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Pancreatic Cancer: Conservative Approach Vs. Non-Conservative approach to Treatment 2
Cancer
Cancer happens when cells in a particular part of the body start growing out of
control. Normal cells divide normally and grow in an orderly fashion, but for cancer cells that
is not the case. They keep on growing and crowd out the normal cells. There are several types
of cancer all have this out-of-control growth of cells common. Cancer is also known as
carcinoma or malignant tumor. Cancerous cells are also termed as malignant cells. (Cancer.
Occasionally cancer cells tend to break away from their cluster and reach other parts
of the body by means of blood or lymph system. They then settle in those new places and
start forming new tumors. This phenomenon is called metastasis. Cancer formed as a result of
metastasis is called metastatic cancer. Even if cancer spreads to other parts of the body, it is
still referred as the cancer of the part where it has started. If prostate cancer reaches the
bones, it is still known as prostate cancer. If breast cancer reaches to the lungs, it is still called
breast cancer. Sometimes cancer returns in a person who had been treated, a rare
Pancreas
The pancreas is an important organ of the human body. It is located deep in the body,
behind the stomach. It is similar to a fish in its shape. Its length is about 6 inches and width is
Functions of Pancreas
Pancreas performs three main jobs. First it has special cells called Islets of
Langerhans that make Insulin that helps control blood sugar, lack of a body’s ability to
produce Insulin cause a condition known as diabetes. This is called “endocrine function” of
Pancreas. Second, the Pancreas has areas called acini that produce digestive enzymes. This is
the “exocrine function” of the Pancreas. Third, duct cells of Pancreas produce a solution of
Sodium bicarbonate, which helps in flushing the digestive enzymes out from the Pancreas.
This solution when reaches the stomach neutralizes the acidic nature of the stomach and helps
in protecting the internal cell lining of stomach. (PEaRL. (2006). Pancreas Education and
Pancreatic Cancer
Both the exocrine and endocrine cells of Pancreas can form tumors. Relatively tumors
arisen from the exocrine cells are more common. It should be kept in mind that all of the
It becomes important knowing which part of Pancreas has developed a tumor, the
exocrine or the endocrine as each type of tumor has its signature signs and symptoms, has
Exocrine tumors
Exocrine tumors are more likely to be cancer. Most of these belong to a kind known
as adenocarcinomas. Treatment of this type of cancer normally depends on the stage of the
cancer, instead of its exact type. The stage here means how far the cancer has progressed.
Pancreatic Cancer: Conservative Approach Vs. Non-Conservative approach to Treatment 4
Ampullary cancer starts where the bile duct and the pancreatic duct open into the
small intestine. Signs like yellowing of the skin and eyes (jaundice) make its detection
possible at an earlier stage than most pancreatic cancers. Early detection means better
Endocrine Tumors
Endocrine tumors are relatively less common. They are also termed as islet cell
tumors and are of several sub-types. Most of them are benign, a few are cancerous. (What Is
According to The American Cancer Society’s prediction “in 2008, about 37,680
people in the United States will be found to have pancreatic cancer and about 34,290 will die
of the disease.” The lifetime chances of having a pancreatic cancer are about 1 in 76. (How
Risk Factors
A risk factor may be anything that affects one's chance of getting a disease, cancer in
this case. Some risk factors, like smoking, are under one’s control. Others, such as one's age,
gender or race, can't be altered. Unfortunately, there is very limited knowledge about exactly
Recent research shows that some of the risk factors listed below have an effect on the
DNA of cells in the Pancreas, leading to abnormal cell growth causing tumors. One important
thing that should always be kept in mind is that having one risk factor, or even more, does not
guarantee that one will get the disease. And there are reported cases where people not having
Pancreatic Cancer: Conservative Approach Vs. Non-Conservative approach to Treatment 5
any known risk factors get the disease. A few of the most important of these risk factors are
listed below:
Age: The risk of Pancreatic cancer increases with age. Nearly 90% of patients are 55
out of 10 cases are linked with smoking. People using smokeless tobacco also are
Diet: There seems to be existing a link between the disease and high-fat diets
including red meat, pork, and processed meat. Studies have shown diets richer in
fruits and vegetables may help reduce the chances of the disease.
Obesity and lack of exercise: Overweight people have more chances of developing
Diabetes: Pancreatic cancer is more common in diabetic people. Exact reason is still
unknown.
