DEFINITION
Cancer of the pancreas can be divided into two main
categories, namely cancer endocrine (hormone-producing part of the pancreas)
and exocrine cancer (pancreas that produce enzymes). Endocrine pancreatic
cancer is rare, and usually grow slowly compared with exocrine pancreatic
cancer.
Exocrine pancreatic cancer formed from cells lining the duct
(ducts) that drain enzymes into the small intestine. This cancer is often
referred to as pancreatic adenocarcinoma and covers about 95% of malignant cancer
of the pancreas.
CAUSE
The cause is unknown. Some risk factors associated with the
occurrence of pancreatic cancer:
·
Age. Pancreatic adenocarcinoma is rare before
the age of 50 years. Patients diagnosed at an average age of about 55 years.
·
Gender. Pancreatic adenocarcinoma is more common
in men than women.
·
Smoke. This cancer is 2-3 times more common in
people who smoke.
·
Genetic. Family history of pancreatic
adenocarcinoma in making a person has a higher risk for this cancer.
·
Overweight (obesity)
·
Less physical activity
·
Diabetes
·
Chronic pancreatitis
·
A diet high in fat
SYMPTOMS
Most occur in the caput pancreatic adenocarcinoma of the
pancreas (pancreatic sections closest to the duodenum and the main bile duct).
Tumors in this section may impede the flow of bile, which can cause jaundice
(discoloration of the skin and the whites of the eyes become yellow). Patients
also feel itching all over the body due to deposition of bile salt crystals
under the skin. Patients also may vomit if cancer in the pancreas caput inhibit
the flow of gastric contents into the small intestine or clog the small
intestine itself.
Pancreatic adenocarcinoma located in the middle and end of
the pancreas can clog the veins coming from the spleen, causing enlargement of
the spleen and varicose veins (dilation of veins) in the area of the stomach
and esophagus. When varicose veins is broken, there can be bleeding.
Pancreatic adenocarcinoma located at the middle or end of
the pancreas (the part that is far from the duodenum) usually does not cause
symptoms until the tumor has grown large. Therefore, when diagnosed, the tumor
has usually spread beyond the pancreas, to nearby lymph nodes, liver or lungs.
In the end, the majority of patients experiencing severe pain in the upper
abdomen, which can also be felt in the middle back. The pain can be eased by
means of bending. Patients may also experience weight loss, at least 10% of the
previous weight.
DIAGNOSIS
Not easy to be able to detect the presence of tumors in the
middle and end of the pancreas early, because the symptoms typically appear
late. In addition, physical examination and blood also often give normal
results.
Several tests that can be done if there is a suspected
pancreatic adenocarcinoma among others:
·
CT (Computed Tomography) scan
·
MRCP (Magnetic Resonance
Cholangiopancreatography)
·
Ultrasonography
·
ERCP (Endoscopic Retrograde
Cholangiopancreatography)
·
MRI (Magnetic Resonance Imaging)
·
Blood tests
·
Biopsy can be done to confirm the diagnosis,
namely by taking a sample of pancreatic tissue using a needle inserted through
the skin and guided by CT scan or ultrasound, to be examined microscopically.
However, tumors are often not drawn, and this action can make cancer cells
spread.
Can also take a sample of the liver to determine the spread
of this cancer. If the doctor suspects an adenocarcinoma, but the tests are
normal result, it can be removed surgically explore the pancreas.
TREATMENT
The only hope for a cure is surgery, which can be done in
10-20% of patients who believed that the cancer has not spread. Surgery is done
to remove the pancreas or pancreas and duodenum (small intestine connected to
the stomach). After surgery, only 15-20% of patients who can survive up to 5
years. Chemotherapy and radiation therapy is usually given, but does not
significantly affect life expectancy.
Another treatment that can be done include:
·
Administration of drugs to treat pain. Sometimes
an injection can be performed on the nerves to overcome the severe pain.
·
Provision of additional pancreatic enzymes, to
overcome existing shortcomings.
·
Stenting in the ducts that drain bile from the
liver and gallbladder. This action can be done if there is a blockage of bile
flow. However, in most cases, the tumor will eventually clog the channel above
and below the stent.
·
Surgery can also be done to bypass the blockage.
For example, blockage of the small intestine can be overcome by connecting the
stomach to the small intestine in the lower part of the blockage.
Because the majority of pancreatic adenocarcinoma is fatal,
it is usually necessary to talk about the end of life of patients, with
doctors, patients themselves, and their families.
REFERENCE
- L, Elliot M. Pancreatic Cancer. Merck Manual Home Health
Handbook. 2013.
- N, Francis W. Pancreatic Cancer. Medicine Net. 2013.
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