PANCREATIC CANCER. - Exocrine: the production of enzymes that help digesting fats and proteins.

Size: px

Start display at page:

Download "PANCREATIC CANCER. - Exocrine: the production of enzymes that help digesting fats and proteins."

Pearl Fleming
6 years ago
Views:

2 PANCREATIC CANCER 1. The pancreas It s a 15 cm gland located between the stomach and the spne, ntmately related to the vascular structures. It s dvded nto 3 parts: the wder end s called head, the mddle part s named body, and the fnal part s the tal of pancreas. It has two man functons: - Exocrne: the producton of enzymes that help dgestng fats and protens. - Endocrne: the producton of hormones such as nsuln or glucagon, whch regulate the sugar level n the blood. Most cancers (adenocarcnomas) have ther orgn n the exocrne cells that form the coatng of the pancreatc conducts through whch the pancreatc juce runs. 2. Rsk factors The cause of pancreatc cancer s not exactly known, but some rsk factors have been dentfed, and they mply a hgher rsk of sufferng from ths condton. Among them, we can lst smokng, chronc pancreatts, overweght and heredtary strange llnesses. All these factors njure the DNA (the genetc materal that contans the necessary nformaton for controllng the chemcal processes of the body), so cells grow wthout control and generate a malgnant tumor. 3. Symptoms Frequently, these symptoms are not vsble untl a late stage of the llness. You must talk to your doctor n case you detect these: - Jaundce: the skn or the eyes turn yellowsh, the urne becomes darker and faeces have a lghter colour. Ths s caused by the accumulaton of a pgment called blrubn n blood. It s normally elmnated by the ble, and goes from the lver to the ntestne through the ble duct. A tumor located n the head of the pancreas can block ths duct and the normal ble flux.

3 However, there can be jaundce n other bengn llnesses such as hepatts or cholelths (bodes formed n the gallbladder). - Itches: due to the accumulaton of substances under the skn normally elmnated wth the ble. It s normally assocated to the yellowsh colour of the skn. - Pan: normally located n the upper part of the abdomen and extended to the back. It s usually constant pan that worsens when eatng or restng. - Tredness, loss of appette, and unjustfed weght loss. - Nausea and vomts: due to the compresson produced on part of the dgestve tract, normally on the duodenum. 4. Dagnoss Sometmes t s not easy to dagnose t, especally n early stages because the symptoms are not very clear. All the tests that the patent undergoes are orentated towards the dagnoss of the condton and ts stagng n order to choose the most adequate treatment. Among all these tests, we can hghlght the followng: - Complete blood analyss, ncludng "oncogene markers", ths s, the level of certan substances n blood that determne the presence of malgnant pancreatc tumors. - Abdomnal ultrasonography: sound waves are released aganst the tssue to form "echoes" that create an mage on the screen. Ths panless technque allows the expert to obtan very mportant nformaton on the pancreas and the rest of abdomnal organs. - Computed tomography (CT): ths procedure obtans hgh resoluton mages of consecutve slces from dfferent parts of the body, so t can be reconstructed n two or three dmensons. - Nuclear magnetc resonance magng (NMRI): a technque that uses magnetc felds and rado waves to obtan detaled mages of dfferent parts of the body on a computer. Smlar to CT, an ntravenous substance can be used to hghlght the mage of certan organs (contrasts). CT and NMRI are the man tests performed to dagnose ths type of tumors. They permt knowng the exact locaton of the tumor and f there s dstant dssemnaton (metastass). - Postron emsson tomography (PET): a substance derved from glucose njected n ven and marked wth a radoactve sotope. The scanner rotates around the body and takes photographs of the areas of the body whch use more glucose. Tumor cells are more actve and consume more glucose, so they are hghlghted n the mages.

