for pancreatic cancer research. Knowledge of the complex factors that cause pancreatic cancer has improved considerably in recent years.
This knowledge, combined with genetic therapies can raise hopes for a new start.
A realistic assessment of the situation shows however that actual therapies have not materialised at this time. Additional studies have lead to a better understanding of changes observed in the molecular-biological structure of pancreatic cancer and have thus established the basis of a new approach to genetic therapies. However, early surgery is still the most promising therapy at this time.
of my pancreas has been removed - what happens now?
1. Pancreatic Enzyme Substitution
These enzyme preparations are normally easily
digestible and have virtually no side-effects. In very rare cases, they
can cause an allergic reaction.
2. Insulin Substitution
It is quite possible to live without a spleen.
The spleen plays a certain role in the human immune system. If it is
removed, a person is more susceptible to bacterial infections. To provide
protection against infection after removal of the spleen, the patient
should be given certain inoculations after the operation. According
to current guidelines, these inoculations should be repeated every 3
to 5 years. In addition, the patient should always seek medical help
if he contracts a serious infection, and tell the doctor that he or
she no longer has a spleen. The doctor can then decide whether treatment
with antibiotics is required.
The removal of the spleen can also lead to a build-up of blood platelets (thrombocytes). It is important to have this situation regularly monitored. If the number of platelets is too high, this can lead to the thickening of the blood and a possible thrombosis. If the level is too high, your doctor will prescribe a temporary course of medication to thin the blood, in order to reduce the risk of thrombosis.
|What is cancer?|
|What is pancreatic cancer?|
|Early stage detection|
|Consequences and after-care|
|What are the chances of a cure?|
|Spleen removed: what next?|