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==Overview==
[[Prevention (medical)|Secondary prevention]] of [[pancreatic cancer]] involves proper [[Diet (nutrition)|diet]] based on American Cancer Society (ACS) guidelines and [[Palliative care|palliative therapy]] for patients. [[Malabsorption]] may arise when [[pancreatic duct]] [[obstruction]] leads to [[Pancreatic insufficiency|exocrine pancreatic insufficiency]]. The [[Diet (nutrition)|diet]] proposed for pancreatic cancer patients is based on ACS guidelines and advocates administration of [[Enzyme replacement therapy|pancreatic enzyme replacement therapy]], avoidance of high-protein/high-fat diets, individualized dietary prescriptions from a registered dietitian and dietary supplementation with [[Omega-3 fatty acid|omega-3 fatty acids]]. [[Palliative care|Palliative therapy]] is considered as an important part of [[Prevention (medical)|secondary prevention]] and includes adequate [[Analgesic|analgesia]], treatment of [[jaundice]] and [[Duodenum|duodenal]] [[obstruction]], arising as complications of [[surgery]].
 
==Secondary prevention ==
=== Diet ===
[[Diet (nutrition)|Diet]] supplementation is an important component in the management of patients after [[Pancreas|pancreatic]] [[surgery]] due to the development of [[Exocrine gland|exocrine]] [[pancreatic insufficiency]]:<ref name="pmid29093615">{{cite journal |vauthors=Singh VK, Haupt ME, Geller DE, Hall JA, Quintana Diez PM |title=Less common etiologies of exocrine pancreatic insufficiency |journal=World J. Gastroenterol. |volume=23 |issue=39 |pages=7059–7076 |year=2017 |pmid=29093615 |pmc=5656454 |doi=10.3748/wjg.v23.i39.7059 |url=}}</ref><ref name="pmid28814218">{{cite journal |vauthors=Nikfarjam M, Wilson JS, Smith RC |title=Diagnosis and management of pancreatic exocrine insufficiency |journal=Med. J. Aust. |volume=207 |issue=4 |pages=161–165 |year=2017 |pmid=28814218 |doi= |url=}}</ref><ref name="pmid28711377">{{cite journal |vauthors=Roberts KJ, Schrem H, Hodson J, Angelico R, Dasari BVM, Coldham CA, Marudanayagam R, Sutcliffe RP, Muiesan P, Isaac J, Mirza DF |title=Pancreas exocrine replacement therapy is associated with increased survival following pancreatoduodenectomy for periampullary malignancy |journal=HPB (Oxford) |volume=19 |issue=10 |pages=859–867 |year=2017 |pmid=28711377 |doi=10.1016/j.hpb.2017.05.009 |url=}}</ref><ref name="pmid28241470">{{cite journal |vauthors=Vujasinovic M, Valente R, Del Chiaro M, Permert J, Löhr JM |title=Pancreatic Exocrine Insufficiency in Pancreatic Cancer |journal=Nutrients |volume=9 |issue=3 |pages= |year=2017 |pmid=28241470 |pmc=5372846 |doi=10.3390/nu9030183 |url=}}</ref><ref name="pmid28099252">{{cite journal |vauthors=Saito T, Hirano K, Isayama H, Nakai Y, Saito K, Umefune G, Akiyama D, Watanabe T, Takagi K, Hamada T, Takahara N, Uchino R, Mizuno S, Kogure H, Matsubara S, Yamamoto N, Tada M, Koike K |title=The Role of Pancreatic Enzyme Replacement Therapy in Unresectable Pancreatic Cancer: A Prospective Cohort Study |journal=Pancreas |volume=46 |issue=3 |pages=341–346 |year=2017 |pmid=28099252 |doi=10.1097/MPA.0000000000000767 |url=}}</ref><ref name="pmid26211872">{{cite journal |vauthors=Bartel MJ, Asbun H, Stauffer J, Raimondo M |title=Pancreatic exocrine insufficiency in pancreatic cancer: A review of the literature |journal=Dig Liver Dis |volume=47 |issue=12 |pages=1013–20 |year=2015 |pmid=26211872 |doi=10.1016/j.dld.2015.06.015 |url=}}</ref><ref name="pmid25822444">{{cite journal |vauthors=Gheorghe C, Seicean A, Saftoiu A, Tantau M, Dumitru E, Jinga M, Negreanu L, Mateescu B, Gheorghe L, Ciocirlan M, Cijevschi C, Constantinescu G, Dima S, Diculescu M |title=Romanian guidelines on the diagnosis and treatment of exocrine pancreatic insufficiency |journal=J Gastrointestin Liver Dis |volume=24 |issue=1 |pages=117–23 |year=2015 |pmid=25822444 |doi= |url=}}</ref><ref name="pmid25164613">{{cite journal |vauthors=Landers A, Muircroft W, Brown H |title=Pancreatic enzyme replacement therapy (PERT) for malabsorption in patients with metastatic pancreatic cancer |journal=BMJ Support Palliat Care |volume=6 |issue=1 |pages=75–9 |year=2016 |pmid=25164613 |doi=10.1136/bmjspcare-2014-000694 |url=}}</ref><ref name="pmid24687867">{{cite journal |vauthors=Berry AJ |title=Pancreatic enzyme replacement therapy during pancreatic insufficiency |journal=Nutr Clin Pract |volume=29 |issue=3 |pages=312–21 |year=2014 |pmid=24687867 |doi=10.1177/0884533614527773 |url=}}</ref><ref name="pmid23448736">{{cite journal |vauthors=Braddick JA, Flaherty AM |title=Management of pancreatic exocrine insufficiency |journal=Oncol Nurs Forum |volume=40 |issue=2 |pages=116–9 |year=2013 |pmid=23448736 |doi=10.1188/13.ONF.116-119 |url=}}</ref><ref name="pmid22711213">{{cite journal |vauthors=Sikkens EC, Cahen DL, van Eijck C, Kuipers EJ, Bruno MJ |title=The daily practice of pancreatic enzyme replacement therapy after pancreatic surgery: a northern European survey: enzyme replacement after surgery |journal=J. Gastrointest. Surg. |volume=16 |issue=8 |pages=1487–92 |year=2012 |pmid=22711213 |pmc=3399077 |doi=10.1007/s11605-012-1927-1 |url=}}</ref><ref name="pmid21450558">{{cite journal |vauthors=Domínguez-Muñoz JE |title=Pancreatic enzyme replacement therapy for pancreatic exocrine insufficiency: when is it indicated, what is the goal and how to do it? |journal=Adv Med Sci |volume=56 |issue=1 |pages=1–5 |year=2011 |pmid=21450558 |doi=10.2478/v10039-011-0005-3 |url=}}</ref><ref name="pmid22237782">{{cite journal |vauthors=Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV, Gapstur S, Patel AV, Andrews K, Gansler T |title=American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity |journal=CA Cancer J Clin |volume=62 |issue=1 |pages=30–67 |year=2012 |pmid=22237782 |doi=10.3322/caac.20140 |url=}}</ref>
* [[Pancreatic insufficiency|Exocrine pancreatic insufficiency]] due to [[pancreatic duct]] [[obstruction]] by the [[tumor]] may lead to [[malabsorption]].
* [[Malabsorption]] in patients presents with [[anorexia]], [[weight loss]], and [[diarrhea]].
* The [[Diet (nutrition)|diet]] proposed for [[pancreatic cancer]] patients is based on American Cancer Society (ACS) guidelines
** [[Enzyme replacement therapy|Pancreatic enzyme replacement therapy]]
** Avoidance of high-protein/high-fat [[Diet (nutrition)|diet]]
** Individualized [[Diet (nutrition)|dietary]] prescriptions from a registered [[dietitian]]
** Supplementation with [[Omega-3 fatty acid|omega-3 fatty acids]]
 