Cirrhosis of the liver: Cirrhosis means scarring of the liver as a result of liver damage
from hepatitis, alcohol use and things like that. People with cirrhosis tend to have a
Work exposure: Heavy exposure at workplace to things like pesticides, dyes, and
chemicals (some of which can be carcinogens) may elevate the chances of getting
Gene changes: Mutations of certain genes, passed from parent to child, may cause
along with certain, other problems pancreatic cancers. The genes causing these
problems have been identified by scientists and can be recognized by genetic testing.
pylori in the stomach may also increase the risks of pancreatic cancer.
Symptoms
very difficult. The symptoms of pancreatic cancer are seldom recognized until the cancer has
progressed to an advanced stage and often spread to the other areas of the body. The
symptoms in more advanced stages are yellowing of skin (jaundice), abdominal or back pain,
unexplained weight loss, loss of appetite, pancreatitis, nausea and fatigue. Some times
diabetes also appears 1-2 years prior to correct diagnosis. What makes diagnosis trickier is
the fact that the same symptoms can occur as a result of several other diseases as well.
(PEaRL. (2005). Pancreas Education and Research Letter. Volume 1, Number 3. Fall 2005.)
Jaundice: Yellowing of eyes and skin is termed as jaundice. Its reason is build-up of
bilirubin from the liver. Nearly half of the pancreatic cancer patients (and all of
Pancreatic Cancer: Conservative Approach Vs. Non-Conservative approach to Treatment 7
ampullary cancer) show signs of jaundice. But jaundice can also be caused as a result
Pain: Abdominal or the back pain is a very common indication of advanced pancreatic
cancer. Again, there are reasons other than cancer for this pain.
Weight loss: Severe weight loss (without intent) over a period of months is a frequent
observation in patients with this cancer. Loss of appetite and fatigue accompany
Digestive problems: If the tumors block the secretion of the pancreatic juice into
intestine, patient may not be able to digest fat-rich diet. Stools may get pale, bulky,
oily, and difficult to flush. Other complexities may include vomiting, nausea and pain
Swollen gallbladder: The doctor may discover that the gallbladder is swollen and
enlarged. The doctor can feel the change and can also see it on imaging studies.
Blood clots: Occasionally blood clots appear in the veins and may cause problems
with fatty tissues beneath the skin. Sometimes these clots may travel to the lungs and
cause dyspnea. But presence of blood clot does not mean that someone has cancer.
The blood clots may appear as a result of several things other than cancer also.
Diabetes: Pancreatic cancer may cause problems with sugar levels of the blood.
Preventions
There are no definite preventions against pancreatic cancer at this time. The best
advice is refraining from smoking, one of the major risk factor one can control. Keeping good
weight, taking good diet, and exercising regularly are also important. (Can Pancreatic Cancer
According to two studies increased intake of vitamin D in diet and in form of pills
reduces the chances of Pancreatic cancer by approximately 40%. (Skinner, H. G.; Michaud,
D. S.; Giovannucci, E.; et al. (2006). Vitamin D intake and the risk for pancreatic cancer in
two cohort studies. Cancer Epidemiol Biomarkers Prev 2006. Volume 15, Number 9.)
Diagnosis
As pancreas lies deep inside the body, the doctor cannot see or feel tumors during a
For diagnosis of cancer and its size and exact location, the doctor may perform
imaging tests like CT scan, ultrasound, PET scan, MRI, angiography, and ERCP. The only
One of the relatively newer techniques of diagnostic approaches used for pancreatic
cancer diagnosis is use of fine needle aspirate (FNA) using an endoscopic ultrasound (EUS).
(ERCP). Another method called “LOH Analysis” detects pre-cancerous and cancerous cells
based on the loss of one or more tumor suppressor genes. (Khalid, A. (2005). The role of
pancreatic cyst fluid molecular analysis in predicting cyst pathology. Clin Gastroenterol
Currently, there are no tests (blood or other) that can find out this cancer in pre-
symptomatic phase. Levels of tumor markers like Ca19-9, CEA, CA-50, SPAN-1, DUPAN-
2, elastase-1, tissue polypeptide antigen and tissue polypeptide-specific antigen and may be
elevated than normal in patients with pancreatic cancer, but by the time the levels elevate the
Tests for genes responsible for the genetic transfer in people with family history of the
disease help predicting the level of risk. But a side effect is that if the results show higher risk
the patients may not be able to get health insurance, or it may cost more. (How Is Pancreatic
Certain other tests, called imaging tests (that make pictures of the inside of the body)
have got popularity these days. These are found to be useful especially in case of vital organs
difficult to examine, such as pancreas. A brief idea of how these tests can be of any use is
presented below:
pictures of the inside organs of the body. It is useful in diagnosing cancer and
estimating its spread, a process called staging the cancer. It may also be used to help
CT scans are frequently used pancreatic cancer diagnosis, as it shows the pancreas
clearly and often can guide about the location of cancer. These scans can also display
the organs nearby, as well as lymph nodes and distant organs where the cancer might
have spread. The CT scan may help the doctor to reach a decision about surgery as a
treatment option.
