Advanced Pancreatic Cancer
Advanced pancreatic cancer is a term used to refer to cancer of the pancreas that has spread to other organs or body parts, or that has returned after an initial remission. This stage is called metastatic or Stage 4. Advanced cancer in any region of the body is difficult to treat, but with pancreatic cancer it is nearly impossible to cure. There are, however, treatments designed to deal with the cancer's symptoms in order to ease the patient's last months.
The symptoms of advanced pancreatic cancer are nonspecific and can be mistaken for symptoms of other disorders such as gallbladder blockage or infection, or pancreatitis. This further complicates matters, for any delay in diagnosis decreases the chances for a good prognosis. Depending on the area of the pancreas that the tumor grows on, the symptoms can range from absent to severe.
Tumors that grow in islet cells or other cells of the pancreas that produce hormones cause problems with glucose metabolism. The growths interfere with the creation of insulin either by destroying the cells that create it or making the hormone themselves (tumors called insulinomas do this). This causes problems with glucose level control.
Diabetes, though a disorder in its own right, is a symptom of these tumors. To control this symptom, doctors prescribe insulin therapy. If the diabetes is severe, insulin injections are used instead of pills or diet control. Blood sugar levels must be controlled before further treatment, so it is important that the controls are successful. If the tumor grows in cells that make other hormones, symptoms differ. They can range from behavioral changes to coma. Treatments depend on the hormone being secreted and are designed to compensate for its elevated levels. If the advanced pancreatic cancer tumor is on the head of the pancreas, it can block the bile duct. The duct is a small pipe that brings bile from the liver to the duodenum, or upper section of the small intestine. When this occurs, bile pigments from the substance bilirubin accumulate in the blood and are deposited in the skin and whites of the eyes, causing a yellow hue. This is called jaundice. Severe itching sometimes accompanies it. Bile acids are thought to cause this symptom as they build up in the skin. To treat it doctors perform a surgical bypass. Because removing the tumor has almost no benefits, surgeons simply reroute the bile's course by attaching part of the bile duct to the small intestine. This allows the bile to enter the digestive system and do its job. Small tubes called stents placed inside the bile duct serve the same purpose. They are best for people with advanced cancer or who are very weak. Pain is the most common symptom experienced by advanced pancreatic cancer sufferers. As the tumor grows, it presses against the surrounding nerves. This causes back and/or abdominal pain. Sometimes it the pain can be so severe as to require surgery to block the nerve pain impulses. Other times alcohol is injected into some the affected nerves to stop the pain. Normally, though, medications are enough. Though advanced pancreatic cancer is usually terminal, a patient need not be miserable through his or her last years. Knowing the options and discussing them with your doctor is the best way to plan a course of treatment to make the last months more comfortable.
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