877-659-0011

SURGICAL SPECIALISTS, P.C.

PANCREATIC CANCER

The pancreas is an organ, about six inches long, that is located in
the abdomen and it lies horizontally behind the lower part of the
stomach.
It sits in front of the spine above the level of the belly button.

The widest part of the pancreas is called the head. It is on the right
side of the abdomen where the stomach is attached to the first part of the
small intestine. The middle section is called the body and the thinnest section
is called the tail. The tail extends to the left side of the abdomen adjacent
to the spleen.

Head of the pancreas

The pancreas has two main functions. The exocrine glands secrete
enzymes that help aid digestion by breaking down proteins into small
parts so they can be easily absorbed by the body and used for energy.
The endocrine glands produce hormones including insulin. These
hormones travel in the bloodstream throughout the body. They help the
body to store or use the energy that comes from food. Insulin helps the
body to regulate and process sugars.

Cancer begins in cells which are the building blocks that make up
tissues.
Tissues then make up the various organs in the body. When the
body requires it, new cells are formed as normal cells grow and divide.
When normal cells get old or damaged, they will die, and new cells will
take their place. There are times when the process does not function
properly. New cells may form when the body doesn't require them, and
old and damaged cells will not die, as they should. A mass of tissue
called a growth (nodule or tumor) is formed as a result of the buildup
of these extra cells. These growths can be benign or malignant.

Pancreatic cancer begins in the cells that make up the tissues of
the pancreas.
Even when diagnosed early, the prognosis is generally
poor because pancreatic cancer is rarely detected in its early stages
and spreads rapidly. For that reason it is a leading cause of cancer
deaths.

Pancreatic cancer can spread to other parts of the body by invading
other tissues, shedding cancer cells into the abdomen or spreading to other
organs.

  • Invading – When a malignant pancreatic tumor grows it can invade
    organs adjacent to the pancreas like the stomach or small intestine.
  • Shedding – Cancer cells can break off (shed) from the original
    pancreatic tumor. New tumors may then form on the surface of
    nearby organs and tissues as the cells shed into the abdomen.
  • Spreading - When cancer cells break away from the original tumor
    they can spread to the liver and lungs through the blood vessels.
    These cancer cells can also spread through lymph vessels to nearby
    lymph nodes. They then may attach to other tissues and grow to
    form new tumors that could damage the tissues which they attached
    to.

Ninety five percent of pancreatic cancer is adenocarcinoma. This cancer
occurs within the exocrine pancreas cells. A minority of pancreatic cancers
begin in the islet cells and they are classified as neuroendocrine tumors.

SYMPTOMS OF PANCREATIC CANCER

Pancreatic cancer is difficult to detect and diagnose for several
reasons:

  • There aren't noticeable signs or symptoms in the early stages of the
    disease.
  • Due to the fact that the pancreas is located deep in the belly in front
    of the spine, pancreatic cancer can grow silently for months before
    becoming detected.
  • Symptoms for pancreatic cancer can easily be attributed to other less
    serious and more common illnesses. That explains why many people
    have an advanced stage of the disease when it is diagnosed.

The signs of pancreatic cancer may not appear until the cancer is
well advanced and surgical removal is impossible.
Once the tumor
grows large enough to press on other nearby structures symptoms begin to
appear. It is important to seek attention from your Connecticut physician if
any of the following symptoms occur:

  • Yellowing of the skin and whites of the eyes (jaundice).
    Sometimes it is accompanied with some of the following: darkened
    urine, pale-colored stool and skin irritation with itching.
  • Upper abdomen pain that radiates to the back. It can be
    intermittent or made worse by eating.
  • Significant weight loss for no known reason
  • Appetite loss
  • Nausea and vomiting
  • Formation of blood clots in the deep veins of the extremities,
    or the superficial veins anywhere on the body
  • Elevated blood sugar levels (diabetes mellitus). Patients with
    pancreatic cancer may develop diabetes months to years before it
    is diagnosed. It is particularly concerning when an elderly patient
    develops diabetes as it may be an early indication of the onset of
    pancreatic cancer.
  • Clinical depression has been reported to be associated with
    pancreatic cancer but there is no known reason for the association
  • Painless distended gallbladder

It is strongly recommended that you seek attention from a doctor or
one of our surgeons at FCB Surgical Specialists if you experience
any of these symptoms.
These symptoms are also indicative of diseases
other than pancreatic cancer and they will also be checked out by your
doctor or surgeon.

