Treating Pancreatic Cancer - Resonating Hope

What Are Pancreas and What Is Their Function?

The pancreas is an important organ that is situated at the back of the stomach in the abdominal region. The pancreas resembles the shape of fish (broad head, wide body, and narrow tail). Which measures about 6 inches in length and 2 inches in diameter. Pancreas is divided into exocrine cells and endocrine cells depending upon the function.

• Exocrine Cells: Exocrine part of the pancreas helps in the production of pancreatic enzymes that help in the digestion of fats. These pancreatic enzymes empty their contents into the intestine through pancreatic ducts. Cancers arising in the exocrine cells are called pancreatic adenocarcinoma. About 95 % of pancreatic cancers belong to adenocarcinomas.

• Endocrine Cells: Endocrine cells of the pancreas secrete insulin and glucagon, which help in balancing the blood glucose levels in the body. Cancers arising in the endocrine cells are called pancreatic neuroendocrine cancers and are very rare to occur.

What Is Pancreatic Cancer?

When the cells in the pancreas divide abnormally, it leads to the formation of a lump or mass of cells called tumors. Tumors are generally benign or malignant. Benign tumors are noncancerous and malignant tumors spread to other body parts. When the pancreatic cancer cells spread to other body parts, it is called metastases. Metastatic cancer is always hard to treat. Treatment options usually depend on the following factors:

• Age of the patient.

• Stage of pancreatic cancer.

• Underlying health conditions.

What Is Pancreatic Cancer Surgery?

Surgery is the common treatment for pancreatic cancers: two types of surgeries are used to treat pancreatic cancers depending on the stage:

• Curative Surgery: Curative surgery is indicated when the stage and the investigation results show a complete cure for cancer through total resection (removal) of the cancerous tissue.

• Palliative Surgery: Palliative surgery is done to relieve the patient's symptoms and extend the life. When the tests and the stage of cancer show that the cancer is widespread and extensive (has spread to other organs), palliative surgery is indicated. Generally, this surgery is indicated to relieve the blocked bile duct or intestine. The main objective of this surgery is not to cure the cancer but relieve the symptoms caused due to cancer.

How to Determine the Stage of Cancer?

Staging of pancreatic cancer is very important in determining the type of surgery to be done for the patient. But the exact staging of pancreatic cancer can be done through imaging tests.

Hence in cases of surgery, the doctor performs a laparoscopy to determine the extent of the cancer. In laparoscopic surgery, the laparoscopic surgeon makes 2 to 3 incisions on the abdominal cavity. Through one of the incisions, a thin long tube consisting of a camera at one end is inserted into the abdomen, and the other end of the tube is connected to the screen. The camera, which is attached to one end, captures pictures of the pancreas and the surrounding abdominal cavity which are displayed on the screen. This helps the doctor to determine the extent of the cancer and decide what type of surgery is needed for the patient. If the doctor feels doubtful, biopsy samples are also taken with the help of laparoscopy and sent to the lab to confirm the spreading (stagging) of the cancer.

What Are the Different Types of Curative Surgeries?

Curative surgery is only indicated when the doctor thinks resection (surgical removal ) of the total pancreas or a part of the pancreas would help in the possible cure of cancer. Since curative surgery is a very complex procedure, a person with pancreatic cancer opting for curative surgery must know the advantages and risks involved in the surgery. The surgery can also lead to complications, and the recovery time in some cases may extend even up to months. In some cases, when the oncologist begins the operation, it could be clearly evident that the cancer has spread over a wide area, and it becomes difficult for the complete removal of cancerous tissue. In such instances, the doctor stops the curative surgery and continues with palliative surgery (surgery intended to relieve and prevent the symptoms) since the curative surgery cannot remove all the cancer. Curative surgeries are always done to cure cancers in the head of the pancreas.

Depending upon the part involved in the pancreas curative surgery is divided into the following types:

1. Pancreaticoduodenectomy: The most common surgical procedure carried out to remove the cancer from the head portion of the pancreas. Pancreaticoduodenectomy is also called Whipple's procedure. During the operation, the surgeon mainly removes the head of the pancreas, and if needed, a part of adjacent structures like the small intestine, gallbladder, lymph nodes, and bile duct are also removed depending upon the spread of the cancer. The cut pieces of the small intestine are ligated for the easy movement of food, remaining part of the bile duct and pancreas are reattached to the small intestine for the easy passage of bile juices and digestive enzymes into the small intestine, which would help in the digestion of food (especially fats).

2. Distal Pancreatectomy: In this type of surgery, the surgeon mainly removes the tail and body portion of the pancreas. In most cases of distal pancreatectomy, the spleen is also resected (removed). Since the spleen plays a vital role in the immune system of the body, its removal can make the patient prone to infections very easily, causing further damage. Hence vaccinations are taken against these infections before the surgery.

Distal pancreatectomy is very rare because, by the time of diagnosis, cancer may have spread far into the surrounding tissues.

1. Total Pancreatectomy: Surgery involving the total removal of the pancreas and gallbladder along with a portion of the small intestine, stomach, and spleen. This type of surgery is less indicated because removal of the entire pancreas may cause major side effects and complications. As the endocrine cells of the pancreas help in the secretion of insulin, which helps in maintaining the glucose levels in the body, surgical removal of the entire pancreas makes the patient diabetic, and these patients completely depend on insulin injections which can cause long-term complications. On the other hand, exocrine cells of the pancreas secrete digestive enzymes, which help in the process of digestion of fats. Hence patients who have undergone total pancreatectomy are advised to have digestive enzyme pills for life long.

What Are the Different Types of Palliative Surgeries?

Palliative surgeries are meant for only symptom relief; even palliative surgeries are not indicated when the cancer has spread to far places. It is also better to prevent palliative surgeries in people with severe illness. Types of palliative surgeries include:

1. Placement of Stent: Cancerous growth of the pancreatic tissue can exert pressure on the bile ducts, leading to the duct's closure. When the duct is closed, bile juice containing digestive enzymes cannot get emptied into the small intestine; therefore, food cannot be digested. The stent can be placed through an endoscope and it makes sure the bile duct remains open. Over a period of time, the stent also fails because of the clogging. In such conditions, the stent must be cleared or replaced.

2. Bypass Surgery: Bypass surgery is indicated in cases of large blocked pancreatic ducts. The blocked part of the bile duct is bypassed to route the bile juice directly into the intestine. This surgery is only indicated in healthy individuals.

Conclusion:

Pancreatic cancer appears to be widely spread even before the diagnosis of the disease. Depending on the health status, stage of the cancer, and age of the patient, the doctor has to weigh the benefits and complications of the surgery. But the overall treatment outcome is good in cases of both curative and palliative surgeries.