Name: Pancreas Cancer
Description: Cancer of the "exocrine" pancreas
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The author of this casebook has identified the following medical topics as being highly relevant to this casebook.
The pancreas is about 6 inches long and is shaped like a flat pear. The widest part of the pancreas is the head, the middle section is the body, and the thinnest part is the tail.
The pancreas makes insulin and other hormones. These hormones enter the bloodstream and travel throughout the body. They help the body use or store the energy that comes from food. For example, insulin helps control the amount of sugar in the blood.
The pancreas also makes pancreatic juices. These juices contain enzymes that help digest food. The pancreas releases the juices into a system of ducts leading to the common bile duct. The common bile duct empties into the duodenum, the first section of the small intestine.
Pancreatic Cancer: Who's at Risk?
No one knows the exact causes of pancreatic cancer. Doctors can seldom explain why one person gets pancreatic cancer and another does not. However, it is clear that this disease is not contagious. No one can "catch" cancer from another person.
Research has shown that people with certain risk factors are more likely than others to develop pancreatic cancer. A risk factor is anything that increases a person's chance of developing a disease.
Studies have found the following risk factors:
Age -- The likelihood of developing pancreatic cancer increases with age. Most pancreatic cancers occur in people over the age of 60.
Smoking -- Cigarette smokers are two or three times more likely than nonsmokers to develop pancreatic cancer.
Diabetes -- Pancreatic cancer occurs more often in people who have diabetes than in people who do not.
Being male -- More men than women are diagnosed with pancreatic cancer.
Being African American -- African Americans are more likely than Asians, Hispanics, or whites to get pancreatic cancer.
Family history -- The risk for developing pancreatic cancer triples if a person's mother, father, sister, or brother had the disease. Also, a family history of colon or ovarian cancer increases the risk of pancreatic cancer.
Chronic pancreatitis -- Chronic pancreatitis is a painful condition of the pancreas. Some evidence suggests that chronic pancreatitis may increase the risk of pancreatic cancer.
Other studies suggest that exposure to certain chemicals in the workplace or a diet high in fat may increase the chance of getting pancreatic cancer.
Most people with known risk factors do not get pancreatic cancer. On the other hand, many who do get the disease have none of these factors. People who think they may be at risk for pancreatic cancer should discuss this concern with their doctor. The doctor may suggest ways to reduce the risk and can plan an appropriate schedule for checkups.
Surgery for pancreatic cancer is a major operation. Patients need to stay in the hospital for several days afterward. Patients may feel weak or tired. Most need to rest at home for about a month. The length of time it takes to regain strength varies.
The side effects of surgery depend on the extent of the operation, the person's general health, and other factors. Most patients have pain for the first few days after surgery. Pain can be controlled with medicine, and patients should discuss pain relief with the doctor or nurse. The section on "Pain Control" has more information.
Removal of part or all of the pancreas may make it hard for a patient to digest foods. The health care team can suggest a diet plan and medicines to help relieve diarrhea, pain, cramping, or feelings of fullness. During the recovery from surgery, the doctor will carefully monitor the patient's diet and weight. At first, a patient may have only liquids and may receive extra nourishment intravenously or by feeding tube into the intestine. Solid foods are added to the diet gradually.
Patients may not have enough pancreatic enzymes or hormones after surgery. Those who do not have enough insulin may develop diabetes. The doctor can give the patient insulin, other hormones, and enzymes. The section "Nutrition for Cancer Patients" has more information.
Radiation therapy may cause patients to become very tired as treatment continues. Resting is important, but doctors usually advise patients to try to stay as active as they can. In addition, when patients receive radiation therapy, the skin in the treated area may sometimes become red, dry, and tender.
Radiation therapy to the abdomen may cause nausea, vomiting, diarrhea, or other problems with digestion. The health care team can offer medicine or suggest diet changes to control these problems. For most patients, the side effects of radiation therapy go away when treatment is over.
The side effects of chemotherapy depend mainly on the drugs and the doses the patient receives as well as how the drugs are given. In addition, as with other types of treatment, side effects vary from patient to patient.
Systemic chemotherapy affects rapidly dividing cells throughout the body, including blood cells. Blood cells fight infection, help the blood to clot, and carry oxygen to all parts of the body. When anticancer drugs damage healthy blood cells, patients are more likely to get infections, may bruise or bleed easily, and may have less energy. Cells in hair roots and cells that line the digestive tract also divide rapidly. As a result, patients may lose their hair and may have other side effects such as poor appetite, nausea and vomiting, diarrhea, or mouth sores. Usually, these side effects go away gradually during the recovery periods between treatments or after treatment is over. The health care team can suggest ways to relieve side effects.
Pain is a common problem for people with pancreatic cancer. The tumor can cause pain by pressing against nerves and other organs.