Pancreatic cancer can metastasize. It usually metastasizes first to regional
lymph nodes and later to the liver. It does not commonly metastasize
to the lungs. Occasionally it will metastasize to the brain and bones.

RISK FACTORS

Many people who get pancreatic cancer had some of the following
risk factors, while others may have had none of them.
The factors
that present a potential for increasing the risk of pancreatic cancer include.

  • Increased age; especially over sixty
  • African American descent
  • Obesity
  • Diabetes
  • Chronic inflammation of the pancreas (pancreatitis)
  • Family history of pancreatic cancer
  • Smoking
  • Males are at a 30% risk higher than females
  • Diets low in vegetables and fruits
  • Diets high in red meat
TREATMENTS AND DRUGS

Several factors determine the treatment that will be selected to treat
the pancreatic cancer.
They include the stage of the cancer and the location
of the cancer. The patient's age, overall health and personal preferences are
also taken into consideration. The primary goal is to eliminate the cancer
when possible. If that is not an option then the goal is to prevent the cancer
from growing and spreading. There are cases when treatment is not an option
because the cancer is advanced and the treatments will not offer any benefits.
Other means may be suggested to relieve the symptoms and help make
the patient as comfortable as possible.

SURGERY
Your medical doctor will discuss surgery as an option. When the
cancer is confined to the pancreas, surgery is an option. The various
surgeries used for the treatment of pancreatic cancer include:

  • Surgery for tumors in the pancreatic head – The Whipple
    procedure (pancreatodudenectomy) may be performed if the
    cancer is in the head of the pancreas. This procedure includes
    removing the head of the pancreas, a portion of the small
    intestine (duodenum), gallbladder, part of the bile duct and
    possibly a portion of the stomach. The remaining parts of the
    pancreas, stomach, and intestines are then reconnected so
    that food can be digested.

    The surgeons at FCB Surgical Specialists are some of the most
    experienced and expert pancreatic surgeons in Connecticut and
    New York. Dr. David Cornell is surgical oncologist in our
    Connecticut offices and an expert whipple surgeon.

    The hospital stay can extend to ten days for the Whipple
    procedure and recovery at home will take several weeks. There
    are risks of infection and bleeding. After surgery some patients
    may experience nausea and vomiting if they experience difficulty
    with the stomach emptying.
  • Surgery for tumors in the pancreatic tail and body – The removal of the tail of the pancreas alone or with a small portion of the body of the pancreas is called a distal pancreatectomy. The spleen may also be removed during this procedure.

CHEMOTHERAPY
Most people with pancreatic cancer get chemotherapy.
Chemotherapy is the use of a drug or a combination of
medications to kill cancer cells.
They can be taken orally or they
can be injected into a vein. The procedure may involve one drug or a
combination of drugs. The medicine travels in the bloodstream
throughout the body.

While a person is receiving chemotherapy, imaging studies are
conducted at various intervals to help evaluate the decrease or
increase of the tumor size. If the tumor grows with the chemotherapy
treatment, it may be an indication that the cancer has become
resistant to the therapy, and an alternate treatment plan should be
considered.

Chemotherapy, after surgery, can lower the chances of the cancer
returning, and it is usually given to people with early pancreatic
cancer. There are some instances where it is given prior to the surgery.
Chemotherapy for metastatic pancreatic cancer can extend life and
improve the quality of life for people with the disease. Chemotherapy
is usually given in an outpatient setting at the Norwalk Hospital Cancer
Center or St. Vincent's Medical Center's Cancer Treatment Center in
Bridgeport.

