Everything about Pancreatic Cancer totally explained
Pancreatic cancer is a
malignant tumor of the
pancreas. Each year about 33,000 individuals in the
United States are diagnosed with this condition, and more than 60,000 in
Europe. Depending on the extent of the tumor at the time of diagnosis, the prognosis is generally regarded as poor, with few victims still alive five years after diagnosis, and complete
remission still extremely rare.
About 95 percent of pancreatic tumors are
adenocarcinomas . The remaining 5 percent include other tumors of the exocrine pancreas (
for example, serous
cystadenomas), acinar cell cancers, and pancreatic
neuroendocrine tumors (such as
insulinomas,, ). These tumors have a completely different diagnostic and therapeutic profile, and generally a more favorable prognosis.
Predisposing factors
Risk factors for pancreatic cancer include:
Diagnosis
History — Most patients with pancreatic cancer experience pain, weight loss, or
jaundice.
Pain is present in 80 to 85 percent of patients with locally advanced or advanced metastic disease. The pain is usually felt in the upper abdomen as a dull ache that radiates straight through to the back. It may be intermittent and made worse by eating.
Weight loss can be profound; it may be associated with
anorexia, early
satiety, diarrhea, or
steatorrhea.
Jaundice is often accompanied by
pruritus and dark urine. Painful jaundice is present in approximately one-half of patients with locally unresectable disease, while painless jaundice is present in approximately one-half of patients with a potentially resectable and curable lesion.
The initial presentation varies according to tumor location. Tumors in the pancreatic body or tail usually present with pain and weight loss, while those in the head of the gland typically present with steatorrhea, weight loss, and jaundice. The recent onset of atypical diabetes mellitus, a history of recent but unexplained
thrombophlebitis, or a previous attack of
pancreatitis are sometimes noted.
Courvoisier sign defines the presence of jaundice and a painlessly distended
gallbladder as strongly indicative of pancreatic cancer, and may be used to distinguish pancreatic cancer from
gallstones.
Pancreatic cancer is usually discovered during the course of the evaluation of aforementioned symptoms.
Liver function tests may show a combination of results indicative of bile duct obstruction (raised
conjugated bilirubin,
γ-glutamyl transpeptidase and
alkaline phosphatase levels).
CA19-9 (carbohydrate antigen 19.9) is a
tumor marker that's frequently elevated in pancreatic cancer.
Imaging studies, such as
ultrasound or abdominal
CT may be used to identify tumors.
Endoscopic ultrasound (EUS) is another procedure that can help visualize the tumor and obtain tissue to establish the diagnosis.
Treatment
Surgery
Treatment of pancreatic cancer depends on the stage of the cancer. The
Whipple procedure is the most common surgical treatment for cancers involving the head of the pancreas. It can only be performed if the patient is likely to survive major surgery, and if the tumor is localised without invading local structures or metastasizing. It can therefore only be performed in the minority of cases. Recent advances have made possible resection (surgical removal) of tumors that were previously unresectable due to blood vessel involvement.
After surgery,
adjuvant chemotherapy with
gemcitabine may be offered to eliminate whatever tumor tissue may remain in the body. This has been shown to increase 5-year survival rates. Addition of
radiation therapy isn't recommended.
Surgery may be performed for palliation, if the tumor is invading or compressing the
duodenum or
colon. In that case, bypass surgery may overcome the obstruction and improve quality of life, but it isn't intended as a cure.
Chemotherapy
In patients not suitable for resection with curative intent, palliative
chemotherapy may be used to improve quality of life and gain a modest survival benefit.
Gemcitabine was approved by the US
FDA in 1998 after a clinical trial reported improvements in
quality of life in patients with advanced pancreatic cancer. This marked the first FDA approval of a chemotherapy drug for a non-survival
clinical trial endpoint. Gemcitabine is administered intravenously on a weekly basis. Addition of
oxaliplatin (Gem/Ox) conferred benefit in small trials, but isn't yet standard therapy.
Fluorouracil (5FU) may also be included.
