Cancer of the Pancreas

Epidemiology

• Pancreatic cancer is the most common GI cancer.

• Fourth leading cause of cancer in US
• Two main categories:
1. arising in the exocrine parenchyma
2. arising in the endocrine cells of the islets of Langerhans.
• The term pancreatic cancer usually refers to cancer of the exocrine
pancreas.
• 7% of all related cancer deaths in men and women (Medscape 2020)
• Pancreatic Cancer more common in men than women, incidence increases
with age 65 and 79 , rarely in those under 45.
• Risk Factors
• Cigarette smoking
• Diabetes mellitus
• Chronic Pancreatitis
• Dietary Factors
• Obesity
• Familial genetic alterations
 Signs and Symptoms of Patients with Pancreatic
Cancer
• Abdominal Pain- dull, constant pain radiating to the middle or upper
back.
-Severe pain usually indicative of invasion of the celiac and
mesentric plexus, a sign of locally advanced or metastatic disease.
• Anorexia, Weight loss -caused by multiple factors , Tumor Obstruction of
the duodenum, decreased gasrtic motility,and increased metabolic activity
due to tumor-related cytokines.
• Early Satiety
• Sleep Problems
• Jaundice- cause by lesions in the pancreatic head.
• Fatigue
• Weakness, nausea,constipation
• Depression
• ascites
Diagnostic
• Multidetector and Multiphase CT
-optimal study for clinical staging of pancreas.
• Laparoscopy- detect extrapancreatic tumor not seen on CT
scans.
• Endoscopic ultrasound (EUS) and Endoscopic retrograde
cholangiopancreatography(ERCP)
-IF a mass is not seen on contrast-enhanced CT
- If mass is located, EUS may be used to guide a fine-needle aspiration.
EUS
ERCP
 TNM Clinical Classification System for staging Pancreatic
Cancer

• PRIMARY TUMOR (T)

TX Primary tumor cannnot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ*
T1 Tumor limited to the pancreas, 2 cm or less in greatest dimension
T2 Tumor limited to the pancreas , more than 2cm in greatest dimension.
T3 Tumor extends beyond the pancreas but w/o involement of the celiac axis or the superior
mesentric artery
T4 Tumor involves the celiac axis or the superior mesentric artery (unresectable primary tumor)
Regional Lymph Nodes (N)
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Regional lymph node metastasis

Distant Metastasis (M)

MX Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
 Treatment
• Surgery
 Pancreaticoduodenectomy ( WHIPPLE procedure)
• - removal of pancreatic head , the gallbladder, the common bile duct, the duodenum, the
distal stomach, and regional lymph nodes.
 Series of anastomoses- performed to reestablish gastro intestinal motility
 Pylorus –preserving pancreaticoduodenectomy – may be used for small periampullary
lesions;however this procedure is controversial.
 Total pancreatectomy- an extension of the pancreadenectomy, removal of the body and tail
of the pancreas, the spleen and more extensive lymph nodes.
• Chemotherapy- the hope to shrink the tumor and eliminate micrometastases.
• Radiation therapy- used in combination with 5-FU or gemcitabine.

• Nursing care
Surgical patient:
-careful post operative monitoring for complications, pain control, and nutritional
support.
Health teaching about the side effects of chemotherapy and radiation therapy