Chemotherapy can also be combined with radiation (chemoradiation).
This treatment is generally used to treat cancers that have spread
outside of the pancreas to organs located near it, but not to organs
outside of the area. Chemoradiation may also be used to try to
prevent a reoccurrence of the pancreatic cancer, even if the cancer
has not spread outside of the pancreas. Chemotherapy is also
combined with targeted drug therapy treatments in patients with
advanced pancreatic cancer.

RADIATION THERAPY
The purpose of radiation therapy is to kill cancer cells that
cannot be surgically removed with the goal of trying to reduce
the risk of cancer returning or spreading.
It is also used to treat
tumors that cannot be removed surgically and are causing symptoms
like jaundice and pain.

High energy beams are used to kill cancer cells or to keep
them from growing.
The radiation comes from a machine that aims
radiation beams at the cancer in the abdomen. It is generally given
at St. Vincent's Medical Center's Cancer Center in Bridgeport and
Norwalk Hospital's Cancer Center, five days a week, for up to six
weeks. Each session lasts approximately thirty minutes.

Radiation treatments may be used before, as well as after the cancer
surgery. It may also be combined with chemotherapy, even if the
patient does have surgery. When pancreatic cancer cannot be treated
surgically, radiation is often used in combination with chemotherapy to
treat the cancer.

There are different methods through which radiation therapy can be
delivered. External beam radiation is the method wherein the beam
comes from a machine outside the body. Brachytherapy is the
procedure where radiation is placed inside the body near the cancer.
Intraoperative radiation is the procedure during which radiation
therapy is used during the surgery.

TARGETED THERAPY
This therapy consists of drugs that are used to attack specific
abnormalities within the cancer cells and slow their growth and
prevent them from spreading.
Those with pancreatic cancer who
are unable to have surgery may receive targeted therapy.

Erllotinib (Tarceva) is a targeted drug that blocks chemicals that
signal cancer cells to grow and divide. It is often combined with
chemotherapy as a form of treatment for people with advanced
pancreatic cancer. Clinical trials investigating other targeted drug
treatments are in process.

OTHER THERAPY
Pancreatic cancer can cause symptoms like jaundice from
obstruction of the bile duct and pain. These symptoms cannot always
be relieved by the other therapies.

The following procedures cannot cure the cancer but they are
aimed at relieving the symptoms.

  • Celiac Plexus Neurolysis (CPN) – This is often referred to as
    a celiac block. It involves the injection of a chemical, which is
    usually alcohol, into the nerves that receive pain signals from
    the pancreas. This injection will damage or numb those nerves
    and will reduce the pain caused by the pancreatic tumor. This
    injection is performed using an endoscope with the guidance of
    ultrasoundor through the skin with the use of a CT scanner for
    guidance.
  • Biliary Stenting – A hollow tube called a stent, is placed in the
    bile duct to keep it open. The external pressure of a growing
    pancreatic tumor could cause it to close. This prevents jaundice
    because it allows bile to flow freely from the liver, past the
    pancreas, and into the intestine. This procedure is performed
    with an endoscope by a gastroenterologist or through the skin
    under CT guidance by an interventional radiologist.

CLINICAL TRIALS
Studies used to test new forms of treatments are called clinical
trials.
Many clinical trials are underway at Norwalk Hospital
and St. Vincent's Medical Center.
They may include new surgical
approaches, new approaches to radiation, testing new drugs, or even
new methods such as gene therapy. These studies can lead to new
methods becoming part of the standard treatment for the cancer when
their results indicate safety and effectiveness.

Clinical trials in Connecticut offer access to treatments that
aren't ordinarily available.
While they may produce serious
unexpected side effects, they may provide positive results that
would not have been received with the normally approved standard
treatments. Clinical trials are closely monitored by the federal
government to ensure safety for the patients participating in the trials.