On the back of the results of a Canadian led Phase III Randomised Controlled trial involving 569 patients with advanced pancreatic cancer, the US FDA has licensed the use of
erlotinib (Tarceva) in combination with
gemcitabine as a palliative regimen for pancreatic cancer. This trial compared the action of gemcitabine/erlotinib vs gemcitabine/placebo and demonstrated improved survival rates, improved tumor response and improved progression-free survival rates. The survival improvement with the combination is on the order of less than four weeks, leading some
cancer experts to question the incremental value of adding
erlotinib to
gemcitabine treatment. New trials are now investigating the effect of the above combination in the adjuvant and neoadjuvant setting. A trial of anti-angiogenesis agent
bevacizumab (Avastin) as an addition to chemotherapy has shown no improvement in survival of patients with advanced pancreatic cancer. It may cause higher rates of high blood pressure, bleeding in the stomach and intestine, and intestinal perforations.
Ukrain is a semisynthetic combination of the herb
greater celandine and the classic cancer drug
ThioTepa. It was recently licensed as an
orphan drug for the treatment of pancreatic cancer in the US and Australia after positive results in two small studies.
Prognosis
Patients diagnosed with pancreatic cancer typically have a poor
prognosis partly because the cancer usually causes no symptoms early on, leading to locally advanced or
metastatic disease at time of diagnosis. Median survival from diagnosis is around 3 to 6 months; 5-year survival is much less than 5%. With 37,170 cases diagnosed in the United States in 2007, and 33,700 deaths, pancreatic cancer has the highest fatality rate of all cancers and is the fourth highest cancer killer in the United States among both men and women. Although it accounts for only 2.5% of new cases, pancreatic cancer is responsible for 6% of cancer deaths each year.
Pancreatic cancer may occasionally result in
diabetes. Insulin production is hampered and it has been suggested that the cancer can also prompt the onset of diabetes and vice versa.
Prevention
According to the
American Cancer Society, there are no established guidelines for preventing pancreatic cancer, although
cigarette smoking is responsible for 20-30% of pancreatic cancers.
The ACS recommends keeping a healthy weight, and increasing consumption of fruits, vegetables, and whole grains while decreasing red meat intake, although there's no consistent evidence that this will prevent or reduce pancratic cancer specifically.
In 2006 a large prospective cohort study of over 80,000 subjects failed to prove a definite association. The evidence in support of this lies mostly in small case-control studies.
In September 2006, a long-term study concluded that taking
Vitamin D can substantially cut the risk of pancreatic cancer (as well as other cancers) by up to 50%. More studies of this have been called for.
Several studies, including one published June 1, 2007, indicate that
B vitamins such as
B12,
B6, and
folate, can reduce the risk of pancreatic cancer when consumed in food, but not when ingested in vitamin tablet form.
Awareness
November is Pancreatic Cancer Awareness Month
Purple is the traditional color chosen to represent pancreatic cancer awareness.
The National Cancer Institute’s cancer research budget was $4.824 billion in 2004, an estimated $52.7 million of which was devoted to pancreatic cancer.
Research spending per pancreatic cancer patient is $1145, the lowest of any leading cancer.
For a list of celebrities who have succumbed to this disease, see . For a list of survivors see .
The Pancreatic Cancer Action Network (PanCAN) was created as an advocacy group for pancreatic cancer.Further Information
Get more info on 'Pancreatic Cancer'.
|
External Link Exchanges
Do you know how hard it is to get a link from a large encyclopaedia? Well we're different and will prove it. To get a link from us just add the following HTML to your site on a relevant page:
<a href="http://pancreatic_cancer.totallyexplained.com">Pancreatic cancer Totally Explained</a>
Then simply click through this link from your web page. Our crawlers will verify your link, extract the title of your web page and instantly add a link back to it. If you like you can remove the words Totally Explained and embed the link in article text.
As long as your link remains in place, we'll keep our link to you right here. Please play fair - our crawlers are watching. Your site must be closely related to this one's topic. Any kind of spamming, dubious practises or removing the link will result in your link from us being dropped and, potentially, your whole site being banned. |
