Pancreatic Tumors: A Case Study

According to Professor John Neoptolemos, "There are approximately 7,000 new cases each year - but it is one of the most lethal cancers." The main reason for the low survival rate from pancreatic cancer is due to its difficulty in finding this cancer early. By the time a person has symptoms, the cancer has often reached a large size and spread to other organs. Because the pancreas is deep inside the body, the doctor cannot see or feel tumors during a routine physical exam. There are currently no blood tests or other tests that can easily find this cancer early in people without symptoms. Tests for certain genes in people with a family history of the disease can help tell if they are at higher risk for cancer. There are some new tests for finding pancreatic cancer early in people with a strong family history of the disease, but these tests are complicated and expensive. Some symptoms of pancreatic cancer include jaundice, a yellow color of the eyes and skin caused by a substance buildup in the liver, pain in the belly area or in the middle of the back, significant weight loss over a number of months, loss of appetite, digestive problems including nausea, vomiting, pain that tends to be worse after eating, a swollen gallbladder that is enlarged, blood clots that form in the veins or cause problems with fatty tissue under the skin, and diabetes. If the doctor has any reason to suspect pancreatic cancer, certain tests will be done to see if the disease is really

When spreading through the body there are certain stages the cancer has to go through to expand. Stage 0. There is no spread.The cancer is limited to only one cell in the pancreas. Stage I: The cancer is only limited to the pancreas cell, but has moved at least two centimeters. Not yet visible in screening tests. Stage II: The cancer has grown outside the pancreas and may have spread to the lymph nodes. Stage III: The tumor has spread drastically making it now possible for the tests to detect the tumor,increasing the possibility for it expand into the blood vessels or nerves. Stage IV: The cancer has spread to different organs of the body.("Pancreatic Cancer Treatments by Stage") The first place to attack after spreading would be the stomach, then it would expand to the liver. After the cancer reaches these points, it travels to other places in the body. ("Treating Pancreatic Cancer, Based on Extent of the Cancer").

There are not many defined risk factors known for pancreatic cancer. Some risk factors are “family history of the disease, smoking, age, and diabetes (Mayoclinic).” Ideally, pancreatic cancer cells can be detected early and the patient can be treated surgically, but once the cancer has spread, it is usually incurable. A popular clinical tool used to detect pancreatic cancer “is a tumor marker called sialylated Lewis blood group antigen CA19–9, which can act as a sensitive tumor marker, value diminishes when used to detect small, resectable tumors (Maitra,

Usually, radiation therapy is treated by neoadjuvant, adjuvant or definitive treatment with systemic therapy. Around 20% to 80 % of the patients with cancer received radiation therapy through the way of their treatment (de Gonzalez et al., 2011). In this treatment the radiation is usually given along with chemotherapy, which is recognized as chemoradiation or chemoradiotherapy. The Duke University conducts investigational study of neoadjuvant radiation therapy in 96 resectable patients. Everyday patients who received 50.4 Gy dose of radiotherapy are combined with 5-FU-based chemotherapy. After this patients were then surgically findout if there was no evidence of metastatic disease and less mortality. Overall survival (OS) and median survival was (28%:23 months) respectively (Spitz et al., 1997; White and Tyler, 2004). In 1980’s The Gastro-intestinal Tumor Study Group (GITSG) conducted randomized study in purpose of adjuvant chemoradiotherapy in resected pancreatic cancer. After R0 resection 49 patients were treated with chemorediotherapy for evaluation of adjuvant

Signs and Symptoms from early to late stages include; Dark urine, pale stools, and yellow skin and eyes from jaundice, Nausea and vomiting, frequent bowel movement, Pain in the upper part of your belly and pain in the middle part of your back, relieved by a shift in position, Others may include weakness or feeling very tired with loss of appetite or feelings of fullness and weight loss. Pancreatic cancer can be diagnosis by having a blood tests, CT scan, an x-ray, ultrasound and endoscopy. Physical exam may examine abdominal changes in areas near the pancreas, liver,

The one-year survival rate for pancreatic cancer is 20 percent, according to pancreatic.org. The five-year survival rate is only 6 percent.