New treatments that are participating in clinical trials include:

  • Pancreatic cancer vaccines – Normally vaccines are used to
    prevent illness. In this case vaccines are being used to treat the
    cancer rather than protect from it. Studies of these vaccines are
    still in the very early stages. Cancer treatment vaccines are used
    as an attempt to strengthen the immune system in an effort to
    help it recognize cancer cells as intruders, and attack a
    particular protein that is secreted by pancreatic cancer cells.
  • Drugs that can be used to prevent cancer from growing
    new blood vessels
    – This is a category of drugs called
    anglogenesis inhibitors. Cancer cells are unable to get the
    necessary nutrients they require in order to grow when they do
    not have access to new blood vessels. The new blood vessels
    would also provide cancer the vehicle in which to move to other
    parts of the body.
PREVENTION

There is no evidence that there are actual steps that can be taken
to prevent the occurrence of pancreatic cancer.
However, certain
lifestyle adjustments may help reduce the risk of it. They include:

  • Maintaining a healthy weight
  • Exercising almost daily
  • Quit smoking
  • Choosing a healthy diet
SUPPORT

The onset of pancreatic cancer can change a patient's life and as well as
the lives of their family and friends. Needing help after receiving this
diagnosis is not uncommon, and there are many sources of support that
help patients and their loved ones deal with all of the emotions and
concerns that the diagnosis brings. Support groups at Norwalk Hospital
and St. Vincent's Medical Center offer support. There are also other support
groups in person, over the telephone, or on the internet. In these groups
patients and/or the family members will meet or talk to other patients and
their family members. They will share their experiences and acquired
knowledge about how to deal with the disease and the effects of the
treatments.

The resources available at FCB Surgical Specialists in Connecticut include
pancreatic cancer surgeons, an experienced surgical oncologist and a caring
anD compassionate staff. We are available to provide support and help to
deal with the emotions, concerns and physical issues that accompany this
diagnosis.

Counselors, social workers and clergy members can also assist in providing
emotional support as well as suggesting resources if needed for financial
aid, transportation and home care.

LOCATIONS


148 EAST AVENUE, SUITE 3A
NORWALK, CT 06851
203-899-0744

2 TRAP FALLS ROAD, SUITE 100
SHELTON, CT 06484
203-256-9707

778 LONG RIDGE ROAD, SUITE 101
STAMFORD, CT 06902
203-348-0589

52 WASHINGTON AVENUE, SUITE 3
NORTH HAVEN, CT 06473
203-285-2861

831 BOSTON POST ROAD, SUITE 202
MILFORD, CT 06460
203-647-0140

SURGICAL SPECIALISTS OF CONNECTICUT
4920 MAIN STREET
BRIDGEPORT CT 06606
203-371-2986

Dr. Craig Floch

the founder and senior partner of Fairfield County Bariatrics & Surgical Specialists, P.C. His commitment has enabled us to become one of the most prominent, dedicated, personal and highly respected practices serving Connecticut, New England and New York.

Learn More

Dr. Neil Floch

the Director of Minimally Invasive Surgery at Norwalk Hospital as well as the Bariatric Director of the Hospital. He is the first fellowship trained advanced Laparoscopic Surgeon in Fairfield County.

Learn More

Dr. Peter Ingraldi

is a partner of Fairfield County Bariatrics & Surgical Specialists, P.C. He joined our practice in 2007. Dr. Ingraldi specializes in general surgery and surgical critical care and is Board Certififed in both fields.

Learn More

Abe Fridman

joined our practice September 1, 2012. Dr. Fridman specializes in general and bariatric surgery.

Learn More

Dr. Marko Lujic

is the newest member of Fairfield County Bariatrics & Surgical Specialists, P.C., having joined our practice in October 2017. Dr. Lujic will lead our initiative in Milford and will provide comprehensive general surgical services, including breast surgery, thyroid surgery and melanoma in addition to managing traditional general surgery consultations.

Learn More