:KENDRICK JACINTO

Pancreas is an organ
located behind the
stomach in the back of
the abdomen.
It is both an endocrine
gland producing
several
important hormones
and a digestive organ,
secreting pancreatic
juice containing
digestive enzymes that
assist the absorption of
nutrients and the
digestion in the small
intestine.
ANATOMY
is on the right side of
the abdomen where
the stomach is
attached to the first
part of the small
intestine (the
duodenum)
its narrowest part -
extends to the left
side of the abdomen
next to the spleen.
Is a malignant neoplasm originating from transformed cells arising in tissue
forming in the pancreas.
Is the fourth most common cause of cancer-related deaths in the United
States and the eighth worldwide.
May develop in the head , body or tail of the pancreas

Has poor prognosis. It has been called a 'silent' disease because early
pancreatic cancer usually does not cause symptoms.

RISK
FACTORS/CAUSES
smoking
Diet high in fat, red meat
Obesity and lack of
physical activity

HEREDITARY

AGE (most cases after age of 60)

Diabetes mellitus

Chronic pancreatitis


Diet HIGH in sugar
sweetened drinks (Soft
drinks)
Pathophysiology
Hereditary pancreatitis , age- after 60 , smoking , diets high in
fat , red meat , low in vegetables and fruits , soft drinks ,
obesity, diabetes mellitus , chronic pancreatitis
Obstruction of common bile duct
Classic signs
of pancreatic
carcinoma
Mid
abdominal
pain
Ascites
Onset of insulin
deficiency
Pain, jaundice
and weight
loss
Radiating
in midback
Glucosuria ,
hyperglycemia ,
abnormal glucose
tolerance
Damage in normal cells of pancreas
Damage on its DNA
Transform to cancer cells
Metastasize on other organs
Clinical features
Pain on the upper
abdomen from the tumor
pushing against nerves
Jaundice
Nausea and Vomiting
Loss of appetite
Significant weight loss
(cachexia)
Weakness
Acholic stool (pale
or grey stool) and
steatorrhea
(excess fat in
stool)
Ascites
Pulmonary embolisms due to
pancreatic cancers producing blood
clotting chemicals.

Diabetes mellitus, or elevated
blood sugar levels. Many patients
with pancreatic cancer develop
diabetes months to even years
before they are diagnosed with
pancreatic cancer, suggesting new
onset diabetes in an elderly individual
may be an early warning sign of
pancreatic cancer.
Common complications
Bowel
obstruction
Malnutrition
Diagnostic tests
Physical examination

Personal and Family medical
history
Blood test
can detect a chemical
called
carcinoembryonic
antigen (CEA) as well
as CA 19-9 - a
chemical released into
the blood by
pancreatic cancer
cells.
Liver function
test
check for bile
duct blockage.
Endoscopic
retrograde
cholangiopan
creatography
(ERCP)
is a technique that
combines the use
of endoscopy and flu
oroscopy to diagnose
and treat certain
problems of
the biliary or pancrea
tic duct systems.
endoscopic
ultrasound (EUS)
To visualize the tumor

endoscopic needle
biopsy or surgical
excision of the radiologically
suspicious tissue
Definitive
diagnosis
is a diagnostic procedure used to investigate superficial (just under
the skin) lumps or masses. In this technique, a thin, hollow needle
is inserted into the mass for sampling of cells that, after being
stained, will be examined under a microscope.
Stages of Pancreatic cancer
TNM (Tumor - Node - Metastasis) system
The standard pancreatic cancer staging method.
T
indicates the size and direct extent of the
primary tumor
N
M
indicates the degree to which the cancer has
spread to nearby lymph nodes
whether the cancer has metastasized to other
organs in the body
Stage
0
written as (Tis, N0, M0) where Tis stands for
carcinoma in situ. This is when the tumor is
confined to the top layers of pancreatic duct cells
and has not invaded deeper tissues nor spread
outside of the pancreas
Stage
IV
is written as (Any T, Any N, M1) and
describes cancer that has spread to distant sites
throughout the body.
Medical Management
Radiation and chemotherapy
(5-fluorouracil[5-FU, Adrucil], leucovorin
[Wellcovorin], and gemcitabine [Gemzi])

