Pancreatic Cancer

Anatomy & Physiology Review

  • Location & Structure

    • Pancreas sits posterior to the stomach in the upper abdomen.

    • Four anatomical segments: head, neck, body, tail.

  • Dual (Mixed) Function

    • Exocrine component

    • Acinar cells → secrete digestive enzymes (amylase, lipase, proteases) into the pancreatic duct → duodenum.

    • Endocrine component

    • Islets of Langerhans → secrete metabolic hormones (insulin, glucagon) directly into the bloodstream.

Types of Pancreatic Cancer

  • Pancreatic adenocarcinoma (≈ 90–95 %)

    • Originates from the exocrine epithelium.

  • Pancreatic neuroendocrine tumors (rare)

    • Derive from endocrine islet cells.

Risk Factors

  • Modifiable

    • Cigarette smoking.

    • Excessive alcohol intake.

    • Chronic pancreatitis.

    • Diabetes mellitus.

    • Obesity.

    • Diet rich in processed meats.

  • Non-modifiable

    • Increased age.

    • Assigned male at birth.

    • Family history of pancreatic cancer.

    • Inherited mutations (e.g., BRCA, PALB2).

Pathophysiology & Tumor Progression

  • Mutations in an exocrine cell → loss of normal cell-cycle control → uncontrolled proliferation.

  • Tumor most commonly arises in the head; less often in body/tail.

  • Angiogenesis supplies the growing mass.

  • Local invasion: bile duct, duodenum, stomach.

  • Regional spread: peripancreatic lymph nodes.

  • Distant metastasis: especially the liver via hematogenous route.

Clinical Manifestations

  • General / Early

    • Fatigue.

    • Unintended weight loss.

    • Nausea & vomiting.

    • Epigastric pain radiating to the back.

    • Malabsorption → diarrhea (↓ pancreatic enzymes).

    • New-onset diabetes mellitus (↓ insulin output).

  • Location-specific

    • Head/Neck tumors

    • Compression of common bile duct → biliary obstruction.

    • Steatorrhea (foul-smelling, greasy stools) from fat malabsorption.

    • Obstructive jaundice: yellow skin/sclera/mucosa, pale stools, dark urine.

    • Courvoisier sign: enlarged, palpable, nontender gallbladder.

    • Body/Tail tumors

    • Generally silent until advanced; do not produce biliary obstruction.

Diagnostic Evaluation

  • History & focused physical examination.

  • Laboratory Findings (non-specific)

    • Possible ↑ serum amylase & lipase.

    • Tumor markers: CA 19-9, CEA.

    • If jaundiced: ↑ bilirubin and alkaline phosphatase (ALP).

  • Imaging Studies

    • Abdominal ultrasound, CT, MRI, endoscopic ultrasound/retrograde cholangiopancreatography.

    • Used for staging (T/N/M), mapping resectability, lymph node involvement, metastasis.

  • Definitive diagnosis = tissue biopsy of the suspicious lesion.

Treatment Overview

  • Prognosis: generally poor, because most tumors are advanced at diagnosis.

  • Localized / Resectable disease

    • Surgical resection is mainstay.

    • Whipple procedure (pancreaticoduodenectomy) for head lesions.

    • Partial or total pancreatectomy for body/tail or extensive disease.

    • Chemotherapy

    • Neoadjuvant: shrink tumor pre-op.

    • Adjuvant: eradicate residual disease post-op.

  • Unresectable / Metastatic disease or non-surgical candidates

    • Systemic chemotherapy ± radiation.

    • Palliative care: opioid analgesics, antiemetics, nutritional & psychosocial support.

Nursing Care

  • Goals: symptom control, complication monitoring, quality-of-life promotion.

Pain Management

  • Perform comprehensive pain assessment (onset, quality, severity, location, aggravating/relieving factors, frequency).

  • Position for comfort, use non-pharmacologic measures.

  • Administer prescribed analgesics; escalate & report if pain is uncontrolled.

Nutritional Support

  • Baseline assessment: weight, nausea/vomiting pattern, current intake.

  • Provide ordered TPN, enteral formulas, or oral diet as tolerated.

  • Administer pancreatic enzyme supplements with all meals/snacks.

  • Give antiemetics per schedule or PRN.

Surgical (Whipple / Pancreatectomy) Post-op Care

  • Usual resection removes: head of pancreas, gallbladder, part of duodenum & common bile duct, regional nodes; remaining structures anastomosed to jejunum.

  • Interventions

    • Semi-Fowler’s to ↓ tension on suture & anastomosis.

    • Maintain IV fluids ➔ correct fluid/electrolyte deficits.

    • NG tube on low intermittent suction; monitor patency & drainage; keep patient NPO until cleared.

    • Biliary drainage tube in dependent position; record color, consistency, volume.

    • Report any:

    • Bloody / clear / bile-tinged leakage (possible anastomotic breakdown).

    • Signs of fistula / peritonitis: board-like abdomen, severe pain, fever.

Glycemic Monitoring

  • Check blood glucose regularly; pancreas removal or dysfunction → labile glucose.

  • Administer insulin as prescribed for hyperglycemia.

Care Coordination

  • Collaborate with case manager for home health, palliative, hospice resources.

  • Facilitate family conferences, advance-care-planning discussions.

Client & Family Teaching

  • Pathophysiology: tumor disrupts both digestive enzyme output & hormone regulation; therapy targets symptom relief & life prolongation.

  • Diet strategies

    • 5–6 small meals/day.

    • Eat when energy highest; consume nutrient-dense foods first.

  • Expected side effects: nausea, vomiting, early satiety.

  • Medication self-management

    • Timing, dosing, side-effects of analgesics, antiemetics, pancreatic enzyme capsules, insulin, chemotherapy agents.

  • Post-surgical home care

    • Site observation: redness, swelling, warmth, drainage.

    • Monitor biliary tube output; report blood immediately.

  • Support resources

    • Local cancer support groups, nutrition services, counseling, hospice.

Ethical / Practical Considerations

  • Prognostic honesty balanced with hope; emphasize quality of life.

  • Early palliative care referral improves symptom control & family coping.

  • