Pancreatic Cancer

Pancreatic Cancer

The pancreas, a small gland located deep in j the abdomen, has two vital functions: It sup-plies the intestines with digestive juices; and it secretes hormones-including insulin-that regulate the body's use of sugars and starches. Endocrine cells in the pancreas are devoted to hormone regulation; they form clusters called islets and are found mostly in the tail and body sections of the gland. Exocrine cells, which outnumber endocrine cells 99 to 1, are spread throughout the gland and perform the digestive functions.

At least 90 percent of pancreatic cancers are exocrine cell cancers, usually originating in the head of the gland. Endocrine cell cancers-or islet cell carcinomas-are slower growing, generally more treatable, and quite rare. Because early pancreatic cancers cause few symptoms, and because indicators of most pancreatic cancer may be misattributed to more benign digestive disorders, the disease is rarely detected before it has spread to nearby tissues or distant organs through the bloodstream or lymphatic system. A few rare types of endocrine cell cancer are likely to be detected early, because they produce abnormal quantities of hormones that cause telltale hormonal imbalances.

Like many other cancers, pancreatic cancer is characteristically a disease of the elderly, usually striking after age 60. It is more commonly diagnosed in men than in women, and most cases are incurable. The incidence of pancreatic cancer has risen with an increase in the average life span, causing some 27,000 new cases and about the same number of deaths annually in the US, making it one of the leading cancer killers.

Causes
Aside from advanced age, smoking is the main risk factor for pancreatic cancer; a smoker is three times more likely than a nonsmoker to acquire the disease. People frequently exposed to certain petroleum products may also be at increased risk. Excessive dietary fat and protein may promote the disease. Diabetes is also linked to pancreatic cancer: 10 to 20 per cent of patients diagnosed with pancreatic cancer also have diabetes. Other diseases associated with pancreatic cancer include hereditary pancreatitis, an inflammatory pancreatic problem; Gardner's syndrome, characterised by growths within and outside the colon; neurofibromatosis, or elephant man's disease; and multiple endocrine neoplasia, a condition that promotes growth of benign islet cell tumors; all these conditions are hereditary.

Diagnostic and Test Procedures
To check for tumors in the pancreas, a doctor relies on imaging studies of the gland. The most common tests are sonograms and CT scans of the abdomen. If necessary, detailed images are obtained by inserting an endoscope through the mouth to the pancreas, injecting dye, then taking X-rays. A tissue sample for biopsy can also be extracted through the scope. If a biopsy confirms cancer, further tests are done to determine how far the disease has advanced. Sometimes exploratory surgery is necessary so the surgeon can study the tumor directly, determine if nearby lymph nodes are cancerous, and take tissue samples for microscopic examination.

Conventional Medicine
Because most cases of pancreatic cancer are advanced when diagnosed, cure is rarely a realistic goal. Instead, treatment usually aims to extend survival and relieve uncomfortable symptoms. Surgery may cure the cancer, but only if it has not spread beyond the pancreas. If possible the surgeon removes the malignant tumor, leaving as much of the pancreas as possible to allow continued function. More often, however, the entire pancreas must be removed. Then the patient must have a lifelong regimen of replacement enzymes and hormones, including insulin.

Depending on the type of cancer, patients may also be administered radiation or chemotherapy treatments, either after surgery in an effort to extend survival time, or as a means of relieving symptoms. Exocrine cell cancer responds best to radiation, sometimes in combination with chemotherapy, while endocrine cell cancer responds best to chemotherapy. Prescription medication, usually including narcotics, is given to help manage the pain that is common with advanced pancreatic cancer.

Complementary Therapies
For many advanced pancreatic cancer sufferers, pain is significant. Besides taking prescription medication, patients can try pain control through massage, acupuncture, and biofeedback training, as well as such relaxation techniques as guided imagery and self-hypnosis.

Prevention
Pancreatic cancer is not easily prevented, but you can take measures to reduce your risk. If you work around petroleum products, take precautions to avoid unnecessary exposure to both materials and fumes. And if you smoke, quit now.

Symptoms
Pancreatic cancer usually produces no symptoms until it reaches an advanced stage: Symptoms that may arise, in typical order of occurrence, include:

Nausea, vomiting, loss of appetite, and weight loss:

A few rare types of pancreatic cancer cause hormonal imbalances that produce their own symptoms, which might' include:

Call Your Doctor If:
Any symptoms listed above endure longer than two weeks. You should have a full physical examination.

Submitted By
Dr. Akhteruzzaman
The author is a surgeion practising in New York

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