References
Introduction
The pancreas in the human body is located behind the stomach and opposite spine. Its function is to produce the juices that assist in the breakage of food. It also produces certain hormones that help in controlling the levels of blood sugar. Pancreatic cancer generally commences in the cells that help in the juices’ production. Smoking, certain genetic disorders, chronic pancreatitis, and long-term diabetes are several risk factors associated with this disease. It is important to note here that “pancreatic cancer is the fourth leading cause of cancer-related death and has the highest case fatality rate” (Abbruzzese & Varadhachary, 2005).
Aetiology (Manner of Causation)
The occurrence of pancreatic cancer becomes apparent when pancreatic cells develop, break up, and multiply in an uncontrollable manner, resulting in the formation of a malignant tumor. It is still a mystery that how is pancreatic cancer caused. Scientists have remained unsuccessful in identifying the causes of pancreatic cancer. Even though a number of environmental factors are associated with this disease, tobacco use is the only evidence that has been identified for playing a causative role. Smokers have a higher risk of developing this disease as compared to nonsmokers. Greater tobacco use increases the risk of development of pancreatic cancer. When people are exposed to smoke for a longer period of time, they may also develop the symptoms of pancreatic cancer. It may also be caused when alcohol, coffee, and aspirin are consumed moderately. However, there is limited data related to these factors. Pancreatic cancer is also common in patients who have a diabetic history or had chronic pancreatitis in the past. The increase in pancreatic cancerous condition is also associated with “chronic cirrhosis, a high-fat, high-cholesterol diet, and previous cholecystectomy” (Hidalgo, 2010). It is important to mention here that patients who have A, AB, or B blood type have an increased risk of pancreatic cancer as compared to patients having blood type O.
Pathophysiology
Pancreatic cancer is a destructive and overwhelming disease, which is typified by insidiousness; speedy development and intense resistance to cure (Bardeesy & Depinho, 2202) There are a number of pathophysiological factors that contribute in the progression of pancreatic cancer. As the growth of pancreatic cancer is mostly noticeable around the digestive system, this condition demonstrates gastrointestinal symptoms for the most part. Abdominal pain is experienced by more than eighty percent pancreatic cancer patients. This pain intensifies with the growth of the tumor. However, there is inconsistency in the occurrence of pain. Some patients also experience a dreary ache in the upper abdominal part that radiates to the back. Bloating is also noticeable in patients with this disease. Other factors contributing in pancreatic cancer’s pathophysiology are diarrhea, nausea, and pale-colored stools. They may also have darker urine.
The growth and spreading out of tumor has a great effect on the patient’s whole body. Patients suffer loss of weight and appetite, malaise, and high levels of blood sugars. In some people, the pancreas does not produce the required amount of insulin due to cancer. As a consequence, such patients become diabetic (Eijgenraam, Heinen, Verhage, Keulemans, Schouten, & Brandt, 2013). On the other hand, it is to be remembered that the majority of people who are diagnosed with diabetes are not patients of pancreatic cancer. Skin problems are also evident in patients with pancreatic Cancer. Itching over the whole body and jaundice are the main pathophysiological factors associate with pancreatic cancer. Itching is caused by the bile ducts’ blockage.
Clinical Manifestations
It is difficult to fraught the early clinical identification and analysis of pancreatic cancer. It is an unfortunate fact that the initial signs and symptoms of this destructive disease are frequently rather unclear and slight in the beginning. As a result, these symptoms are often linked to other conditions or processes until the medical doctor has a high suspicious indication for the probability of primary pancreatic carcinoma (Wolfgang, Herman, Laheru, Klein, Erdek, Fishman, et al. 2013). As mentioned, patients usually report the slow but sure commencement of vague symptoms such as fatigue, malaise, anorexia, nausea, or back pain. Pancreatic cancer significantly causes weight loss. Patients with pancreatic cancer suffer from depression more commonly as compared to patients that have other abdominal tumors. It is important to mention here that depression is sometimes the most outstanding presenting cancerous symptom in several patients. This is the reason pancreatic cancer may devastate a person emotionally as well.
As mentioned earlier, pancreatic cancer is the fourth top reason that causes cancer deaths in the United States of America. As far as diagnosis of the disease is concerned, a majority of cases are diagnosed with distant metastasis. The most helpful tool for diagnosing and staging the disease is computed tomography. Additional information may be obtained by employing MIR (magnetic resonance imaging, ultrasonography, and ERC (endoscopic retrograde cholangiopancreatography). It is not possible to get the majority of tumors resected through surgical means due to presence of metastasis. In addition, resection becomes impossible as the major vessels associated with pancreas are invaded. However, tumors that are resectable can be treated by employing the Whipple procedure. It is also known as the pylorus-preserving Whipple procedure. The survival of pancreatic cancer patients may be prolonged by the use of adjuvant fluorouracil-based chemotherapy. Patients that have nonresectable tumors can extend their life span with the use of gemcitabine chemotherapy. Studies are also conducted to examine the effectiveness of other agents. Cancers that have advanced locally are also slowed down from progression by combining radiation with chemotherapy. Laboratory studies suggest that a comprehensive symptom control is needed by the pancreatic cancer patients throughout the disease and end-of-life care (Freelove & Walling, 2006).
