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Pancreatic Cancer｜Pancreatic Cancer 

1. Basic knowledge

      The pancreas is located behind the stomach, about 20cm long, and is a slender glandular organ left and right. Viewed from its right side, the bulging part is called the head of the pancreas, which is surrounded by the duodenum. The long, narrow part on the left, called the tail of the pancreas, joins the spleen. In the middle is the body of the pancreas. Long, thin tubes called pancreatic ducts run through the entire pancreas.

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        The pancreas has two functions. One is the secretion of pancreatic juice, which aids in digestion (exocrine), and insulin, which regulates blood sugar (endocrine). Pancreatic juice is transported through the pancreatic duct and concentrates in the main pancreatic duct. At the duodenal papilla, it merges with the bile that passes from the liver through the bile duct into the duodenum.

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        Pancreatic cancer:More than 90% of pancreatic cancers arise from pancreatic duct cells. It is called pancreatic duct cancer, which is what pancreatic cancer is usually referred to. Others are neuroendocrine tumors, intraductal papillary mucinous tumors of the pancreas, and so on.

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        Symptoms: The pancreas is located deep in the back of the stomach, even if it becomes cancerous, it is not easy to have symptoms, let alone early detection. Pancreatic cancer is not prone to initial symptoms. As the disease progresses, abdominal pain, loss of appetite, fullness (sudden abdominal fullness), jaundice, and waist or back pain may occur. Sometimes it can also cause diabetes. However, the above-mentioned symptoms are not necessarily caused by pancreatic cancer, and pancreatic cancer does not necessarily have the above-mentioned symptoms.

胰臟癌期數

2. Treatment

        Disease stage: The treatment method will be discussed with the attending physician according to the state of pancreatic cancer and physical condition. The progression of cancer is classified according to the stage of the disease. The stage of the disease can be judged by the size of the tumor, the extent of spread, whether there is lymph node metastasis and distant metastasis. Pancreatic cancer can be divided into stage 0, stage I, stage II, stage III, and stage IV.

​Pancreatic Cancer Stages (Japanese Pancreatic Society)

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​Pancreatic cancer stage (UICC)

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        The stage classification of pancreatic cancer is based on the classification established by the Japanese Pancreatic Society and the UICC classification used internationally. Although there are differences, both classifications are used.

treatment options

        The method of treatment is based on the standard treatment according to the patient's physical condition, age, and patient's wishes, etc., and is decided after discussion with the attending physician. Standard treatments for pancreatic cancer can be divided into: surgery (surgical treatment), drug therapy (chemotherapy), and radiation therapy. Considering the state of cancer spread and the state of the whole body, one or more of the above-mentioned methods are used. Pancreatic cancer is one of the more troublesome types of digestive organ cancer, but effective treatments are being actively developed.

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        If surgery is available, it will be given along with medical treatment. However, when the cancer has invaded important blood vessels or metastasized to other organs and surgery is not possible, radiation therapy and drug therapy will be used.

(1) Surgery (surgical treatment): In the treatment of pancreatic cancer, if surgical resection is possible, surgery is generally recommended. Whether or not surgery can be performed is judged through CT examination, etc., and surgery is divided into three types.

胰臟癌治療方式

  • can be resected

  • borderline resectable

  • Unresectable

        Borderline resectable refers to cancer that has not metastasized distantly but has invaded major blood vessels. Can be subdivided into: has invaded the arterial system (superior mesenteric artery, celiac artery, common hepatic artery) or only invaded the portal venous system. But no matter what the situation is, if only standard surgery is used, there will still be some residual cancer, and the follow-up treatment needs to be discussed according to the physical condition.

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The type of surgery is selected from the following methods according to the location and extent of the cancer.

  • Pancreaticoduodenectomy: If the cancer is centered in the head of the pancreas, the head of the pancreas is removed, including the duodenum, bile duct, and gallbladder. If the cancer is close to the stomach, part of the stomach is removed, and if it has invaded into blood vessels, part of the blood vessels are also removed. After resection, the remaining pancreas is connected to the small intestine so that pancreatic juice can flow into the small intestine. For the remainder, the bile duct is connected to the small intestine, and the junction of the stomach and small intestine is sutured.

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  • Resection of the tail of the pancreas: When the cancer is located at the tail of the pancreas, the body and tail of the pancreas are removed. Usually the spleen is also removed. Reconstruction of the digestive tract is not required after resection.

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  • Total pancreasectomy: When the cancer has spread throughout the entire pancreas, the entire pancreas is removed. At this time, the function of the pancreas is lost, resulting in metabolic and digestive disorders. If it is judged that total resection cannot be cured, this method will not be considered.

 

  • Bypass surgery: When resection is not possible and the duodenum is blocked by cancer, bypass surgery that connects the stomach to the small intestine is performed. Or when jaundice occurs due to obstruction of the bile duct, bypass surgery is performed to connect the bile duct to the small intestine.

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Complications of Surgery

        Depending on the method of operation, it generally takes more time to recover from resection of the head of the pancreas compared to resection of the tail of the pancreas because more parts are reconnected with the intestines. Depending on the location of the cancer, the nerves that regulate intestinal peristalsis are removed, which can easily cause diarrhea.

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        Complications of pancreatoduodenectomy: bile and pancreatic juice may leak from the connecting part due to resection, infection, membrane inflammation, and bleeding may also occur. Because intestinal peristalsis adjustment has not been carried out, there may be conditions that affect diet and nausea. By improving the way of eating and extending the meal time, you can gradually return to the state of being able to eat smoothly. Antibiotics are given for cholangitis or fever caused by reflux from the part where the bile duct joins the jejunum.

