Pancreatic Cancer

Causes

While little is known about the cause, the following factors may increase the risk of getting pancreatic cancer. They include exposure to cancer-causing agents; cigarette smoking; a high fat, low fiber diet; a diet high in foods containing food additives; and diabetes. Although the link has not been proven, people who work with petroleum and certain chemicals used in the dry cleaning industry should follow the safety guidelines for handling these chemicals. 

Signs and symptoms

The following are the other most common symptoms of pancreatic cancer. However, each individual may experience symptoms differently. Symptoms may include:

• pain in the upper abdomen
• poor appetite
• weight loss
• jaundice
• indigestion
• nausea
• vomiting
• diarrhea
• fatigue

The symptoms of pancreatic cancer may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

Diagnosis

Definitive diagnosis requires a laparotomy with a biopsy. Other tests used to detect pancreatic cancer include:

• ultrasound-can identify a mass but not its histology
• computed tomography scan-similar to ultrasound but shows greater detail
• angiography- shows vascular supply of tumor
• endoscopic retrograde cholangiopan­creatography - allows visualization, instillation of contrast medium, and specimen biopsy
• magnetic resonance imaging-shows tumor size and location in great detail.

Laboratory tests supporting this diagnosis include serum bilirubin (increased), serum amylase and serum lipase (sometimes elevated), prothrombin time (prolonged), and aspartate aminotransferase and alanine aminotransferase (elevations indicate necrosis of liver cells).

Additional pertinent studies are alkaline phosphatase (marked elevation occurs with biliary obstruction); plasma insulin immunoassay (shows measurable serum insulin in the presence of islet cell tumors); hemoglobin and hematocrit (may show mild anemia); fasting blood glucose (may indicate hypoglycemia or hyperglycemia); and stools (occult blood may signal ulceration in GI tract or ampulla of Vater).

Treatment

In pancreatic cancer, treatment is rarely successful because this disease has usually metastasized widely at diagnosis.

Therapy consists of surgery and, possibly, radiation and chemotherapy. Small advances have been made in the survival rate with surgery:

• Total pancreatectomy may increase survival time by resecting a localized tumor or by controlling postoperative gastric ulceration.
• Cholecystojejunostomy, choledocho-duodenostomy, and choledochojejunostomy have partially replaced radical resection to bypass obstructing common bile duct. extensions, thus decreasing the incidence of jaundice and pruritus.
• Whipple's operation, or pancreato­duodenectomy, has a high mortality but can produce wide lymphatic clearance except with tumors located near the portal vein, superior mesenteric vein and artery, and celiac axis. This rarely used procedure removes the head of the pancreas, the duodenum, and portions of the body and tail of the pancreas, stomach, jejunum, pancreatic duct, and distal portion of the bile duct.
• Gastrojejunostomy is performed if radical resection isn't indicated and duodenal obstruction is expected to develop later.

Although pancreatic carcinoma generally responds poorly to chemotherapy, recent studies using combinations of fluorouracil, streptozocin, ifosfamide, and doxorubicin show a trend toward longer survival time. Other medications used in pancreatic cancer include:

• antibiotics (oral, I.V., or I.M.)-to prevent infection and relieve symptoms .
• anticholinergics (particularly propantheline) - to decrease GI tract spasm and motility and reduce pain and secretions
• diuretics-to mobilize extracellular fluid from ascites
• insulin - to provide adequate exogenous insulin supply after pancreatic resection
• adiation therapy - high-dose x-rays used to kill cancer cells.
• chemotherapy - drugs used to kill cancer cells.
• pain medication
• oral enzyme preparations

Prevention

Although it's not always possible to prevent pancreatic cancer, these lifestyle changes may help reduce your risk:

• Exercise regularly.
• A diet high in fruits and vegetables and low in animal fat can reduce your risk of pancreatic cancer.
• Quit smoking.