Lancaster Physician Spring 2020 - 18

L A N C A S T E R M E D I C A L S O C I E T Y.O R G

Best Practices

PANCREATIC CANCER
Risks, Treatment, Prognosis
ROBERT L. CONTER,
MD, FACS

General & Surgical Oncology
Specialists of Central PA

P

ancreatic cancer is a serious form
of cancer. But surgeries, like the
Whipple procedure (also known
as pancreaticoduodenectomy), are
becoming safer and more effective, offering
patients more hope than ever before.
The cause of pancreatic cancer (ductal
adenocarcinoma of the pancreas) in an individual is generally never fully known. A risk
factor is a variable that may tend to increase
an individual's risk of acquiring pancreatic
cancer. Who we are and what we do has some
effect on the diseases that we may contract.
However, there is still a great deal that we do
not understand about the cause and effect
of risk factors to pancreatic cancer.
Pancreatic cancer is more common in some
families, such as those that appear to carry
one of the BRCA genetic mutations. You
may have an increased risk if you have two
or more relatives who have had pancreatic
cancer or a parent, sibling, or child who
developed it before age 50. A person may
also be more likely to get pancreatic cancer
because of long standing diabetes, chronic
pancreatitis, smoking, African-American
descent, diets high in processed meats, and
obesity. Having many risk factors does not
necessarily mean that one will contract pancreatic cancer. Again, in many individuals,
we do not fully understood reasons why they
may have acquired the disease.
The incidence of pancreatic cancer
increases with age. Most people are between
the ages of 60 to 80 when they receive the
diagnosis. More than 57,000 Americans are
expected to be diagnosed with pancreatic

cancer in 2020. It is, however, the third
deadliest cancer, causing more than 45,000
deaths last year.
When cancer develops in the pancreas,
it can spread rapidly to other parts of the
body, so it is important to identify and
treat it quickly. But pancreatic cancer
is hard to find early. The pancreas is
deep inside the body, so early tumors
often can't be detected during routine
physical exams. People usually have
no symptoms until the cancer has spread
to other organs.
The symptoms of pancreatic cancer
vary with the location of the tumor in
the gland. The most common location
is in the "head" of the pancreas, near the
exit point of the stomach. Patients may
present with weight loss, jaundice (yellowing of skin and eyes), itching, nausea,
recent onset of diabetes, or dark urine and
clay-colored bowel movements. Diagnosis
involves blood tests, CT scans or MRIs,
and often an endoscopic ultrasound to
assess blood vessel involvement and to
obtain a pathologic diagnosis.
Surgery offers the best chance for cure.
Surgery for adenocarcinoma of the pancreas
is only offered to patients whose tumor is
localized and meets other criteria. Only
about 15 to 20 percent of individuals with
pancreatic cancer will be found to be initially
eligible for surgery. This is one reason why so
much effort is given in pre-operative testing
for pancreatic cancer to try to identify those
patients who may be good candidates for
surgery. Another reason for such care is

LANCASTER

18

PHYSICIAN

to avoid offering unnecessary surgery to
patients who would be best served by starting
medical treatment with chemotherapy or
radiation therapy. Patients who demonstrate
improvement after medical treatment may
then be re-evaluated for surgery.
The surgical operation, known as the
Whipple operation, is typically done for
patients who have tumors that are located
in the head of the pancreas or in regions
adjacent to the head of the pancreas. It
removes the head of the pancreas, where
most pancreatic tumors occur, as well as
the gallbladder, the duodenum, a portion
of the stomach, and the surrounding lymph
nodes.  The surgeon then reconnects the
remaining pancreas and digestive organs.
In experienced hands, the operative mortality is less than 1 percent. When identified
and treated early, pancreatic cancer survival
rates have approached greater than 25 percent
for five years.
The hidden location of the gland and
its often-atypical symptoms make it hard
to diagnose early and patients are, unfortunately, not diagnosed until later and not
able to initially be offered surgery. Research
is ongoing to find a blood test to detect
circulating tumor cells.
Although a diagnosis of pancreatic cancer
is a frightening diagnosis for patients to hear,
today there are more treatment options and
cures than ever. But treatment needs to be
start quickly. Talk to a surgeon immediately
to find out if the Whipple procedure is right
for your patient.



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