- Pancreatic Cancer: Symptoms, Diagnosis and Treatments
- Signs and Symptoms
- Establishing Diagnosis
- Treatment Options
Pancreatic Cancer: Symptoms, Diagnosis, Treatments, and More
Pancreas cancer ranks fourth among cancer fatal cases. It refers to persons of both gender identities. The disease destroys the head or the neck of the pancreas in about 75% of all cases of pancreas cancer. 15-20% cases involve the pancreas body and in 5-10% – it hurts the pancreas tail.
Signs and Symptoms
The initial presentation of this type of cancer is rather indistinctive and mild. People usually complain of the same set of symptoms, as loss of appetite, general feeling of being unwell, feeling seek, over fatigue and epigastric or back pains.
People having pancreas cancer can have the following symptomatology:
- Massive weight loss: it is a distinguishing feature of pancreas cancer;
- Epigastric pain: it is a general symptom of pancreas cancer; there are also pains in the middle or lower parts of the back;
- Frequent intense pains, which happen especially at night;
- Beginning of pancreatic diabetes during the foregoing year;
- Obstructive jaundice, which is a distinguishing sign of pancreas head affect;
- Intense itching, which is an alarm sign for each patient;
- Ambulant thrombophlebitis and venous thrombosis, which can be in the initial stage;
- Cholecele, which means that one`s gallbladder is enlarged and strained;
- Progression of intra-abdominal disorder: there are ascites, palpable abnormalities, large liver mass due to metastases or enlarged spleen due to portal-venous obstruction;
- Advanced case: there are subdermal paraomphalic metastases;
- Possible metastatic tumors in the rectal zone (Blumer’s symptom);
- Potential presence of palpable metastatical cervical nodes in the collar bone area.
It is really hard to set a diagnosis revealing pancreas cancer with early stage.
There is nothing special in labs of people with pancreas cancer. However, those ones, who have an advanced stage of the disease, involving a considerable weight reduction, show nutritional deficiency in their labs (low serum albumin or cholesterol level).
It is recommended to have the following tests at suspicion on pancreas cancer:
- Complete blood workup;
- Hepatobiliary testing: obstructive jaundice becomes the cause of significant bilirubin elevations, ALP, GGT, and to a lesser degree, AST and ALT;
- Serum amylase and lipase levels, which are elevated in less than 50% of patients with operable pancreatic cancers and in only 25% of patients with inoperable tumors;
- Cancer-specific markers as CA 19-9 antigen and CEA: 75-85% have elevated CA 19-9 levels; 40-45% have elevated CEA levels.
Radiology, which helps to detect pancreatic cancer, involves the following:
- Computer assisted tomography;
- Transcutaneous ultrasonography;
- Endoscopic retrograde cholangiopancreatography;
- Positron tomography.
Surgical measure is the main type of medical maintenance in case of pancreatic cancer. Moreover, chemical therapy and radiological therapy are also important.
The list of curative operation options is below:
- Pancreaticoduodenectomy (Whipple Procedure), with/without sparing of the pylorus;
- Total pancreatectomy;
- Distal pancreatectomy.
Antineoplastic medications and combinations of medications used in treatment of pancreatic carcinoma involve the following:
- Single agent therapy with the use of Gemcitabine, which is effective for patients with metastatic or regional inoperable cancer with poor performance status;
- GTX medication regimen (gemcitabine, docetaxel and capecitabine);
- Gemcitabine and albumin-bound paclitaxel;
- Folfirinox (LV5-FU [leucovorin/5-fluorouracil] in combination with oxaliplatin and irinotecan): this combination is advised as an active first-line therapy for patients with metastatic colorectal cancer;
- Paclitaxel protein bound 125 mg/m 2 in combination with gemcitabine 1000 mg/m 2 IV over 30-40 min on Days 1, 8, and 15 of each 28-day cycle;
- Erlotinib in combination with gemcitabine;
- Single substance therapy with the use of capecitabine or capecitabine in combination with erlotinib: this can be used as a second-line treatment in case of patient’s refractory to gemcitabine;
Rescue therapy with the use of gemcitabine is considered a standard one for surgically removed pancreatic cancer.
- The rational explanation of the neoadjuvant treatment involves three main reasons:
- pancreas cancer is a general disease, thus, it requires general treatment right from the beginning;
- people will be able to bear better any toxic impact of chemical therapy before the main pancreatic resection than afterwards;
- the tumor will contract with the help of the neoadjuvant treatment, thus, the resection will become less challenging.
Palliative treatment can be used for the following cases of pancreatic cancer:
- Pain: pain management is required for patients, who are not exposed to pancreatic cancer resection; opioid pain reliever must be used early and in sufficient dose regimen;
- Jaundice: Obstructive jaundice warrants palliation if the patient has pruritus or right upper quadrant pain or has developed cholangitis;
- Duodenal obstruction can happen in case of pancreas carcinoma: it can be reprieved with the help of gastronesteostomy or an endoscopy.