=== Palliative Therapy ===
Palliative therapy in patients with pancreatic cancer mainly involves the management of symptoms arising as a result of complications of surgery or chemoradiation therapy:<ref name="pmid28890822">{{cite journal |vauthors=Kulaylat AS, Mirkin KA, Hollenbeak CS, Wong J |title=Utilization and trends in palliative therapy for stage IV pancreatic adenocarcinoma patients: a U.S. population-based study |journal=J Gastrointest Oncol |volume=8 |issue=4 |pages=710–720 |year=2017 |pmid=28890822 |pmc=5582050 |doi=10.21037/jgo.2017.06.01 |url=}}</ref><ref name="pmid28850428">{{cite journal |vauthors=Mastenbroek TC, Kramp-Hendriks BJ, Kallewaard JW, Vonk JM |title=Multimodal intrathecal analgesia in refractory cancer pain |journal=Scand J Pain |volume=14 |issue= |pages=39–43 |year=2017 |pmid=28850428 |doi=10.1016/j.sjpain.2016.10.002 |url=}}</ref><ref name="pmid28772092">{{cite journal |vauthors=Schenker Y, Bahary N, Claxton R, Childers J, Chu E, Kavalieratos D, King L, Lembersky B, Tiver G, Arnold RM |title=A Pilot Trial of Early Specialty Palliative Care for Patients with Advanced Pancreatic Cancer: Challenges Encountered and Lessons Learned |journal=J Palliat Med |volume= |issue= |pages= |year=2017 |pmid=28772092 |doi=10.1089/jpm.2017.0113 |url=}}</ref><ref name="pmid28734721">{{cite journal |vauthors=Ouyang H, Ma W, Liu F, Yue Z, Fang M, Quan M, Pan Z |title=Factors influencing survival of patients with pancreatic adenocarcinoma and synchronous liver metastases receiving palliative care |journal=Pancreatology |volume=17 |issue=5 |pages=773–781 |year=2017 |pmid=28734721 |doi=10.1016/j.pan.2017.07.002 |url=}}</ref><ref name="pmid28705009">{{cite journal |vauthors=Agarwal R, Epstein AS |title=Palliative care and advance care planning for pancreas and other cancers |journal=Chin Clin Oncol |volume=6 |issue=3 |pages=32 |year=2017 |pmid=28705009 |doi=10.21037/cco.2017.06.16 |url=}}</ref><ref name="pmid28612201">{{cite journal |vauthors=Laquente B, Calsina-Berna A, Carmona-Bayonas A, Jiménez-Fonseca P, Peiró I, Carrato A |title=Supportive care in pancreatic ductal adenocarcinoma |journal=Clin Transl Oncol |volume= |issue= |pages= |year=2017 |pmid=28612201 |doi=10.1007/s12094-017-1682-6 |url=}}</ref><ref name="pmid28567456">{{cite journal |vauthors=Kayaalp C, Dogan MS, Ersan V |title=Surgery for intractable pain in a patient with chronic pancreatitis complicated with biliary obstruction, portal vein stenosis and mesenteric venous collaterals |journal=Ann Hepatobiliary Pancreat Surg |volume=21 |issue=2 |pages=101–105 |year=2017 |pmid=28567456 |pmc=5449365 |doi=10.14701/ahbps.2017.21.2.101 |url=}}</ref>
 
==== Pain: ====
* There are various techniques for [[pain]] management as [[Palliative care|palliative therapy]] in patients with advanced stage of [[pancreatic cancer]]:
** [[Narcotic]] [[Analgesic|analgesics]]
** [[Narcotic]] [[Analgesic|analgesics]]+ [[Tricyclic antidepressant|tricyclic antidepressants]]/ [[Antiemetic|antiemetics]]
** [[Radiation therapy]]
 
* Surgical techniques used to treat [[pain]] in advanced [[pancreatic cancer]] cases include:
** [[Endoscopy|Endoscopic]] [[decompression]] with [[stent]] placement in patients with [[Bile duct|biliary]] or [[pancreatic duct]] [[obstruction]]
** [[Neurolysis]] of the [[celiac ganglia]] by many approaches:
*** Intraoperative
*** Transgastric
*** Transthoracic
*** Transabdominal
 
==== Jaundice: ====
* [[Jaundice|Obstructive jaundice]] can present with features of [[cholangitis]]:
** [[Fever]] and [[Rigor|chills]]
** [[Nausea and vomiting|Nausea]], [[Nausea and vomiting|vomiting]]
** [[Acholic stools|Clay-colored stools]]
** Dark [[urine]]
** Yellowish discoloration of skin
** [[Itch|Pruritus]]
** [[Abdominal pain|Right upper quadrant pain]]
** [[Anorexia]]
* Preferred treatment in patients: [[Endoscopy|Endoscopic]] [[decompression]] with [[stent]] placement in patients with [[Bile duct|biliary]] [[obstruction]].
* Techniques of [[Bile duct|biliary]] [[decompression]]:
** ''Cholecystojejunostomy''
** ''Choledochojejunostomy''
 