4 -PET-CT: t s a state-of-the-art technology that combnes both technques, so the locaton of the orgnal tumor and the dstant metastass can be establshed wth greater accuracy. - Endoscopc retrograde cholangopancreatography (ERCP): a flexble tube wth lght s ntroduced through the mouth, reaches the duodenum and locates the mouth of the common ble duct and the pancreas (paplla). A contrast s then ntroduced and t permts seeng any tumors or obstructon areas. Bopses can be performed and/or a small plastc tube called stent can be located there to release the obstructon of the ble duct and therefore mprove the tch and the jaundce before the operaton. - Endoscopc ultrasonography: an endoscope wth a small ultrasound devce s used, and therefore t s possble to have a detaled ultrasound mage of the pancreas and the nearby organs through the stomach wall of the duodenum. It allows detectng small njures that would pass unnotced, and even take samples of the tssue from the suspcous areas that are later examned wth the mcroscope (bopsy). - Transparetohepatc cholangography: the lver s punctured wth a thn needle that trespasses the skn and the rbs. It ntroduces the contrast and the x-rays permt mappng the ble ducts. If an obstructon area s found, we can leave a catheter to allow the passng of ble, towards the ntestne or to an external pouch. -Laparoscopy: ths test s done n the operatng room and s done under general anesthesa. The surgeon does a 1 to 2 cm ncson n the abdomnal wall and explores the abdomnal cavty. It permts takng bopses and determnng f the tumor has extended to other organs. 5. Treatment Once all these tests are evaluated, we can plan the most adequate strategy dependng on the stage and the general state of the patent. There are three man types of treatment, although n many cases t s necessary to combne them. 1. SURGERY: t s necessary n the followng cases: a) When the tumor s removable (curatve surgery), we can fnd three mal procedures: - Total pancreatectomy: removal of the whole pancreas, part of the stomach, duodenum, spleen, gallbladder, blary tree, and all the lymph nodes that surround the pancreas. - Cephalc pancreatectomy: removal of the head of the pancreas, part of the stomach, duodenum, gallbladder, blary tree, and all the lymph nodes that surround the head of the pancreas. - Dstal pancreatectomy: removal of the body and the tal of the pancreas, and frequently the spleen and lymph nodes n that area as well. After ths type of surgcal process, the patent must stay from 24 to 48 hours at the ntensve care unt (ICU) and n hosptal

5 about 2 more weeks. The recovery at home s dfferent n each case, but the patents can normally return to ther normal habts n 1 to 2 months. b) When the tumor s dssemnated and s mpossble to remove completely, t may be necessary to operate the patent (pallatve surgery) to releve the symptoms. Two dfferent procedures are normally used: - Blary bypass: a seres or connectons are made (anastomoss) n order to avod the obstructed area of the ble duct, allowng the passng of the ble towards another area of the dgestve duct. - Dgestve bypass: anastomoss between the stomach and another area of the ntestne n order to mantan oral feedng. 2. RADIOTHERAPY: dfferent types of radaton are used n order to destroy tumor cells. The radaton can be delvered externally wth a devce that rradates from outsde the body, or nternally, usng devces (needles or catheters wth a sealed radoactve substance nsde) that are ntroduced nsde or near the tumor. Under certan crcumstances, t may be necessary to apply radaton durng the operaton. For ths purpose we use an operatng room specfcally desgned. 3. CHEMOTHERAPY: Medcaton s used n order to destroy cancerous cells and therefore avod ther growth. It s normally admnstrated orally or ntravenously. Sometmes t s necessary to combne chemotherapy and radotherapy so that tumor cells are more senstve to radaton and therefore the recurrence of the condton n other parts of the body can be avoded. There are several clnc trals n whch the patent can take part that are amed to assess the effectveness of the dfferent treatments. Apart from that, an adequate nutrtonal therapy (meal plan) s needed as well as the use of certan medcnes n order to correct metabolc dsorders produced by the lack of enzymes and hormones (nsuln) that the pancreas used to produce. 6. Prognoss The prognoss (lfe expectancy) after the treatment for pancreatc cancer depends on the followng facts: - The possblty of a total removal wth surgery. - The stage of the cancer, whch can be establshed under three parameters: sze of the tumor, affecton of lymph nodes and dstant organs. - Health condton of the patent. - The exstence of recurrences (reappearance of the llness n the surgcal area or n dstant organs). Pancreatc cancer can be controlled only f t s detected before ts dssemnaton, and can be removed n a surgcal operaton. If t s extended, the treatment can only be pallatve (t can only mprove the qualty of lfe of the patent controllng the symptoms and the complcatons that may occur).

7 Ant er orandpost er or vagalt r unk St omach Gal l bl adder Commonhepat c duct Spl en car t er y Ta lof t hepancr eas Duodenum Super ormesent er c vessel s Jej unum Spl een

HEPATIC METASTASES. We can state 3 types of metastases depending on their treatment options:

HEPATIC METASTASES. We can state 3 types of metastases depending on their treatment options: HEPATIC METASTASES 1. Definition Metastasis means the spread of cancer. Cancerous cells can separate from the primary tumor and enter the bloodstream or the lymphatic system (the one that produces, stores,