However these treatment options are not the most effective. According to Andraka, we have used the same ineffective method for testing pancreatic cancer for the past 60 years. When tested, “over 85 percent of all pancreatic cancers are diagnosed late, when someone has less than a two percent chance of survival.” “ it’s extremely expensive costing 800 dollars per test, and its grossly inaccurate, missing 30 percent of all pancreatic cancers” (Andraka). Assuming someone gets diagnosed in time a general surgeon would try their best to save the life of the patient. The most common procedure performed by a general surgeon to remove a pancreatic tumor is a pancreaticoduodenectomy, more commonly referred to as a whipple. “In a standard whipple procedure, the surgeon removes the head of the pancreas, the gallbladder, part of the duodenum which is the Upmost portion of the small intestine, a small portion of the stomach called the pylorus, and the lymph nodes near the head of the pancreas, the surgeon then reconnects the remaining pancreas and digestive organs so that the pancreatic digestive enzymes, bile, and stomach contents will flow into the small intestine during digestion” (“Whipple”). Of course with every surgery there are risks of complications, in the

Context: Surgical resection remains the primary and the only potentially-curative treatment for pancreatic carcinoma. However, aggressive multi-visceral surgical option in the presence of locally-advanced disease is controversial.

In August 2009 M.W. a 56 year old female, was diagnosed with a stage II-B adenocarcinoma of the pancreatic head, ductal type, with perinueral invasion, with two of nine lymph nodes involved by direct extension and positive margin. Shortly after diagnosis, she received the Whipple procedure followed by treatment with gemcitabine and 5FU chemoradiation. She was diagnosed later with a regional cancer recurrence in the retro portal space nestled between the portal vein, the inferior vena cava, the superior mesenteric artery, and the left renal vein. It is possible this recurrence was nodal in origin rather than in the autonomic neural sheath surrounding the artery which is the typical region of recurrence. Subsequently, she was treated with six cycles of Folifirinox with 5FU adjuvant followed by an additional four cycles ending in May of 2012. Following this treatment, a CT scan showed improvement of her disease. A few months later she received a partial cycle of Abraxane with Gemcitabine. In the first few months of 2014, she was enrolled in a

Stage IA: There is a very small amount of cancer, it can only be seen under a microscope.

Clinical Staging determines how much cancer there is based on the physical examination, imaging tests, and biopsies of affected areas.

Pancreatic cancer tumors are staged according to tumor-node-metastasis (TNM) classifications of the American Joint Committee on Cancer (AJCC). The staging of tumors is based on tumor size and localization, and connected to resectability. 19 Further staging reflect whether lymph node metastasis (N stage) or distant metastasis (M stage) are present. Tumor stage, nodal stage and distant metastasis are combined into stages which tell about the overall disease. See Table 1 for complete overview of this staging strategy. 19

In stage II, [3] The tumor has spread to 1 to 3 the lymph hubs and encompassing organs of the colon, however, has not spread to different parts of the body. Stage III, cancer spreads to distant parts of the body, such as the liver or lungs.[1] Treatment in this phase is surgery, but your doctor may recommend adjuvant chemotherapy after surgery if your cancer has a higher risk of recurring.

This is due to the invasive ability of pancreatic cancer cells during the early stages of carcinogenesis. Therefore, a majority of patients diagnosed with pancreatic cancer often results in death due to metastatic disease, even after treatment, making it very complex and difficult to treat (2).

Data management and statistical analysis by SPSS software version 13 was used. Baseline laboratory markers were expressed as mean ± standard deviation (SD) or standard of error (SE) when appropriate. Progression free survival and overall survival were analysed by the Kaplan-Meier method. Paired t test was used to compare AFP, size and number of focal lesions after therapy. ANOVA test was used when appropriate, P< 0.05 indicating statistically significance result.