Cancer of the Pancreas
What is the pancreas?
It is a pulpy, flat gland about 5 inches long by a few inches high, which lies far back on the rear wall of the upper abdominal cavity. The part it plays in the body is a vital and specialized one. It manufactures digestive juices which are passed through the pancreatic duct into the intestine for digestion of proteins, fats, and carbohydrates. Insulin, which is essential for the utilization of sugar, is manufactured in the pancreas and deposited directly into the bloodstream. A duct, called the pancreatic duct, runs through the entire length of the pancreas. The pancreas is often referred to as having a head, a body, and a tail. The head fits into the curve of the duodenum on the right, close to the common bile duct, and the tail curves up toward the spleen. At the head of the pancreas there is often a branching of the main pancreatic duct. These ducts are responsible for collecting the digestive juices manufactured by the gland and depositing them through their openings into the small intestine.
What are the beginning signs of cancer of the pancreas?
A variety of symptoms that can also be the signals of diseases other than cancer of the pancreas, as well as the hidden location of the pancreas, combine to make cancer difficult to diagnose. For this reason, pancreatic cancer is often advanced before it is detected. Cancer in the head of the pancreas, because it involves the common bile duct, usually causes jaundice, and often there is intense itching of the skin. There may be some abdominal pain and discomfort, nausea, diarrhea, belching, a feeling of fullness, and intolerance of fatty foods. Weight loss, loss of appetite, and loss of strength or energy may be other symptoms. The color of the bowel movement may be affected, being foamy, clay colored, or, more rarely, silvery in color. All of these symptoms might also be present when there are cysts or benign tumors in the pancreas. Another set of symptoms can present themselves in cases where the tumor is located in the body portion of the pancreas. Severe back pain may be present as the result of the size of the tumor. The pain may worsen after eating or when lying down and be slightly relieved when bending forward or sitting. The disease is so difficult to diagnose that the majority of patients are treated for 3 to 6 months for other causes before actual diagnosis of the pancreatic cancer is made.
What tests will the doctor need?
The doctor will usually order barium x-rays, liver function studies, and angiography to determine more clearly where the tumor is located.
Can cysts in the pancreas turn into cancer?
Rarely will a cyst in the pancreas become cancerous. Usually, cysts can be removed successfully with a good chance of recovery. If allowed to remain they can continue to grow and cause serious problems in pancreatic activity. It is important to remember that all cysts, tumors, or inflammations of the pancreas do not indicate the presence of cancer.
Can the doctor tell whether or not the condition of the pancreas is cancerous before he operates?
Usually he cannot. Benign tumors and growths often grow in the pancreas, causing the cells that produce insulin to overproduce, causing symptoms that include intense hunger, trembling, fainting, confusion, or convulsions. The operation to remove a cyst is a low risk one. However, if the presence of cancerous cells is found, it may be necessary to operate so as to bypass the obstruction or to remove the entire gland. Then it becomes a complicated operation.
What kinds of cancer of the pancreas are there?
There are two kinds of cancer of the pancreas: islet cell carcinoma of the endocrine pancreas and adenocarcinoma of the exocrine pancreas. Cancer of the endocrine pancreas is a highly treatable and often curable collection of tumors. Cancer of the exocrine pancreas, on the other hand, is much more difficult to treat and is not often curable.
How does the doctor decide if there is cancer in the pancreas?
The only certain way at present is through a biopsy which in this case requires a laparotomy. However, many experimental programs are under way to help aid better diagnosis, such as endoscopy, ultrasound, CT scans, and CEA. Doctors agree that ultrasound looks promising in diagnosing small pancreatic cancers earlier.
What is a laparotomy?
A laparotomy is a surgical operation to open the abdominal cavity either to make an inspection or to perform surgery.
What does the incision look like, and where is it?
The incision for a laparotomy is about 4 or 5 inches long and is located in the upper abdomen.
The doctor says I'll need more than one operation. Why?
Sometimes operations for cancer of the pancreas are done in several steps.
How long does the operation take?
The operation to remove a localized tumor or cyst of the pancreas takes 1 to 3 hours. If the entire pancreas is to be removed, the operation can take anywhere from 3 to 6 hours.
What happens when the entire gland is removed?
The operation to remove the entire gland and the adjacent duodenum, called a pancreaticoduodenectomy, is one ofthe most extensive in all surgery. The bile duct and the stomach are both reconnected into the small intestine. This is a highrisk operation, not often performed. It can be successful in those cases in which the tumor has not spread to other organs.
Can a person live with only part of the pancreas or without the pancreas?
Yes, an active, comfortable existence is possible when medicines are prescribed to substitute for the function of the pancreas.
What happens if the cancer has spread beyond the pancreas?
If the cancer has spread and is in places where it cannot be removed, the prognosis is very serious.
Would the doctor advise against surgery?
Since this cancer is so difficult to diagnose, surgery is usually a necessity. If cancer is not the cause, the surgery will determine this happy diagnosis. If cancer is the cause, the doctor can at least relieve the jaundice and the exasperating itching through surgery, even when the cancer cannot be removed. Sometimes, when the patient is elderly or has other health problems which put him in a high risk category, surgery will not be attempted.
What sort of operation is performed?
If possible, the tumor of the pancreas, the surrounding bile duct, and part of the stomach and intestine are removed, and everything is rejoined. If that is not possible, a new opening is made for the bile, to relieve the jaundice and help in the digestive process.
What are the chances for cure of exocrine cancer of the pancreas?
Of course it depends upon many factors. However, it is important for the patient with exocrine pancreatic cancer to understand the seriousness of the condition and the risks. Because it is usually found late and has frequently spread to nearby organs, the five year survival rate at the present time is only 2 percent.
Will I need transfusions and other intravenous medication?
Yes. This is an extremely serious operation. Blood transfusions may be needed during and after the operation. Intravenous feedings, medications, and special drugs will be used to help speed recovery. You will usually not be allowed out of bed until several days after the operation.
What are the aftereffects when the pancreas is removed?
The recovery period will be a long one, and a permanent low sugar, low fat diet will be essential. Vitamin K will probably be prescribed. Because of the restricted diet, it is very difficult to gain weight, which makes recovery slower than usual.
When will I be able to get back to work?
Convalescence will take from 2 to 6 months. Physical exercise should be postponed for 4 to 6 months. About 2 months after the wound is completely healed, you will be able to resume some of your normal activities.
Will radiation therapy or chemotherapy be prescribed?
Sometimes radiation therapy is used after surgery. In other cases chemotherapy is used, either alone or in combination with the radiation therapy. The drug 5-Fluorouracil has been used with some success; other drugs are being evaluated.
Are most doctors qualified to diagnose and operate for pancreatic cancer?
This is a difficult diagnosis and a very specialized area. Major medical centers, especially those specializing in cancer treatment, have had more experience than smaller local hospitals. You should ask your doctor to check with the clinical cooperative groups in your area for information on new treatments or to see if you can be admitted into one of the controlled studies being conducted on pancreatic cancer.