Pancreatic Cancer: Conservative Approach Vs. Non-Conservative approach to Treatment 10
Magnetic Resonance Imaging (MRI): MRI scans make use of radio waves and strong
magnets in place of x-rays to take pictures. MRI scans are especially helpful for
looking at the brain and spinal cord. Most doctors prefer CT scans for pancreas, but
Positron Emission Tomography (PET) Scan: PET scans need injecting a form of
sugar into the blood that contains radioactive atoms. Cancerous cells tend to absorb
large amounts of this sugar. A camera then shows the location of these cells. This test
is useful to observe whether or not the cancer has reached the lymph nodes or other
places.
PET/CT Scan: This test combines the 2 types to even better pinpoint the tumor. This
test is especially useful for locating cancer which has spread beyond pancreas and
now can not be removed by surgery. It is also be useful for staging the cancer. It can
Ultrasound: It uses sound waves for imaging of the interior of the body. The pictures
are then combined by a computer for a detailed image. This test is helpful in telling
the type of tumor in the pancreas. Endoscopic ultrasound is performed with a probe
inserted through the mouth or nose into the stomach. The probe is then pointed toward
the pancreas, resulting in good picture and better diagnosis than CT scans for spotting
small tumors. Patients are first sedated for this type of ultrasound.
and then a thin, flexible tube is inserted down the throat, all the way to the small
intestine. The location of opening of common bile duct into the small intestine is
traced and then a small quantity of harmless dye is then passed through the tube into
the ducts. The dye outlines the ducts on x-rays. The pictures may show blocked or
Pancreatic Cancer: Conservative Approach Vs. Non-Conservative approach to Treatment 11
narrowed ducts as a result of pancreatic cancer. A small brush can also be put through
the tube to remove cells for microscopic examination. ERCP may also be used to
place a stent into the bile duct to keep it open if a tumor nearby is pressing on it.
Angiography: It is a type of x-ray used to monitor blood vessels. The test show if the
blood flow in an area is slowed or blocked by a tumor. It also shows whether there are
any abnormal blood vessels. The results assist the doctor to decide if the cancer can be
Biopsy: Biopsy is a tissue removal from the tumor for microscopic examination for
cancerous cells. FNA (fine needle aspiration) biopsy is most frequently used method,
though there are other biopsy methods as well. A thin needle is inserted, with the help
of ultrasound, through the skin and into the pancreas to remove small pieces of tissue.
(laparoscopy). The patient is sedated and the surgeon makes small incisions and
inserts small, thin, telescope-like instruments into the abdominal cavity. One of the
instruments is linked with a video screen. The surgeon looks at the tumor and
observes its spread. Biopsy samples can also be taken in the process. Usually surgery
is avoided unless it seems that the operation will surely remove all of the cancer.
Treatment
Pancreatic Cancer: Conservative Approach Vs. Non-Conservative approach to Treatment 12
Three main types of treatment can be used for pancreatic cancer: surgery, radiation
therapy and chemotherapy. Decision to choose one or a combination depends upon the stage
Surgery
Potentially curative surgery: (also called the Whipple procedure) used when it seems
Palliative surgery: used when tumor is too widespread, it is done to relieve symptoms
or to prevent certain problems, like blockage of the bile ducts or the intestine by the
cancer.
Disadvantage
Some studies have shown that removing only part of the cancer does not help patients
to live longer. Pancreatic cancer surgery is one of the hardest operations for patients to have
as there are frequent complications and recovery can take many weeks. The 5-year survival
Radiation therapy
Radiation therapy is done by using high energy rays (such as x-rays) to either kill or
shrink cancerous cells. Treatment is given 5 times a week usually for a number of weeks or
even months. Radiation (sometimes combined with chemotherapy) can also be used for
Disadvantages
Pancreatic Cancer: Conservative Approach Vs. Non-Conservative approach to Treatment 13
Its side effects are skin changes that look like sunburn or suntan, upset stomach, loose
Chemotherapy
Chemotherapy is the use of drugs to cure cancer. The drugs have an advantage over
radiation and surgery that once the drugs enter the bloodstream, they reach to every organ of
the body. This makes it useful for cancers spreading beyond the place they started.
