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.

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.

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:

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:

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.

Treatments & 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:

Chemotherapy

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 whoare 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.

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:

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:

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.

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