The patient's doctor or a specialist in pain control can relieve or reduce pain in several ways:
Pain medicine -- Medicines often can relieve pain. (These medicines may make people drowsy and constipated, but resting and taking laxatives can help.)
Radiation -- High-energy rays can help relieve pain by shrinking the tumor.
Nerve block -- The doctor may inject alcohol into the area around certain nerves in the abdomen to block the feeling of pain.
Surgery -- The surgeon may cut certain nerves to block pain.
The doctor may suggest other ways to relieve or reduce pain. For example, massage, acupuncture, or acupressure may be used along with other approaches to help relieve pain. Also, the patient may learn relaxation techniques such as listening to slow music or breathing slowly and comfortably.
More information about pain control can be found in the NCI publications called Pain Control: A Guide for People with Cancer and Their Families, Get Relief from Cancer Pain, and Understanding Cancer Pain. The Cancer Information Service can send these booklets.
People with pancreatic cancer may not feel like eating, especially if they are uncomfortable or tired. Also, the side effects of treatment such as poor appetite, nausea, or vomiting can make eating difficult. Foods may taste different. Nevertheless, patients should try to get enough calories and protein to control weight loss, maintain strength, and promote healing. Also, eating well often helps people with cancer feel better and have more energy.
Careful planning and checkups are important. Cancer of the pancreas and its treatment may make it hard for patients to digest food and maintain the proper blood sugar level. The doctor will check the patient for weight loss, weakness, and lack of energy. Patients may need to take medicines to replace the enzymes and hormones made by the pancreas. The doctor will watch the patient closely and adjust the doses of these medicines.
Followup care after treatment for pancreatic cancer is an important part of the overall treatment plan. Patients should not hesitate to discuss followup with their doctor. Regular checkups ensure that any changes in health are noticed. Any problem that develops can be found and treated. Checkups may include a physical exam, laboratory tests, and imaging procedures.
Support for People with Pancreatic Cancer
Living with a serious disease such as pancreatic cancer is not easy. Some people find they need help coping with the emotional and practical aspects of their disease. Support groups can help. In these groups, patients or their family members get together to share what they have learned about coping with their disease and the effects of treatment. Patients may want to talk with a member of their health care team about finding a support group.
People living with pancreatic cancer may worry about the future. They may worry about caring for themselves or their families, keeping their jobs, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, diet, working, or other matters. Meeting with a social worker, counselor, or member of the clergy can be helpful to those who want to talk about their feelings or discuss their concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, emotional support, or other services.
Materials on coping with cancer are available from the Cancer Information Service (1-800-4-CANCER) and through other sources listed in the "National Cancer Institute Information Resources" section. The Cancer Information Service can also provide information to help patients and their families locate programs, services, and publications.
The Promise of Cancer Research
Laboratory scientists are studying the pancreas to learn more about it. They are studying the possible causes of pancreatic cancer and are researching new ways to detect tumors. They also are looking for new therapies that may kill cancer cells.
Doctors in clinics and hospitals are conducting many types of clinical trials. These are research studies in which people take part voluntarily. In these trials, researchers are studying ways to treat pancreatic cancer. Research already has led to advances in treatment methods, and researchers continue to search for more effective approaches to treat this disease.
Patients who join clinical trials have the first chance to benefit from new treatments that have shown promise in earlier research. They also make an important contribution to medical science by helping doctors learn more about the disease. Although clinical trials may pose some risks, researchers take very careful steps to protect their patients.
In trials with people who have pancreatic cancer, doctors are studying new drugs, new combinations of chemotherapy, and combinations of chemotherapy and radiation before and after surgery.
Biological therapy is also under investigation. Scientists are studying several cancer vaccines to help the immune system fight cancer. Other studies use monoclonal antibodies to slow or stop the growth of cancer.
Patients who are interested in joining a clinical study should talk with their doctor. They may want to read the NCI booklet Taking Part in Cancer Treatment Research Studies. It explains how clinical trials are carried out and explains their possible benefits and risks. NCI's Web site at http://www.cancer.gov on the Internet provides general information about clinical trials. It also offers detailed information about specific ongoing studies of pancreatic cancer by linking to PDQ®, NCI's cancer information database. The Cancer Information Service at 1-800-4-CANCER can answer questions about cancer clinical trials and can provide information from the PDQ database.
Bookmarks The following information, which has been distilled by the casebook author from this and other websites is particularly relevant to this casebook.
|U.S. National Cancer Institute. Treatment, causes, prevention, research and clinical trials||(Pancreatic carcinoma)|
|U.S. National Library of Medicine. Lots of links. Also en Espanol||(Pancreatic carcinoma)|
|National Pancreas Foundation support groups||(Pancreatic Adenocarcinoma)|
|" Helping Patients and Physicians Create Optimal Treatment Strategies."||(Pancreatic Adenocarcinoma)|