By: Cruz Jerome JC R.

Anatomy of Pancreas:

What is pancreatic cancer?

Two Categories of Pancreatic Cancer:
A.

cancers of the endocrine pancreas (the part that makes insulin) are called "islet cell" or "pancreatic neuroendocrine" cancers cancers of the exocrine pancreas (the part that makes enzymes).

B.

Islet cell cancers are rare and typically grow slowly compared to exocrine pancreatic cancers. Islet cell tumors often release hormones into the bloodstream and are further characterized by the hormones they produce (insulin,glucagon, gastrin, and other hormones).

Cancers of the exocrine pancreas develop from the cells that line the system of ducts that deliver enzymes to the small intestine and are called commonly referred to as pancreatic adenocarcinomas.

Adenocarcinoma of the pancreas comprises 95% of all pancreatic ductal cancers and is the subject of this review.

Clinical Manifestation:
Pain in the abdomen, the back, or both Weight loss, often associated with the following: Loss of appetite (anorexia) Bloating Diarrhea or fatty bowel movements that float in water (steatorrhea) Rarely may present with new diabetesin a person with weight loss and nausea Jaundice (yellowing of the skin)

Pathophysiology:
Typically, pancreatic cancer first metastasizes to regional lymph nodes, then to the liver and, less commonly, to the lungs. It can also directly invade surrounding visceral organs such as the duodenum, stomach, and colon, or it can metastasize to any surface in the abdominal cavity via peritoneal spread. Ascites may result, and this has an ominous prognosis. Pancreatic cancer may spread to the skin as painful nodular metastases. Metastasis to bone is uncommon. Pancreatic cancer rarely spreads to the brain, but it can produce meningeal carcinomatosis.

How to detect Pancreatic Cancer?

o

Abdominal ultrasound: This may be the initial test if a person has abdominal pain and jaundice. Abdominal computed tomography (CT): This is the test of choice to help diagnose pancreatic cancer. A CT scan can locate small tumors in the pancreas that might be missed by ultrasound. In addition, a CT scan can accurately show whether the mass has extended beyond the pancreas and what the relation is to nearby blood vessels and organs - information vital to a surgeon planning an operation to remove the cancer. If a pancreatic tumor is suspected, then a specialized CT scan, called a pancreatic protocol scan, is preferred prior to surgery.

How to prevent Pancreatic Cancer?

No known preventative measure exists for pancreatic cancer; however, minimizing certain risk factors is important. Risk factors that can be controlled include limiting smoking and excessive alcohol intake.

What is the management for Pancreatic Cancer?

The treatment of pancreatic cancer depends on whether complete surgical removal of the cancer is possible. Complete surgical removal of the cancer is the only known cure for pancreatic cancer. Only 1520% of people with pancreatic cancer have disease that can be surgically removed at the time of diagnosis.

Cancer that is localized may be completely removed and thereby considered resectable. If all the cancer could not be removed with surgery or if a surgery would not be safe to perform, then the cancer is considered unresectable.

Whipple procedure: This is done when the pancreatic cancer is in the head or uncinate process. This procedure removes the head and uncinate process of the pancreas, the duodenum, and thegallbladder. A portion of the stomach is often removed as well.
Distal subtotal pancreatectomy: This is performed when the pancreatic cancer is in the body or tail of the pancreas. This procedure removes the body and tail of the pancreas as well as the spleen.

Medication:

Gemcitabine (Gemzar):This drug has direct effects on the cancer cells and is usually given alone for the treatment of metastatic pancreatic cancer. Side effects includefatigue, nausea, increased risk of infection because of its effects on the immune system, and anemia. Fluorouracil (5-FU):This drug has direct effects on the cancer cells and is usually used in combination with radiation therapy because it makes cancer cells more sensitive to the effects of radiation. The side effects include fatigue, diarrhea, mouth sores, and hand-andfoot syndrome (redness, peeling, and pain on the palms of the hands and the soles of the feet).

Pancrelipase (pancreatic enzyme replacement) may be given if the function of the pancreas is impaired, usually after the surgical removal of a portion of the pancreas.

Rehabilitation for cancer patients:

After surgery and some cancer treatments, you may need rehabilitation or occupational therapy to help you regain or reinforce daily living skills. Our therapists will work with you to evaluate your skills, and then talk to you and your family about your goals. They will prepare a program to help you become physically able to meet goals which can range from walking to the mailbox to being able to cook for your family.

Long-term rehabilitation is not a consideration for most individuals with pancreatic cancer as the condition is usually fatal. For those individuals who have had Whipple's procedure, intermittent positive pressure breathing exercises may be useful in preventing postoperative pulmonary complications. Certain exercises may also be performed to reduce postoperative pain and speed recovery including progressive relaxation and deep breathing techniques. This is especially valuable during the first 48 hours after surgery and may continue until recovery from surgery is complete and pain is no longer noticeable while walking or breathing.