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Pancreatic cancer

Seeking immediate medical attention is important if any of the symptoms of pancreatic cancer occur. If pain, unexplained weight loss, or jaundice  persists despite initial medical treatments, further evaluation should be pursued in a timely fashion.

Other Therapy

Radiation therapy

Radiation therapy is treatment that uses high-energy x-rays aimed at the cancer to kill cancer cells or to keep them from growing. For pancreatic cancer cases, radiation therapy is usually given in conjunction with chemotherapy.

The goals of radiation therapy are as follows:

  • Kill cancer cells that cannot be surgically removed to reduce the risk of the cancer returning or spreading.
  • Treat tumors that cannot be surgically removed and that are causing symptoms, such as pain or jaundice

Typically, radiation treatments are given 5 days a week, for up to 6 weeks. Each treatment lasts only a few minutes and is completely painless; it is similar to having an x-ray film taken. However, some patients may experience abdominal discomfort during the last few weeks of therapy or for several months following completion of treatment.

The main side effects of radiation therapy include mild skin irritation, loss or appetite, nausea, diarrhea, or fatigue. These side effects usually resolve soon after treatment is complete (within 1-2 months).

Other therapy

Pancreatic cancer may cause symptoms that cannot always be relieved by surgery, chemotherapy, or radiation therapy. These symptoms include the following:

  • Pain
  • Jaundice from obstruction of the bile duct

Therapies aimed at relieving the symptoms of pancreatic cancer, but not at treating the cancer itself, include the following:

  • Celiac plexus neurolysis (CPN): Sometimes referred to as a celiac block, celiac plexus neurolysis involves an injection of a chemical (usually alcohol) into the collection of nerves called the celiac plexus that receives pain signals from the pancreas. This chemical injection damages or numbs these nerves and reduces the sensation of pain caused by a pancreatic tumor.
  • The injection is performed either using an endoscope with ultrasound guidance or through the skin using a CT scanner for guidance.
  • Side effects include temporary diarrhea and lowering of blood pressure; abdominal pain  occurs during and immediately after the procedure.
  • Bleary stinting: This involves placing a hollow tube, called a stent, into the bile duct to keep it open despite the external pressure from a growing pancreatic tumor. This prevents jaundice by allowing the bile to flow freely and unimpeded from the liver, past the pancreas, and into the intestine. This procedure is usually performed with an endoscope by a gastroenterologist, but it can also be performed percutaneously (through the skin) under CT guidance by an interventional radiologist.

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Follow-up

 Because pancreatic cancer has a risk of returning after surgical or medical therapy, continuous vigilant follow-up with the doctor is important. On a routine schedule recommended by the doctor, the following are performed:

  • Physical exams
  • Blood studies, including CA 19-9
  • Periodic imaging studies, usually CT scans at 6-month intervals or earlier if needed to assess new symptoms
Prevention

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.

Outlook

Despite recent advances in the surgical and medical treatment of pancreatic cancer, the prognosis associated with this disease is still relatively poor.

For people who have pancreatic cancers completely removed by surgery, the probability of being alive in 5 years is 20-30%. If lymph nodes were found to contain cancer at the time of surgery, then the probability of being alive in 5 years decreases to 10%.

The addition of chemotherapy after surgical removal of the pancreatic cancer is likely to increase this probability of being alive in 5 years, but only by about 10%.

For people who have unrespectable locally advanced pancreatic cancer, surviving beyond 3 years is rare. For those with metastatic pancreatic cancer who have symptoms of weight loss or pain, the chance of surviving 1 year is less than 20% for those undergoing chemotherapy and less than 5% for those who choose not to receive chemotherapy.

These statistics underscore the importance of clinical trials attempting to discover more effective therapies for this disease. People with pancreatic cancers are encouraged to ask their doctor about the possibility of participating in a clinical trial that is well-suited for them.

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