Pancreas / Pancreatic Cancer

Pancreas / Pancreatic
Cancer

اخواني الاعزاء آثرنا على طرح هذا الموضوع لما
فيه من اهمية وانتشاره

Description of Pancreatic Cancer

Cancer of the pancreas is a disease in which cancer
(malignant) cells are found in the tissues of the pancreas. The pancreas is
about 6 inches long and is shaped something like a thin pear, wider at one end
and narrowing at the other. The pancreas lies behind the stomach, inside a loop
formed by part of the small intestine. The broader right end of the pancreas is
called the head, the middle section is called the body, and the narrow left end
is the tail.

The pancreas has two basic jobs in your body. It produces
juices that help you break down (digest) your food, and hormones (such as
insulin) that regulate how your body stores and uses food. The area of the
pancreas that produces digestive juices is called the exocrine pancreas. About
95% of pancreatic cancers begin in the exocrine pancreas. The hormone-producing
area of the pancreas is called the endocrine pancreas. Only about 5% of
pancreatic cancers start here. This statement has information on cancer of the
exocrine pancreas. For more information on cancer of the endocrine pancreas
(also called islet cell cancer) see the PDQ Patient Information Statement on
Islet Cell Carcinoma.

Cancer of the pancreas is hard to find (diagnose)
because the organ is hidden behind other organs. Organs around the pancreas
include the stomach, small intestine, bile ducts (tubes through which bile, a
digestive juice made by the liver, flows from the liver to the small intestine),
gallbladder (the small sac below the liver that stores bile), the liver, and the
spleen (the organ that stores red blood cells and filters blood to remove excess
blood cells). The signs of pancreatic cancer are like many other illnesses, and
there may be no signs in the first stages. You should see your doctor if you
have any of the following: nausea, loss of appetite, weight loss without trying
to lose weight, pain in the upper or middle of your abdomen, or yellowing of
your skin (jaundice).

If you have symptoms, your doctor will examine you
and order tests to see if you have cancer and what your treatment should be. You
may have an ultrasound, a test that uses sound waves to find tumors. A CT scan,
a special type of x-ray that uses a computer to make a picture of the inside of
your abdomen, may also be done. Another special scan called magnetic resonance
imaging (MRI), which uses magnetic waves to make a picture of the inside of your
abdomen, may be done as well.

A test called an ERCP (endoscopic
retrograde cholangiopancreatography) may also be done. During this test, a
flexible tube is put down the throat, through the stomach, and into the small
intestine. Your doctor can see through the tube and inject dye into the drainage
tube (duct) of the pancreas so that the area can be seen more clearly on an
x-ray. During ERCP, your doctor may also put a fine needle into the pancreas to
take out some cells. This is called a biopsy. The cells can then be looked at
under a microscope to see if they contain cancer.

PTC (percutaneous
transhepatic cholangiography) is another test that can help find cancer of the
pancreas. During this test, a thin needle is put into the liver through your
right side. Dye is injected into the bile ducts in the liver so that blockages
can be seen on x-rays.

In some cases, a needle can be inserted into the
pancreas during an x-ray or ultrasound so that cells can be taken out to see if
they contain cancer. You may need surgery to see if you have cancer of the
pancreas. If this is the case, your doctor will cut into the abdomen and look at
the pancreas and the tissues around it for cancer. If you have cancer and it
looks like it has not spread to other tissues, your doctor may remove the cancer
or relieve blockages caused by the tumor.

Stages Of Cancer Of The
Pancreas

Once cancer of the pancreas is found, more tests will be done
to find out if the cancer has spread from the pancreas to the tissues around it
or to other parts of the body. This is called staging. The following stages are
used for cancer of the pancreas:

Stage I Cancer is found only in the
pancreas itself, or has started to spread just to the tissues next to the
pancreas, such as the small intestine, the stomach, or the bile duct.

Stage II Cancer has spread to nearby organs such as the stomach, spleen,
or colon, but has not entered the lymph nodes. (Lymph nodes are small,
bean-shaped structures that are found throughout the body; they produce and
store infection-fighting cells).

Stage III Cancer has spread to lymph
nodes near the pancreas. The cancer may or may not have spread to nearby organs.

Stage IV Cancer has spread to places far away from the pancreas, such as
the liver or lungs.

Recurrent Recurrent disease means that the cancer
has come back (recurred) after it has been treated. It may come back in the
pancreas or in another part of the body.

How Cancer Of The Pancreas Is
Treated

There are treatments for all patients with cancer of the
pancreas. Three kinds of treatment are used: surgery (taking out the cancer or
relieving symptoms caused by the cancer) radiation therapy (using high-dose
x-rays or other high-energy rays to kill cancer cells) chemotherapy (using drugs
to kill cancer cells).

The use of biological therapy (using the body's
immune system to fight cancer) is being tested for pancreatic cancer.