If the patient undergoes surgery,
Intraoperative radiation therapy(IORT) may
be used to deliver a high dose of radiation to
the tumor with minimal injury to other tissues
, relief of pain

Interstitial implantation of radioactive sources
also been used

A large biliary stent inserted percutaneously or
by endoscopy may be used to relieve jaundice

Surgery
Whipple procedure (most common in cancers of the
head of the pancreas): the pancreas head, and sometimes the entire
organ, is removed along with a portion of the stomach, duodenum, lymph
nodes, and other tissue. The procedure is complex and risky with
complications such as leaking, infections, bleeding, and stomach problems.
Distal pancreatectomy: the pancreas tail is
removed, and sometimes part of the body, along with the spleen. This
procedure is usually used to treat islet cell or neuroendocrine tumors.
Total pancreatectomy: The entire pancreas and spleen
are removed. Although you can live without a pancreas, diabetes often
results because your body no longer produces insulin cells.
Palliative surgery is also an option
when the cancer in the pancreas cannot
be removed. Often, a surgeon will create a bypass around the
common bile duct or the duodenum if either is blocked so that bile can
still flow from the liver and pain or digestive problems can be kept at a
minimum. Bile duct blockage can also be relieved by inserting a small
stent in the duct to keep it open, a less invasive procedure using an
endoscope.

Nursing management
Pain management and nutritional requirements
to improve level of patient comfort

Skin care - Special mattresses are beneficial and
protect bony prominences from pressure
Nursing Diagnoses
Acute pain
Imbalanced nutrition less than body
requirements
Risk for infection
Prevention
Quit smoking

Maintain healthy weight

Exercise daily

Increase consumption of fruits and vegetable

Vitamin D has been associated with reducing the risk of several types
of cancer, including pancreatic cancer.

B vitamins such as B12, B6, and folate that are consumed in food (not
in pill or tablet form) have also been suggested to reduce pancreatic
cancer risk.
Dangers of Pancreatic cancer
Only curable when
found in its earliest
stages, and before
the cancer cell has
begun to spread to
other organs.
If cancer has
spread, palliative
treatment can
improve the
patients quality of
life by controlling
the symptoms and
complications.
Even though
there are
treatments such
as chemotherapy,
surgery, the
survival rate is
still very slim.
Questions

1. Mr. Cuevas, age 71 diagnosed with
pancreatic tumor, he experiencing
these classic signs
a. pain b. jaundice c. fever d. weight
loss
2. This is the fourth leading causes of
cancer death
a. lung cancer c. brain cancer
b. pancreatic cancer d. liver cancer


3. Nurse Becky assessing Mr. Cuevas she might
observe which of the following manifestation:
a. Mid abdominal pain c. ascites
b. Jaundice d. all of the above
4. The risk of pancreatic tumor increases as the
extent of:
a. Cigarette smoking c. age
b. Diabetes mellitus d. diets low fat
5. Nurse Mark suspected Mr.Cuevas insulin
deficiency as evidences:
a. glucosuria c. hyperglycemia
b. an abdominal glucose tolerance d. all of
the above



6. Diagnostic test used to confirm the diagnosis
tumor are not resectable
a. ECRP c. MRI
b. percutaneous needle biopsy d.all of the
above
7. Also known removal of the pancreas
a. pancreaticoduodenectomy c. pseudotectomy
b. pancreatectomy d. none of the
above




8. Mr. Cuevas will undergo surgery, what
therapy may be used to deliver:
a. intraoperative radiation therapy
b. chemotherapy
c. radiation therapy
d. physical therapy
9. What nursing measures should nurse lovely
implement to improve the level of patient
comfort
a. skin care
b. pain management
c. nutritional needs
d. allof the above

10. Which nursing diagnosis takes highest
priority for this patient
a. acute pain
b. activity intolerance
c. fatigue
d. risk for injury