Treatment of pancreatic cancer
Treatment of pancreatic cancer
The pancreas is an organ of the abdominal cavity placed between the stomach and the spine, and performs many functions. Its exocrine part is responsible for the formation of pancreatic enzymes that are essential for the digestion of certain food components. Its endocrine part produces hormones insulin and glucagon, which regulate the metabolism of sugars in the body. Like other organs the pancreas may also be affected by cancer. Benign pancreatic tumors are rare, but on the contrary malignant pancreatic tumors are very dangerous and can lead to serious complications and often also to the patient's death. Their detection and early treatment is therefore extremely important and in many cases it can significantly prolong and improve the patient's quality of life.
A tumor is a group of interrelated processes that lead to a change of normal cell behavior. For tumor cells it is typical that they proliferate uncontrollably, completely independent of the host organism. Generally tumors may be benign and malignant. For benign tumors characteristic is slow growth, they do not invade into the surrounding tissues and do not metastasize, form distant cancerous sites. On the other hand malignant tumors in most cases grow rapidly and destroy adjacent tissues, and form metastasis in the body.
Types of pancreatic tumors
Pancreatic tumors can be malignant or benign. Very rarely we encounter benign pancreatic tumors such as cystadenomas, lipomas, apudomas, or teratomas. It is reported that up to 90% of all pancreatic tumors are malignant, called carcinomas. The most common is ductal adenocarcinoma, which is characteristic for the pancreatic duct. Normally digestive enzymes are secreted through them from the pancreas into the intestine, where they are significantly involved in the digestion of food. Even with early treatment, and intensive aftercare this tumor has a very poor prognosis and 90% of patients die within five years.
Clinical symptoms of pancreatic cancer
Malignant and benign pancreatic tumors are manifested similarly. The maliciousness of especially the malignant pancreatic tumor consists in the fact that in the beginning it causes no significant problems. It is also the cause of its late diagnosis. Initially the symptoms are subtle and do not cause the patient any trouble. Gradually may appear fatigue, anorexia, vague abdominal pressure, nausea or vomiting soon after eating. Potential oppression of the biliary tract frequently results in jaundice. More severe damage of the pancreatic tissue can result in diabetes or outbreaks of acute pancreatitis, i.e. acute pancreatic necrosis. The warning symptom is acute pancreatitis without excessive intake of alcohol and other risk factors. Pancreatic cancer is also suspected with the onset of new diabetes after 60 years. Indeed, if its source was a different disease it would be manifested in a much younger age.
Diagnosis of pancreatic cancer
Diagnosis of pancreatic cancer results from a careful medical history, laboratory and imaging methods. Mainly ultrasonography and CT of the abdomen is used, sometimes also an approach called ERCP, endoscopic retrograde cholangiopancreatography. In this examination a probe is introduced through the mouth to the duodenum, where is the common bile and pancreatic tract orifice. The probe is then directed into the duct where a contrast agent is applied to monitor and obtain a comprehensive image of the state and patency of the ducts. It is also necessary to remove a tissue for histological examination, a biopsy.
Treatment of pancreatic cancer
Using a variety of investigative techniques it is now possible to accurately determine not only the type of tumor, but also its exact location and other parameters. According to this, the doctors can predict the likely progress of the patient's condition, but can also initiate the most effective treatment. This requires the cooperation of experts from many medical specialties, especially surgery, oncology, radiology, endoscopy, gastroenterology, and some others. The care is then truly complex and the patient's health is under close supervision. Depending on the stage and type the treatment can be surgical, chemotherapy and radiotherapy. In the case of a small benign tumor the patient is only under observation. In other cases it is surgically removed. For malignant tumors we combine the above mentioned treatment options.
Surgical treatment of pancreatic cancer
Surgical treatment of the pancreatic tumor consists of a partial or total removal of the organ, called resection. The extent of the removal is determined by the location and size of the tumor. We distinguish several types of surgical procedures, such as the Whipple procedure, distal, or total pancreatectomy.
The Whipple procedure is chosen in cases when the carcinoma is located in the so-called head of the pancreas, which is removed together with the adjacent parts of the stomach, small intestine and bile ducts. If necessary, other adjacent tissue is removed.
Distal pancreatectomy is a partial removal of the pancreas, where the end portion of the organ is removed, the so-called body and the tail. This means that this procedure is chosen if the location of the tumor is in these areas. Besides the pancreas also the spleen is removed.
Total pancreatectomy is a complete removal of the pancreas, including the adjacent parts of the stomach, small intestine, gall bladder with its ducts, spleen and draining lymph nodes.
If the tumor can not be removed and it prevents bile flow, bridging is performed, a so-called bypass.
Chemotherapy of pancreatic cancer
Chemotherapy is a systematic treatment of pancreatic cancer, and involves the application of special drugs that destroy cancer cells. Unfortunately, it is an aggressive treatment that attacks also healthy cells of the human body, which is associated with side effects. If chemotherapy is applied before surgery, it is expected that the tumor shrinks and is easier to remove, this is called neoadjuvant chemotherapy. If chemotherapy is applied after surgery, this is called adjuvant chemotherapy and its aim is to prevent metastasis.
Radiotherapy of pancreatic cancer
Radiotherapy is a local treatment of pancreatic cancer and involves irradiation of the tumor. It is used in combination with previous methods. Radiotherapy is often used after surgery to destroy cancer cells that may remain in the area of the previous tumor. Irradiation is used in the case of incurable pancreatic cancer to relieve pain. The patients get this therapy for several weeks.