Pancreatic Cancer (Part Three)

• Physical Examination- The skin and eyes are checked for jaundice. The abdomen is examined for changes around the pancreas area, liver, and gallbladder. Also, a check for the presence of ascites (abnormal accumulation and increase of fluid in the abdomen) is performed.
• Laboratory Tests - blood, urine, and stool tests can be done to check for bilirubin and other substances. Bilirubin is a substance that passes from the liver to the gallbladder into the small intestine. If the common bile duct is blocked by the tumor, bilirubin cannot make its usual journey. Continual blockage can increase bilirubin levels in the blood, urine, and stool. High levels of bilirubin may indicate cancer or non-cancerous conditions.
• CT Scan (Computed Tomography) - An X-ray machine is connected to a computer to create detailed images of the pancreas, organs, and blood vessels of the abdomen.
• Ultrasound - This examination uses ultrasound waves to create images of the pancreas and other organs in the abdomen. Images created from an organ with a tumor are different from those of healthy organs. The ultrasound procedure can be external (from outside) and internal (from inside):
• Abdominal Echo: To obtain images of the pancreas, the doctor uses an ultrasound probe over the abdomen.

• Endoscopic Ultrasound (EUS) In Endoscopic Ultrasound (EUS), a wave transmitter is placed at the tip of a flexible endoscope. By inserting the scope through the mouth into the esophagus and then into the stomach (upper digestive tract endoscopy), high-quality images of the pancreas and surrounding organs can be obtained.
• Endoscopic Retrograde Cholangiopancreatography (ERCP): - the first phase of the examination is performed similarly to a gastroscopy, and when the doctor reaches the beginning of the small intestine, he injects a special dye that temporarily stays in the ducts of the biliary system. After injection, X-ray images are taken, which show whether the ducts are narrowed or blocked by tumors or other conditions.
• Percutaneous Transhepatic Cholangiography (PTC): A dye is injected through a thin needle from the skin towards the liver. This dye passes into the biliary ducts (canals), making them visible on X-ray (radiography). Through this procedure, the doctor can see if there are blockages caused by the tumor or other conditions.
•  Biopsy – in some cases, several cell samples from the tumor are taken and examined by a pathologist (a doctor specialized in examining cells) under a microscope for the presence of cancerous cells and their type. The cell samples can be taken in several ways, including:
  
  • Through a needle that is directly inserted into the liver to draw cells from it. In this procedure, the doctor uses X-rays (radiography) or ultrasound (echo) for guidance
  • Another method is during the Endoscopic Retrograde Cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS) procedures. - Another way is through open surgery.

Staging

At the moment pancreatic cancer is diagnosed, the doctor needs to know the stage, the spread of the disease to draft a treatment plan. Staging is a careful procedure based on which treatment schemes are decided. Staging means assessing the cancer for its size, whether it has spread, and which other organs it has affected.

Treatment

• Many patients with pancreatic cancer want to have an active participation in making decisions about their treatment. However, the shock following a cancer diagnosis can make it difficult for them to make decisions, hence the presence and assistance of family members is important.
• Pancreatic cancer is difficult to keep under control with current medications, therefore doctors encourage patients to become subjects for clinical studies. Clinical studies are an important opportunity for people at all stages of pancreatic cancer.
• Pancreatic cancer can only be treated when caught in early stages before it spreads to other organs. However, other treatments are possible to keep the disease under control, providing the patient with life extension. When cure or disease control are not possible, the doctor and patient choose palliative care. Palliative care helps improve quality of life by controlling pain and other problems caused by the disease, but it does not cure the disease.
• After being diagnosed with pancreatic cancer, the doctor refers you to an oncologist, a doctor specialized in cancer treatment. Specialists who treat pancreatic cancer may include; surgical oncologist, radiation oncologist. Generally, treatment begins a few weeks after diagnosis, once the patient has received proper information about the disease and together with the doctor have decided on the treatment method.

Treatment Methods

People with pancreatic cancer may have a range of treatment methods. Depending on the type and stage, pancreatic cancer can be treated with surgery, radiation therapy, or chemotherapy. Some patients undergo combined therapies.

Surgery can be done alone or combined with radiation and chemotherapy. And when diagnosed, only 20% of pancreatic cancers can be surgically removed. The standard surgical procedure is called pancreaticoduodenectomy.

The extent of the surgery depends on the tumor's location and size, the disease's stage, and the patient's overall health condition. A brief description of surgical procedures:

• Whipple Procedure: If the tumor is in the head of the pancreas, the surgeon removes the part of the head of the pancreas and a part of the small intestine, the bile duct, and the stomach. Also, tissues around the tumor may be removed.
•  Distal Pancreatectomy: If the tumor is located in the body and tail of the pancreas, the surgeon removes these parts. The spleen is also removed.
•  Total Pancreatectomy: The surgeon removes the entire pancreas, parts of the small intestine, a part of the stomach, the common bile duct, the gallbladder, the spleen, and surrounding lymph nodes.