+A A-

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.