Treatment Options and Interventions
It is not an untold secret that pancreatic cancer is one of the most fatal solid malignancies in the present times. Nevertheless, it is a fortunate fact that surgery for the resection of pancreatic neoplasms is safer and less persistent as compared to the resections done in previous times. In addition, “novel drug combinations have been shown to improve survival, advances in radiation therapy have resulted in less toxicity, and enormous strides have been made in the understanding of the fundamental genetics of pancreatic cancer” (Wolfgang, Herman, Laheru, Klein, Erdek, Fishman, et al. 2013). It is extremely important to mention that the mentioned advancements are a source of hope and expectation for survival. However, they also result in making patient-caring complex at the same time. There is no doubt that the most efficient and useful way for the management of patients with pancreatic cancer is multidisciplinary care (Sun, 2010). This treatment approach makes complete and synchronized assessment and treatment possible (Wolfgang, Herman, Laheru, Klein, Erdek, Fishman, et al. 2013).
Most recently, the role and use of endoscopy in diagnosing and managing pancreatic disorders has significantly increased. Several pancreatic disorders are therapeutically treated by using ERCP i.e. post-endoscopic retrograde cholangio-pancreatography. It includes pancreatitis treatment as well as pancreatic neoplasia treatment. Researchers and scientists are currently focusing on the improvement of this procedure to prevent post-ERCP pancreatitis (Wamsteker, 2014). It is worth-mentioning that treatment of pancreatic cancer has not made substantial improvements over the past many decades. The present treatment options do not have a great effect to prolong the survival time. For this reason, the mortality rate of pancreatic cancer may be reduced significantly with its prevention (Michaud, 2004). As far as future directions of treatment of pancreatic cancer are concerned, there is great probability of effective improvement in all treatment aspects. It is critical to make use of screening of individuals who have high risk of developing pancreatic cancer. This can be done by using innovative imaging methods or serum biomarkers in the initial diagnosis (Hidalgo, 2010).
References
Abbruzzese, J. L., & Varadhachary, G. R. (2005). Treatment of Pancreatic Cancer.US Oncology Review, 1(1), 1-5. Retrieved September 10, 2014, from http://www.touchoncology.com/articles/treatment-pancreatic-cancer
Bardeesy, N., & Depinho, R. A. (2002). Pancreatic Cancer Biology and Genetics.Nature Reviews Cancer, 2(12), 897-909.
Eijgenraam, P., Heinen, M. M., Verhage, B. A., Keulemans, Y. C., Schouten, L. J., & Brandt, P. A. (2013). Diabetes Type II, Other Medical Conditions and Pancreatic Cancer Risk: A Prospective Study in The Netherlands. British Journal of Cancer,109, 2924-2932.
Freelove, R., & Walling, A. D. (2006). Pancreatic Cancer: Diagnosis and Management. American Family Physician,73(3), 485-492. Retrieved September 10, 2014, from http://europepmc.org/abstract/MED/16477897
Hidalgo, M. (2010). Pancreatic Cancer.New England Journal of Medicine, 362(3), 1605-1617. Retrieved April 29, 2010, from http://www.nejm.org/doi/full/10.1056/NEJMra0901557
Michaud, D. S. (2004). Epidemiology of Pancreatic Cancer. Minerva chirurgica,59(2), 99-111. Retrieved September 10, 2014, from http://europepmc.org/abstract/MED/15238885
Sun, V. (2010). Update on Pancreatic Cancer Treatment. The Nurse Practitioner,35(8), 22-23.
Wamsteker, E. J. (2014). Endoscopic approach to the diagnosis and treatment of pancreatic disease. Current Opinion in Gastroenterology, 30(5), 524-530. Retrieved September 10, 2014, from http://europepmc.org/abstract/MED/25023381
Vincent, A., Herman, J., Schulick, R., Hruban, R. H., & Goggins, M. (2011). Pancreatic Cancer. The Lancet, 378(9791), 607-620.
Wolfgang, C. L., Herman, J. M., Laheru, D. A., Klein, A. P., Erdek, M. A., Fishman, E. K., et al. (2013). Recent Progress in Pancreatic Cancer. CA: A Cancer Journal for Clinicians, 63(5), 318-348.