*Types of [[Stent|stents]]:
**Metal- costly, longer lifespan
**Plastic- cheaper, need replacement every three months
 
==== Duodenal obstruction ====
* Preferred treatment:
** [[Endoscopy|Endoscopic]] [[Stent|stenting]] of [[Duodenum|duodenal]] [[obstruction]]
** [[Gastrojejunostomy]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 23:33, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]

Overview

Secondary prevention of pancreatic cancer involves proper diet based on American Cancer Society (ACS) guidelines and palliative therapy for patients. Malabsorption may arise when pancreatic duct obstruction leads to exocrine pancreatic insufficiency. The diet proposed for pancreatic cancer patients is based on ACS guidelines and advocates administration of pancreatic enzyme replacement therapy, avoidance of high-protein/high-fat diets, individualized dietary prescriptions from a registered dietitian and dietary supplementation with omega-3 fatty acids. Palliative therapy is considered as an important part of secondary prevention and includes adequate analgesia, treatment of jaundice and duodenal obstruction, arising as complications of surgery.

Secondary prevention

Diet

Diet supplementation is an important component in the management of patients after pancreatic surgery due to the development of exocrine pancreatic insufficiency:[1][2][3][4][5][6][7][8][9][10][11][12][13]

Palliative Therapy

Palliative therapy in patients with pancreatic cancer mainly involves the management of symptoms arising as a result of complications of surgery or chemoradiation therapy:[14][15][16][17][18][19][20]

Pain:

Jaundice:

  • Types of stents:
    • Metal- costly, longer lifespan
    • Plastic- cheaper, need replacement every three months