Chemotherapy may be used at any stage of pancreatic cancer, even in advanced stages.
Disadvantages
Its side effects depend on the type of drugs used, the dosage, and length of treatment.
They may include diarrhea, loss of appetite, hair loss, nausea and vomiting and mouth sores.
Low blood cell counts from treatment may result in increased chances of infection, bleeding
or bruising after minor cuts, and fatigue. (How Is Pancreatic Cancer Treated? American
Cancer Society)
International statistics:
Among cancer cases, the ranking of Pancreatic cancer’s incidence is 13th worldwide, with a
fatality rank of 8th among cancer types. The average incidence of Pancreatic cancer in the
world is 8-12 per 100,000 people, with Black males experiencing the highest rates amounting
to 13 per 100,000 individuals. Similarly Korean, Czech, Latvian and New Zealand-Maori
nationalities have the second highest incidence rates i.e. 11 per 100,000 people. India has the
lowest incidence rate with 2 per 100,000 people plagued with the disease.
American statistics:
A disease which was expected to claim 37,680 people in the United States alone; with an
expected death percentage of 91% explains the fatalistic nature of the disease. Europe
Pancreatic Cancer: Conservative Approach Vs. Non-Conservative approach to Treatment 14
experiences almost 60,000 diagnosed cases of cancer each year. Almost 1 in 76 people
experience Pancreatic Cancer with distribution between both the sexes discovered to be on an
equal basis. A meager 5% patients are alive five years after initial diagnosis and complete
recovery is even more circumspect. However, other factors do affect the incidence of this
Age factor:
The probability of Pancreatic Cancer is directly proportional to age and almost 90% of
patients are above 55 years old. The average age is discovered to be 72 years. These facts
reveal that as we get older we should pay greater attention towards avoiding such ailments
Sex:
The probability of cancer is higher in males than in females which means that attention
should be focused on finding the relevant reasons and providing preventive cure. The male-
female ratio is approximately 1.2-1.5:1. However, during the last two decades this statistic is
Causes:
and among the rest 30% are attributed to smoking and 20% cases are related to dietary
The disease is the third most common malignancy where cancers belonging to the
gastrointestinal tract are concerned and ranks as the fifth leading cause of cancer deaths. This
disease can arise from both the endocrine and exocrine portions of the pancreas with
diagnosis difficult in the early stages. The exocrine portion accounts for 95% of the
pancreatic tumors, most probably from the ductal epithelium and connective tissues.
Approximate figures indicate that 75% of the tumor originates from the pancreatic head and
Survival statistics:
True long-term cures are extremely rare in this form of cancer, with most individuals
eventually succumbing to the disease. Pancreatic adenocarcinoma has a higher fatality rate
than endocrine and cystic neoplasms. As discussed before, only 5% of patients survive after 5
years and the median survival age is in the range of 4-6 months. In the event of successful
curative therapy, which is realized by 20% of the patients, the median survival age increases
to 12-19 months and the 5 year survival rate becomes 15-20%. The survival rate for people
Five year survival rates are used for comparative analysis, with respect to people who have
cancer to those who don’t have it. This analysis reveals how many people die due to the type
of cancer in question. The numbers are meant to provide a comprehensive overview and
situation. A table describing the relationship between stages of cancer and the associated
Stage IB 21%
Stage IIA 12%
Stage IIB 6%
Stage III 2%
Stage IV 1%
With overall highest incidence rates found in males and especially Black Americans,
Pancreatic Cancer is a fatal disease that has a low detection probability and even lower
survival rate. Few success stories are found and statistically speaking a full recovery is an
extremely rare event. The stage of Pancreatic cancer progression has a significant impact on
recovery and to what extent the disease can be cured. Among the identified factors, smoking
and dietary trends received a combined weightage of approximately 50%, with a significant
portion of the American population already ranked as obese. Long-term recovery rates do not
even rank in double figures which explains the alarming significance of the situation.
