pancreatic cancer

list risk factors for pancreatic cancer?

modifiable: smoking or smokeless tobacco, heavy alcohol consumption, diabetes, chronic pancreatitis, diet, obesity

non-modifiable: age, sex, race, inherited genetics

what are the parts of the pancreas?

the head, body, and tail

describe pancreatic cancer

most pancreatic cancers are adenocarcinoma

cancer spreads to ly mph nodes, then commonly to the liver

are very often fatal within 1-3 yrs after diagnosis

what are the manifestations of pancreatic cancer?

usually presents late

early signs are vague:

1. jaundice, clay colored stools, dark urine

2. unexplained weight loss, anorexia, nausea

3. early satiety

4. fatigue

5. abdominal, back pain

   1. new onset diabetes gas, fatty stools

what diagnostic testing is done for pancreatic cancer?

abd ultrasound

contrast enhanced CT scna

MRI

ERCP

tissue biopsy

may require stent insertion

lab testing: elevated bilirubin, elevated liver function tests, anemia, elevated CA 19-9

what are the treatments for pancreatic cancer?

surgery, chemo, radiation

describe surgery for pancreatic cancer

only 20% of patients are eligible

decision to have surgery:

1. done for a tumor that is local

2. tumors that are in the head of the pancreas

3. no metastasis

4. comorbidities of the patient

5. proximity of tumor to the major blood vessels

even with surgery, the risk of recurrence is high

what is a pancreaticoduodenectomy?

removes the head of the pancreas

removes the duodenum and a portion of the common bile duct, gall bladder and sometimes part of the stomach

the remaining intestine bile duct and pancreas are reconnected

also called a Whipple procedure

what is care post Whipple procedure?

routine: pain control, pulmonary, ear ambulation, wound assessments

semi fowlers

monitor for hyperglycemia

assess for signs of sepsis

monitor for bleeding

NG tube to low continuous suction

I/O including gastric suction

what radiation is done for pancreatic cancer?

used in combination with chemotherapy and surgery to eliminate any remaining cancer cells

can shrink locally advanced tumors so that surgery can be performed safely

used to relieve pain and other symptoms of metastatic disease

what is chemotherapy for pancreatic cancer?

may be used prior to surgery to decrease tumor size

may be give after surgeyr

can be given concurrently with radation

chemo agent given depends on: current research evidence, expected toxicities, potential benefits, comorbidities, age and performance status

what are issues that can occur with pancreatic cancer?

pain, nutrition, fatigue, bowels, sleep, SOB, symptoms management, education and advocacy

what are issue specific to pancreatic cancer?

enzymatic needs

cachexia/food issues: high calories, low fat, small frequent meals

jaundice

glucose monitoring