Duodenal obstruction

References

  1. ↑ Singh VK, Haupt ME, Geller DE, Hall JA, Quintana Diez PM (2017). "Less common etiologies of exocrine pancreatic insufficiency". World J. Gastroenterol. 23 (39): 7059–7076. doi:10.3748/wjg.v23.i39.7059. PMC 5656454. PMID 29093615.
  2. ↑ Nikfarjam M, Wilson JS, Smith RC (2017). "Diagnosis and management of pancreatic exocrine insufficiency". Med. J. Aust. 207 (4): 161–165. PMID 28814218.
  3. ↑ Roberts KJ, Schrem H, Hodson J, Angelico R, Dasari B, Coldham CA, Marudanayagam R, Sutcliffe RP, Muiesan P, Isaac J, Mirza DF (2017). "Pancreas exocrine replacement therapy is associated with increased survival following pancreatoduodenectomy for periampullary malignancy". HPB (Oxford). 19 (10): 859–867. doi:10.1016/j.hpb.2017.05.009. PMID 28711377. Vancouver style error: initials (help)
  4. ↑ Vujasinovic M, Valente R, Del Chiaro M, Permert J, Löhr JM (2017). "Pancreatic Exocrine Insufficiency in Pancreatic Cancer". Nutrients. 9 (3). doi:10.3390/nu9030183. PMC 5372846. PMID 28241470.
  5. ↑ Saito T, Hirano K, Isayama H, Nakai Y, Saito K, Umefune G, Akiyama D, Watanabe T, Takagi K, Hamada T, Takahara N, Uchino R, Mizuno S, Kogure H, Matsubara S, Yamamoto N, Tada M, Koike K (2017). "The Role of Pancreatic Enzyme Replacement Therapy in Unresectable Pancreatic Cancer: A Prospective Cohort Study". Pancreas. 46 (3): 341–346. doi:10.1097/MPA.0000000000000767. PMID 28099252.
  6. ↑ Bartel MJ, Asbun H, Stauffer J, Raimondo M (2015). "Pancreatic exocrine insufficiency in pancreatic cancer: A review of the literature". Dig Liver Dis. 47 (12): 1013–20. doi:10.1016/j.dld.2015.06.015. PMID 26211872.
  7. ↑ Gheorghe C, Seicean A, Saftoiu A, Tantau M, Dumitru E, Jinga M, Negreanu L, Mateescu B, Gheorghe L, Ciocirlan M, Cijevschi C, Constantinescu G, Dima S, Diculescu M (2015). "Romanian guidelines on the diagnosis and treatment of exocrine pancreatic insufficiency". J Gastrointestin Liver Dis. 24 (1): 117–23. PMID 25822444.
  8. ↑ Landers A, Muircroft W, Brown H (2016). "Pancreatic enzyme replacement therapy (PERT) for malabsorption in patients with metastatic pancreatic cancer". BMJ Support Palliat Care. 6 (1): 75–9. doi:10.1136/bmjspcare-2014-000694. PMID 25164613.
  9. ↑ Berry AJ (2014). "Pancreatic enzyme replacement therapy during pancreatic insufficiency". Nutr Clin Pract. 29 (3): 312–21. doi:10.1177/0884533614527773. PMID 24687867.
  10. ↑ Braddick JA, Flaherty AM (2013). "Management of pancreatic exocrine insufficiency". Oncol Nurs Forum. 40 (2): 116–9. doi:10.1188/13.ONF.116-119. PMID 23448736.
  11. ↑ Sikkens EC, Cahen DL, van Eijck C, Kuipers EJ, Bruno MJ (2012). "The daily practice of pancreatic enzyme replacement therapy after pancreatic surgery: a northern European survey: enzyme replacement after surgery". J. Gastrointest. Surg. 16 (8): 1487–92. doi:10.1007/s11605-012-1927-1. PMC 3399077. PMID 22711213.
  12. ↑ Domínguez-Muñoz JE (2011). "Pancreatic enzyme replacement therapy for pancreatic exocrine insufficiency: when is it indicated, what is the goal and how to do it?". Adv Med Sci. 56 (1): 1–5. doi:10.2478/v10039-011-0005-3. PMID 21450558.
  13. ↑ Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV, Gapstur S, Patel AV, Andrews K, Gansler T (2012). "American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity". CA Cancer J Clin. 62 (1): 30–67. doi:10.3322/caac.20140. PMID 22237782.
  14. ↑ Kulaylat AS, Mirkin KA, Hollenbeak CS, Wong J (2017). "Utilization and trends in palliative therapy for stage IV pancreatic adenocarcinoma patients: a U.S. population-based study". J Gastrointest Oncol. 8 (4): 710–720. doi:10.21037/jgo.2017.06.01. PMC 5582050. PMID 28890822.
  15. ↑ Mastenbroek TC, Kramp-Hendriks BJ, Kallewaard JW, Vonk JM (2017). "Multimodal intrathecal analgesia in refractory cancer pain". Scand J Pain. 14: 39–43. doi:10.1016/j.sjpain.2016.10.002. PMID 28850428.
  16. ↑ Schenker Y, Bahary N, Claxton R, Childers J, Chu E, Kavalieratos D, King L, Lembersky B, Tiver G, Arnold RM (2017). "A Pilot Trial of Early Specialty Palliative Care for Patients with Advanced Pancreatic Cancer: Challenges Encountered and Lessons Learned". J Palliat Med. doi:10.1089/jpm.2017.0113. PMID 28772092.
  17. ↑ Ouyang H, Ma W, Liu F, Yue Z, Fang M, Quan M, Pan Z (2017). "Factors influencing survival of patients with pancreatic adenocarcinoma and synchronous liver metastases receiving palliative care". Pancreatology. 17 (5): 773–781. doi:10.1016/j.pan.2017.07.002. PMID 28734721.
  18. ↑ Agarwal R, Epstein AS (2017). "Palliative care and advance care planning for pancreas and other cancers". Chin Clin Oncol. 6 (3): 32. doi:10.21037/cco.2017.06.16. PMID 28705009.
  19. ↑ Laquente B, Calsina-Berna A, Carmona-Bayonas A, Jiménez-Fonseca P, Peiró I, Carrato A (2017). "Supportive care in pancreatic ductal adenocarcinoma". Clin Transl Oncol. doi:10.1007/s12094-017-1682-6. PMID 28612201.
  20. ↑ Kayaalp C, Dogan MS, Ersan V (2017). "Surgery for intractable pain in a patient with chronic pancreatitis complicated with biliary obstruction, portal vein stenosis and mesenteric venous collaterals". Ann Hepatobiliary Pancreat Surg. 21 (2): 101–105. doi:10.14701/ahbps.2017.21.2.101. PMC 5449365. PMID 28567456.
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