Sandbox:Cherry
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Pancreatic cancer Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]
| Disease | Abdominal pain | History and Symptoms | Fever | Physical examination | Laboratory findings | Imaging findings | Comments | |
|---|---|---|---|---|---|---|---|---|
| Steatorrhea | Weight loss | |||||||
| Chronic pancreatitis | ✔ | ✔ | ✔ | - | DM type II, amylase and lipase levels may be slightly elevated | CT scan shows calcifications of the pancreas |
| |
| Pancreatic cancer | ||||||||
| Ampullary carcinoma | ||||||||
| Autoimmune pancreatitis | ||||||||
| Lymphoma | ||||||||
| Pancreatic endocrine tumors | ||||||||
| Acute pancreatitis | ||||||||
| Cholangitis | ||||||||
| Biliary obstruction | ||||||||
| Pseudocyst | ||||||||
| Pancreatic duct stricture/stone | ||||||||
| Cholecystitis | ||||||||
| Chronic gastritis | ||||||||
| Bile duct stones | ||||||||
| Intestinal perforation | ||||||||
| Crohn disease | ||||||||
| Myocardial infarction | ||||||||
| Mesenteric artery ischemia | ||||||||
| Peptic ulcer disease | ||||||||
| Retroperitoneal hematoma | ✔ | Anemia | MRI is the best radiologic tool to differentiate between retroperitoneal masses. | |||||
| Retroperitoneal abscess | ✔ | ✔ | Leukocytosis, positive inflammatory markers | |||||
| Retroperitoneal tumors (.e.g. liposarcoma) | ✔ | ✔ | ✔ | positive tumor marker | ||||
Obstructive jaundice may be painful due to calculous disease. Patients may be younger.
Stones can be demonstrated on abdominal ultrasound, both in the gallbladder and in the bile duct. However, stones may also be seen in patients with pancreatic cancer. ERCP will clarify the situation by ruling out stricture (seen in pancreatic cancer) and confirming bile duct stones, which can be cleared at the time of intervention.
Treatment Options by Stage
Stages I and II Pancreatic Cancer
Treatment of stage I and stage II pancreatic cancer may include the following:
- Surgery alone.
- Surgery with chemotherapy and radiation therapy.
Stage III Pancreatic Cancer
Treatment of stage III pancreatic cancer may include the following:
- Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine.
- Chemotherapy with gemcitabine.
Stage IV Pancreatic Cancer
Treatment of stage IV pancreatic cancer may include the following:
- Chemotherapy with gemcitabine with or without erlotinib.
- Palliative treatments for pain, such as nerve blocks, and other supportive care.
- Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine.
Treatment Options for Recurrent Pancreatic Cancer
Treatment of recurrent pancreatic cancer may include the following:
- Chemotherapy.
- Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine.
- Palliative radiation therapy.
- Other palliative medical care to reduce symptoms, such as nerve blocks to relieve pain.
prevention
Primary Cessation of cigarette smoking: The risk of pancreatic cancer falls with cessation of cigarette smoking, which is one of the most important modifiable risk factors.[1][2][3][4][5][6][6][7][8] Smoking accounts for the incidence of pancreatic cancer in one-fourth of all cases.[1][9] Nicotine in cigarettes stimulates tumorigenesis, increasing metastasis and resistance to treatment, hence impacting survival in patients.[10] The risk of developing pancreatic cancer becomes almost equivalent to that of a nonsmoker after five years of cessation.[2][11][4][8]
Regular exercise:
Obesity is considered as a potential risk factor for pancreatic cancer.[12]
Regular exercise decreases the risk of pancreatic cancer as compared to people living a sedentary lifestyle.[4][13]
The American Cancer Society (ACS) has issued guidelines for diet and physical activity at individual and community levels. Diet: A healthy balanced diet doesn't exceed 2000 calories daily and includes the following:[5][7][14] plenty of vegetables and fruits- blueberries, spinach, broccoli, tomatoes lean meat from fowl, fish and plant sources like nuts or whole grains monounsaturated fats help control insulin levels in type 2 diabetics[8] Tuna, mackerel, salmon, and sardine are major sources of long-chain omega-3 fatty acids due to anticancer properties
Poor diet: A poor diet includes the presence of the following:[12][2][14] Food preservatives and additives Smoked meat Heavy alcohol use High cholesterol Red meat Low consumption of fruits and vegetables Saturated fatty acids Processed foods high-fat, high-protein diet Chemicals known as heterocyclic amines, nitrates, and heme iron, found in foods, are capable of damaging cells and DNA, influencing cancerogenic processes
Aging: Aging is associated with the development of pancreatic cancer.[11][11][4]
Secondary
Diet: 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.
Treatment: based on American Cancer Society(ACS) guidelines[15]
Pancreatic enzyme replacement therapy
avoidance of high-protein/high-fat diets
Individualized dietary prescriptions from a registered dietitian
Supplementation with omega-3 fatty acids
Palliative Therapy
- Pain:
- There are various techniques for pain management as palliative therapy in patients with advanced stage of pancreatic cancer:
Pain:
- There are various techniques for pain management as palliative therapy in patients.