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Complications caused by total pancreatectomy

        It can cause problems such as carbohydrate metabolism (diabetes), digestion and absorption, and fatty liver. Diabetes requires regular use of insulin. For digestion and absorption and fatty liver, it is necessary to take digestive agents that replace pancreatic juice.

(2) Radiation therapy

  • Chemoradiotherapy: Combination treatment of radiation therapy and chemotherapy. It is performed in the absence of clear distant metastasis, but the main blood vessels have been invaded. Treatment performed concurrently with chemotherapy is expected to have a high therapeutic effect and is recommended as one of the standard treatments.

 

  • Radiation therapy aimed at relieving pain and symptoms: As one of the methods to relieve pain and other symptoms caused by metastasis to the bone.

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side effects of radiation therapy

        Symptoms may vary depending on the dose of radiation therapy. The more common symptoms are skin pigmentation, nausea, vomiting, loss of appetite and leukopenia. There may also be bleeding from the gastric or intestinal mucosa, resulting in darker stools.

(3) Drug treatment

  • Postoperative adjuvant chemotherapy: It has been confirmed that after pancreatic cancer surgery, the use of chemotherapy can prolong the survival period and reduce the possibility of recurrence. The following are common chemotherapy treatments in general.

 

  1. TS-1 (Tegafur & Gimeracil & Oteracil) Single Agent Therapy

  2. Genetex monotherapy

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  • Chemotherapy when surgery is inoperable or relapsed: It has been proven that chemotherapy can prolong the survival period and relieve symptoms when surgery is inoperable or relapsed. When used with radiation therapy, it is called chemoradiation therapy. The following are chemotherapy treatments that are given at the same time as radiation therapy.

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  1. FOLFIRINOX therapy (irinotecan, oxaliplatin, fluorouracil, leucovorin).

  2. Jianze + Albert Shan therapy.

  3. Genetics single-dose therapy.

  4. Health choice + soothing therapy.

  5. TS-1 (Tegafur & Gimeracil & Oteracil) single agent therapy.

 

chemotherapy side effects

        Because cells with strong metabolism such as mucous membranes in the mouth or digestive tract, hair and bone marrow are easily affected by drugs, symptoms such as stomatitis, diarrhea, nausea and hair loss are prone to occur. Others are general fatigue, liver and kidney dysfunction. Most of the side effects are short-lived, and there are drugs that can effectively relieve them, but if the side effects are too strong, you can consider stopping or changing to other treatments. Due to the side effects of drugs, please ask your doctor to evaluate your physical condition and cancer status to choose the most appropriate treatment.

3. Rehabilitation

  • Precautions in daily life: According to the condition, operation method and treatment status, the precautions in daily life are different. Please adjust according to your own condition and discuss with your doctor.

 

  • Daily life after surgery: Eat foods that are easy to digest and put a lot of thought into how you eat.

After the operation, the bile that helps digest and absorb fat and the pancreatic juice containing digestive enzymes will decrease or stop secreting. Therefore, indigestion is prone to cause diarrhea, etc. Please eat foods that are easy to digest in the case of a balanced diet. Here are the dos and don'ts of diet.

  1. From a small amount to a gradual increase in food intake: digestion and absorption will take more time.

  2. Small amount of frequent meals: Eating too much at one time can easily cause inability to absorb and digest.

  3. Intake of high-quality protein (soy products and fish, etc.).

  4. Reduce your intake of spices.

  5. Reduce intake of coffee and black tea.

  6. Check with your doctor if you can drink alcohol.

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  • Watch for changes in blood sugar.

       Diabetes may develop after surgery, and patients with a history of diabetes may have a risk of exacerbation. If so, please discuss it with a diabetes specialist. After undergoing a total pancreatectomy, insulin, which suppresses blood sugar, will not be secreted and needs to be supplemented by injection.

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  • Daily Life During Chemotherapy

       In recent years, with advances in anticancer drugs and supportive care, outpatient chemotherapy with anticancer drugs at the time of visit is increasing. In this way, not only can you maintain your current daily life while receiving treatment, but also reduce the impact on work and family. After all, it can be unnerving not to have a medical staff around to take care of you all the time. During the outpatient clinic, please ask the attending physician about possible side effects and how to deal with the period, or discuss with the attending physician if you have other doubts or concerns. While getting help from family and others, it is also important to find ways to cope with side effects that work for you.

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       In addition, although there is no impact on sexual life, please take contraceptive measures during treatment. If you plan to have a baby, please consult the attending physician first.   When taking special hormones such as oral contraceptives, please consult the attending physician first.

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  • follow up observation

       Even after the operation, you should go to the hospital for regular checkups to check the recovery status and recurrence. How often you go depends on your physical condition, but at least five years after the operation, you should go to the hospital for regular checkups. Blood tests are done to confirm jaundice, blood sugar, hormonal status, and tumor markers. Imaging examinations such as X-rays, abdominal ultrasound, and CT will be performed when necessary. Follow-up visits can check for jaundice, abdominal pain, and changes in appetite. Jaundice is difficult to notice on your own, but is characterized by yellowing of the whites of the eyes and darkened urine. Consult your doctor if you have any concerns. You may need to be hospitalized if you have a fever such as severe pain or cholangitis. Please contact the medical unit as soon as possible.

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For information on drugs related to pancreatic cancer, please refer to the Medical Assistant Blog

https://www.medicalsupporter.org/medicalblog/tag/pancreatic cancer

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