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 | |||
| Pancreatic cancer | ||||||||
| Ampullary carcinoma | ||||||||
| Autoimmune pancreatitis | ||||||||
| Lymphoma | ||||||||
| Pancreatic endocrine tumors | ||||||||
| Acute pancreatitis | ||||||||
| Cholangitis | ||||||||
| Biliary obstruction | ||||||||
| Pseudocyst | ||||||||
| Pancreatic duct stricture/stone | ||||||||
| Cholecystitis | ||||||||
| Chronic gastritis | ||||||||
| Community-Acquired Pneumonia (CAP) | ||||||||
| 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 | ||||
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.