Role of Nurses
Nurses perform a godly duty of helping people, making them feel and stay
utmost importance in treating pancreatic cancer. There are a number of areas where nurses
Nutrition
Besides possible bile duct blockage, patients of pancreatic cancer tend to lose their
appetite and suffer weight loss and fatigue. The symptoms may be a result of treatment or the
cancer itself. When possible, nurses can advise patients to try taking high-energy diet and
food supplements. Many patients have to take pancreatic enzymes in form of a tablet for
Pancreatic Cancer: Conservative Approach Vs. Non-Conservative approach to Treatment 17
assistance in absorbance of digested food. For some patients the doctors may put a feeding
tube into the stomach to improve nutrition and energy levels, usually temporarily, here the
Pain
Abdominal or back pain can become a major nuisance for people with pancreatic
cancer. Treatment is there to help relieve this pain. There are many ways of relieving pain
Cutting some of the nerves that carry pain sensations or injecting alcohol into these nerves
can provide relief. Morphine or other similar medicines (opioid agents) reduces pain
significantly for most patients. Pain medicines work best when they are given regularly on a
schedule, this is where nurses step in. (Palliative and Supportive Care. American Cancer
Society)
neuropathic) is vital for proper treatment. The treatments currently available are ample, they
customized to the patient’ needs. When relief is below the desired level with pharmacological
interventions, celiac block and other interventions could be considered. (Cruciani, R. A.; Jain,
235.)
Reference
Pancreatic Cancer: Conservative Approach Vs. Non-Conservative approach to Treatment 18
American Cancer Society (Corporate Author, Editor); Pierce, M. (Ed.); Walker, C. L. (Ed.);
Ades, T. B. (Ed.); Varricchio, C. G. (Ed.). (1997). A Cancer Source Book for Nurses.
Barton-Burke, M.; Wilkes, G. M. (2006). Cancer Therapies. Jones & Bartlett Publishers.
Can Pancreatic Cancer be Prevented? American Cancer Society. Retrieved November 18,
2008 from
http://www.cancer.org/docroot/CRI/content/CRI_2_2_3X_Can_pancreatic_cancer_be
_prevented_34.asp?sitearea=
Cancer. Health Guide. The New York Times. Retrieved November 18, 2008 from
http://health.nytimes.com/health/guides/disease/cancer/overview.html
Cruciani, R. A.; Jain, S. (2008). Pancreatic Pain: A Mini Review. Pancreatology. Volume 8,
Number 3, p. 230-235.
Gold, E.B.; Diener, G. L. et al. (1985). Diet and other risk factors for cancer of the pancreas.
How Is Pancreatic Cancer Found? American Cancer Society. Retrieved November 18, 2008
from
http://www.cancer.org/docroot/CRI/content/CRI_2_2_3X_How_is_pancreatic_cancer
_found_34.asp?sitearea=
How Is Pancreatic Cancer Treated? American Cancer Society. Retrieved November 18, 2008
from
http://www.cancer.org/docroot/CRI/content/CRI_2_2_4X_How_Is_Pancreatic_Cance
r_Treated_34.asp?sitearea=
How Many People Get Pancreatic Cancer? American Cancer Society. Retrieved November
http://www.cancer.org/docroot/CRI/content/CRI_2_2_1X_How_many_people_get_p
ancreatic_cancer_34.asp?sitearea=
Khalid, A. (2005). The role of pancreatic cyst fluid molecular analysis in predicting cyst
Klapman, J.; Malafa, M. P. (2008). Early Detection of Pancreatic Cancer: Why, Who, and
How to Screen. Cancer Control. Volume 15, Number 4, p. 280- 287. ©2008 H. Lee
Palliative and Supportive Care. American Cancer Society. Retrieved November 18, 2008
from
http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Palliative_and_Supportive
_Care_34.asp?sitearea=
Pancreatic Cancer: Conservative Approach Vs. Non-Conservative approach to Treatment 20
http://www.cancer.com/cancer/pancreatic_cancer.html
PEaRL. (2005). Pancreas Education and Research Letter. Volume 1, Number 3. Fall 2005.
PEaRL. (2006). Pancreas Education and Research Letter. Volume 2, Number 3. Winter 2006.
Skinner, H. G.; Michaud, D. S.; Giovannucci, E.; et al. (2006). Vitamin D intake and the risk
for pancreatic cancer in two cohort studies. Cancer Epidemiol Biomarkers Prev 2006.
What Causes Pancreatic Cancer? American Cancer Society. Retrieved November 18, 2008
from
http://www.cancer.org/docroot/CRI/content/CRI_2_2_2X_What_causes_pancreatic_c
ancer_Can_it_be_prevented_34.asp?sitearea=
What Is Cancer of the Pancreas? American Cancer Society. Retrieved November 18, 2008
from
http://www.cancer.org/docroot/CRI/content/CRI_2_2_1X_What_is_pancreatic_cance
r_34.asp?sitearea=
What is Cancer? American Cancer Society. Retrieved November 18, 2008 from
http://www.cancer.org/docroot/CRI/content/CRI_2_2_1x_What_Is_Cancer.asp?
sitearea=