Surgery may be used to take out the tumor. Your doctor may take out the
cancer using one of the following operations:

A Whipple procedure
removes the head of the pancreas, part of the small intestine, and some of the
tissues around it. Enough of the pancreas is left to continue making digestive
juices and insulin.

Total pancreatectomy takes out the whole pancreas,
part of the small intestine, part of the stomach, the bile duct, the
gallbladder, spleen, and most of the lymph nodes in the area.

Distal
pancreatectomy takes out only the tail of the pancreas.

If your cancer
has spread and it cannot be removed, your doctor may do surgery to relieve
symptoms. If the cancer is blocking the small intestine and bile builds up in
the gallbladder, your doctor may do surgery to go around (bypass) all or part of
the small intestine. During this operation, your doctor will cut the gallbladder
or bile duct and sew it to the small intestine. This is called biliary bypass.
Surgery or x-ray procedures may also be done to put in a tube (catheter) to
drain bile that has built up in the area. During these procedures, your doctor
may make the catheter drain through a tube to the outside of the body or the
catheter may go around the blocked area and drain the bile to the small
intestine. In addition, if the cancer is blocking the flow of food from the
stomach, the stomach may be sewn directly to the small intestine so you can
continue to eat normally.

Radiation therapy uses high-energy x-rays to
kill cancer cells and shrink tumors. Radiation may come from a machine outside
the body (external radiation therapy) or from putting materials that produce
radiation (radioisotopes) through thin plastic tubes in the area where the
cancer cells are found (internal radiation therapy).

Chemotherapy uses
drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put
into the body by a needle in the vein or muscle. Chemotherapy is called a
systemic treatment because the drug enters the bloodstream, travels through the
body, and can kill cancer cells outside the pancreas.

Biological therapy
tries to get your own body to fight cancer. It uses materials made by your own
body or made in a laboratory to boost, direct, or restore your body's natural
defenses against disease. Biological therapy is sometimes called biological
response modifier (BRM) therapy or immunotherapy. Biological therapy is being
tested in clinical trials.

Treatment By Stage

Treatment for
cancer of the pancreas depends on the stage of your disease, your age, and your
overall condition.

You may receive treatment that is considered standard
based on its effectiveness in a number of patients in past studies, or you may
choose to go into a clinical trial. Most patients with cancer of the pancreas
are not cured with standard therapy and some standard treatments may have more
side effects than are desired. For these reasons, clinical trials are designed
to find better ways to treat cancer patients and are based on the most
up-to-date information. Clinical trials are going on in most parts of the
country for all stages of cancer of the pancreas.

STAGE I PANCREATIC
CANCER

Your treatment may be one of the following: 1. Surgery to remove
the head of the pancreas, part of the small intestine, and some of the
surrounding tissues (Whipple procedure). 2. Surgery to remove the entire
pancreas and the organs around it (total pancreatectomy). 3. Surgery to remove
the tail of the pancreas (distal pancreatectomy) for tumors in the tail of the
pancreas. 4. Surgery followed by chemotherapy and radiation therapy. 5. Clinical
trials of radiation therapy with or without chemotherapy given before, during,
or after surgery.

STAGE II PANCREATIC CANCER

Your treatment may
be one of the following: 1. Surgery or other treatments to reduce symptoms. 2.
External radiation therapy with or without chemotherapy. 3. Surgery to remove
all or part of the pancreas with or without chemotherapy and radiation therapy.
4. Clinical trials of radiation therapy and chemotherapy given before surgery.
5. Clinical trials of radiation therapy plus drugs to make cancer cells more
sensitive to radiation (radiosensitizers). 6. Clinical trials of chemotherapy.
7. Clinical trials of radiation therapy given during surgery with or without
internal radiation therapy.

STAGE III PANCREATIC CANCER

Your
treatment may be one of the following: 1. Surgery or other treatments to reduce
symptoms. 2. External radiation therapy with or without chemotherapy. 3. Surgery
to remove all or part of the pancreas with or without chemotherapy and radiation
therapy. 4. Clinical trials of radiation therapy given before surgery. 5.
Clinical trials of surgery plus radiation therapy plus drugs to make cancer
cells more sensitive to radiation (radiosensitizers). 6. Clinical trials of
chemotherapy. 7. Clinical trials of radiation therapy given during surgery, with
or without internal radiation therapy.

STAGE IV PANCREATIC CANCER

Your treatment may be one of the following: 1. Surgery or other
treatments to reduce symptoms. 2. Treatments for pain. 3. Clinical trials of
chemotherapy or biological therapy.

RECURRENT PANCREATIC CANCER

Your treatment may be one of the following: 1. Chemotherapy. 2. Surgery
or other treatments to reduce symptoms. 3. External radiation therapy to reduce
symptoms. 4. Treatments for pain. 5. Other medical care to reduce symptoms. 6.
Clinical trials of chemotherapy or biological therapy