- Surgical techniques used to treat pain in advanced pancreatic cancer cases include:
- Endoscopic decompression with stent placement in patients with biliary or pancreatic duct obstruction
- Neurolysis of the celiac ganglia by many approaches:
- Intraoperative
- Transgastric
- Transthoracic
- Transabdominal
Jaundice:
- Obstructive jaundice can present with features of cholangitis:
- Fever and chills
- Nausea, vomiting
- Clay-colored stools
- Dark urine
- Yellowish discoloration of skin
- Pruritus
- Right upper quadrant pain
- Anorexia
- Preferred treatment in patients: Endoscopic decompression with stent placement in patients with biliary obstruction.
- Techniques of biliary decompression:
- Cholecystojejunostomy
- Choledochojejunostomy
- Types of stents:
- Metal- costly, longer lifespan
- Plastic- cheaper, need replacement every three months
Duodenal obstruction
- Preferred treatment:
- ↑ 1.0 1.1 Bochatay L, Girardin M, Bichard P, Frossard JL (2014). "[Pancreatic cancer in 2014: screening and epidemiology]". Rev Med Suisse (in French). 10 (440): 1582–5. PMID 25276995.
- ↑ 2.0 2.1 2.2 Lowenfels AB, Maisonneuve P (2006). "Epidemiology and risk factors for pancreatic cancer". Best Pract Res Clin Gastroenterol. 20 (2): 197–209. doi:10.1016/j.bpg.2005.10.001. PMID 16549324.
- ↑ Bosetti C, Bertuccio P, Malvezzi M, Levi F, Chatenoud L, Negri E, La Vecchia C (2013). "Cancer mortality in Europe, 2005-2009, and an overview of trends since 1980". Ann. Oncol. 24 (10): 2657–71. doi:10.1093/annonc/mdt301. PMID 23921790.
- ↑ 4.0 4.1 4.2 4.3 Bosetti C, Bertuccio P, Negri E, La Vecchia C, Zeegers MP, Boffetta P (2012). "Pancreatic cancer: overview of descriptive epidemiology". Mol. Carcinog. 51 (1): 3–13. doi:10.1002/mc.20785. PMID 22162227.
- ↑ 5.0 5.1 Hart AR (1999). "Pancreatic cancer: any prospects for prevention?". Postgrad Med J. 75 (887): 521–6. PMC 1741344. PMID 10616684.
- ↑ 6.0 6.1 Vimalachandran D, Ghaneh P, Costello E, Neoptolemos JP (2004). "Genetics and prevention of pancreatic cancer". Cancer Control. 11 (1): 6–14. PMID 14749618.
- ↑ 7.0 7.1 Ghadirian P, Lynch HT, Krewski D (2003). "Epidemiology of pancreatic cancer: an overview". Cancer Detect. Prev. 27 (2): 87–93. PMID 12670518.
- ↑ 8.0 8.1 8.2 Landi S (2009). "Genetic predisposition and environmental risk factors to pancreatic cancer: A review of the literature". Mutat. Res. 681 (2–3): 299–307. doi:10.1016/j.mrrev.2008.12.001. PMID 19150414.
- ↑ Qiu D, Kurosawa M, Lin Y, Inaba Y, Matsuba T, Kikuchi S, Yagyu K, Motohashi Y, Tamakoshi A (2005). "Overview of the epidemiology of pancreatic cancer focusing on the JACC Study". J Epidemiol. 15 Suppl 2: S157–67. PMID 16127228.
- ↑ Toki MI, Syrigos KN, Saif MW (2014). "Risk determination for pancreatic cancer". JOP. 15 (4): 289–91. PMID 25076322.
- ↑ 11.0 11.1 11.2 Li D, Xie K, Wolff R, Abbruzzese JL (2004). "Pancreatic cancer". Lancet. 363 (9414): 1049–57. doi:10.1016/S0140-6736(04)15841-8. PMID 15051286.
- ↑ 12.0 12.1 Bracci PM (2012). "Obesity and pancreatic cancer: overview of epidemiologic evidence and biologic mechanisms". Mol. Carcinog. 51 (1): 53–63. doi:10.1002/mc.20778. PMC 3348117. PMID 22162231.
- ↑ Kollarova H, Azeem K, Tomaskova H, Horakova D, Prochazka V, Martinek A, Shonova O, Sevcikova J, Sevcikova V, Janout V (2014). "Is physical activity a protective factor against pancreatic cancer?". Bratisl Lek Listy. 115 (8): 474–8. PMID 25246281.
- ↑ 14.0 14.1 Kuroczycki-Saniutycz S, Grzeszczuk A, Zwierz ZW, Kołodziejczyk P, Szczesiul J, Zalewska-Szajda B, Ościłowicz K, Waszkiewicz N, Zwierz K, Szajda SD (2017). "Prevention of pancreatic cancer". Contemp Oncol (Pozn). 21 (1): 30–34. doi:10.5114/wo.2016.63043. PMC 5385470. PMID 28435395.
- ↑ 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.