Pancreatic Tumors: A Case Study

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,

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

Staging is the process of finding out how much cancer there is in the body and where it is located. It is how the doctor learns the stage of a person's cancer. Doctors use this information to plan treatment and to help predict a person's outlook (prognosis). Cancers with the same stage tend to have similar outlooks and are often treated the same way. The cancer stage is also a way for doctors to describe the extent of the cancer when they talk with each other about a person’s case.

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

Stage III: The tumor cannot be completely removed with surgery, and some cancer remains in the abdomen; 20 to 25 percent of Wilms tumors are stage

Approximately 20% of pancreatic cancer is found to be operable or resectable. The complete resection of the primary lesion is best treatment for patients with localized pancreatic cancer. However the risk of both local and distal recurrence is high in following resection. In early stage pancreatic cancer the complete resection are associated with considerable morbidity in 40–60% of patients and mortality in less than 3% of patients (Sohn et al., 2000; Winter et al., 2006). Moreover, it takes 2–3 months for complete recovery to a normal quality of life. Although the 5-year survival rate of resected pancreatic cancer is approximately 20% and the median overall survival time is 17–27 months (Winter et al., 2006).

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

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,

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").

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.

Pathologic staging is likely to be more accurate that clinical (American cancer society, 2015). Pathologic staging is

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.

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.