What is pancreatic cancer?
Pancreatic cancer or pancreatic carcinoma is a rare form of cancer. In 2014 were diagnosed in the Netherlands in 2292 patients with this disease of the pancreas. Most people are between 65-85 years old when diagnosed.
Types of pancreatic cancer
There are different types of pancreatic cancer. In 85% of the cases it is ductal adenocarcinoma, this is a cancer that develops from the cells of the pancreas corridor. Besides adenocarcinomas, there may also develop neuroendocrine cancers. These are based on, among other tissues which produce insulin, and gastrin, and are referred to in accordance with and insulinomas gastrinomas. These cancers are much rarer than adenocarcinomas.
Clinical presentation
Usually the tumor has been some time in the pancreas present before symptoms occur. The symptoms depend on the localization and size of the tumor.
The most common symptoms are:
- General body weakness (asthenia)
- Weight loss (unintentionally)
- Loss of appetite (anorexia)
- Bellyache
In 2/3 of the cases, the tumor is located in the head of the pancreas; this is the part of the pancreas that is closest to the intestine. In the head, the smaller pancreas corridors together in a large pancreas corridor. Also here is situated the duct of the gallbladder. When the tumor is located in the head of the pancreas, it is more likely that the large hallway pancreas and bile duct be compressed and can not be disposed of bile and pancreatic juice. If this happens may jaundice (jaundice) can occur. The stool is usually the light colored ('putty color) and the urine is very dark (cola color). In a later stage of the disease may cause itching, vomiting, severe fatigue and vetdiarree arise. This as a result of accumulation of bilirubin in the blood which can not be removed through the bile ducts.
Pancreatic cancer treatment options
Pancreatic cancer is often fits discovered at a late stage and treatment of this cancer is often difficult. The only chance of long term survival is a surgery in which the tumor is removed in its entirety. This is called a "curative treatment". If this is not possible or is not desired, it opted for a palliative treatment.
Curative treatment
Only 15-25% of patients with pancreatic cancer are eligible for surgery. Is then, if possible, a pancreatoduodenectomy performed. This operation was first performed by dr. Whipple and is therefore often referred to as "a Whipple operation." Here, the head of the pancreas is removed together with a part of the duodenum, bile duct, gall bladder and surrounding lymph nodes. After this, the stomach, bile duct, and the remaining part of the pancreas are again connected to the intestine. In some cases, there is recommended chemotherapy after the operation for a better prognosis.
Sometimes, however, it appears during the operation that surgical removal is no longer possible; there is then chosen for the palliative treatment options.
Palliative treatment options
As mentioned earlier can give thrust of biliary annoying symptoms. In order to prevent this cholestasis and remedy can be placed there is a stent. This is a small tube with which the bile ducts are kept open. The placing of this tube is usually done by means of an Endoscopic retrograde cholangiopancreatography. When it is detected that during the operation to remove the tumor is no longer possible, there can also be applied surgically a detour in order to reduce the cholestasis. Also the tumor for a blockage in the gut can provide, so the stomach can not empty and someone goes broke. To remedy this, or prevented can also be a stent to be placed in the duodenum. If this conclusion is discovered during surgery or expected in the short term, there may be a bypass during surgery. In patients which is already clear that the tumor can not be removed or if there are metastases of the tumor, chemotherapy can be considered with gemcitabine.
Other palliative care:
- Adequate analgesia
- Nutrition in the palliative phase, a dietitian can help.
- Psychosocial care for help with dealing with the disease and the home.
Pancreatic cancer prognosis
The survival of patients with pancreatic carcinoma is very slight: after 5 years is less than 5% of them still alive. Most death within months. The other tumors in and around the pancreatic Neuroendocrine cancers as duodenum and have a much better prognosis. Research shows that the more often the Whipple operation is carried out in a particular hospital, the lower the postoperative mortality rate in the hospital is. This difference can amount to 5% lower risk of mortality. Also, the survival times if the operation is carried out in a hospital where many Whipple operations are carried out.