Pancreatic cancer secondary prevention
|
Pancreatic cancer Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Pancreatic cancer secondary prevention On the Web |
|
American Roentgen Ray Society Images of Pancreatic cancer secondary prevention |
|
Risk calculators and risk factors for Pancreatic cancer secondary prevention |
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
- Exocrine pancreatic insufficiency due to pancreatic duct obstruction by the tumor may lead to malabsorption.[1]
- Malabsorption in patients presents with anorexia, weight loss, and diarrhea.
- The diet proposed for pancreatic cancer patients is based on American Cancer Society (ACS) guidelines[2]
- 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
Palliative therapy in patients with pancreatic cancer mainly involves the management of symptoms arising as a result of complications of surgery or chemoradiation therapy:[3][4][5][6][7][8][9]
Pain:
- There are various techniques for pain management as palliative therapy in patients with advanced stage of pancreatic cancer:
- 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:
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.