Pancreatic juice contains enzymes involved in the digestion of food. It is secreted into the pancreatic duct, which connects to the common bile duct opening in the upper part of the small intestine (into the duodenum). In the lumen of the intestine through this duct comes both pancreatic juice and bile from both bile ducts of the liver and from the gallbladder. The hormones produced by the pancreas include insulin and glucagon. They are emitted directly into the bloodstream and regulate blood sugar levels. How to treat pancreatic cancer and what are the complications?
Signs of pancreatic cancer
• Back pain, often worse at night.
• Jaundice.
• Itching (typical of icteric patients).
• Weight loss.
• Bad feeling.
• Vomiting.
• Fatty stool (steatorrhea - feces of pale color, voluminous and with a disgusting smell).
• Disturbance of digestion.
• Diabetic symptoms such as thirst and discharge of a large amount of urine. Pancreatic cancer is usually diagnosed at advanced stages, since the symptoms are often nonspecific and can mimic other conditions, for example irritable bowel syndrome. At the time of diagnosis, the tumor often grows around the surrounding structures - the liver, stomach, intestines, lungs and lymph nodes. The exact cause of pancreatic cancer is unknown, but it is believed that the development of the disease is affected by the following risk factors:
• Smoking (doubles the risk).
• Chronic inflammation of the pancreas (chronic pancreatitis).
• Diabetes mellitus, especially in the elderly.
• Effects of industrial pollutants and DDT (insecticide).
• Partial removal of the stomach (partial gastrectomy).
Morbidity
Pancreatic cancer occupies the fifth place among malignant tumors and the incidence is constantly increasing. At a young age, this tumor is more common in men than in women, later this difference is erased. When examining patients with suspicion of a pancreatic tumor, the doctor often discovers the patient's yellowing of the skin and mucous membranes, an increase in the liver and gall bladder (palpable under the edge of the right costal arch). The last symptom may indicate both a tumor that compresses the excretory bile ducts and gallstones. The course of the survey includes:
• Blood test to determine liver function (hepatic functional tests).
• Ultrasound scanning - used to detect a tumor, as well as to control the needle supply during biopsy.
• CT (computed tomography) and / or MRI (magnetic resonance imaging) - provide a digital image of the internal organs of the abdominal cavity.
• Endoscopic methods - provide a direct view of the inner wall of the small intestine.
• ERCP (endoscopic retrograde cholangiopancreatography) is a study in which a flexible tube is carried through the mouth and stomach into the small intestine, after which a contrast agent is injected into the common bile duct to detect obstruction.
• Laparoscopy - the introduction of a laparoscope into the abdominal cavity through a small incision of the abdominal wall with the possibility of taking a biopsy. Treatment of pancreatic cancer depends on the age of the patient and the general state of health, the size of the tumor and the extent of its spread.
Surgery
Small tumors coming from the pancreatic tissue can be cured by removing the whole or part of the organ. With a radical operation, part of the small intestine and stomach, the bile duct, gall bladder, spleen and lymph nodes adjacent to the lesion area can be removed. This is an extremely difficult intervention, mortality after which remains high, although it has significantly decreased in recent years due to the improvement of anesthesia and surgical technologies. With inoperable tumors, treatment is directed, rather, to alleviating the symptoms. If the tumor compresses the common bile duct, a palliative surgery can be performed to restore its lumen by installing a metal conductor (stent) during ERCP. As a result of this manipulation, the patient is relieved by itching and a decrease in jaundice.
Drug therapy
Radiation therapy and chemotherapy are used to kill cancer cells and reduce the tumor mass, but their effect is rather palliative rather than therapeutic. An integral part of the therapeutic process are powerful painkillers, for example, long-acting oral morphine preparations; Special technologies of drug delivery in a pulsed mode can be applied.
Forecast
The prognosis for pancreatic carcinoma is extremely unfavorable, since approximately 80% of patients have a tumor already spread to the lymph nodes at the time of diagnosis.
Survival
Only 2% of patients with pancreatic cancer survive a five-year threshold, patients with an inoperable tumor die an average of 9 weeks after diagnosis. If the tumor is removed, the prognosis improves by about 10%.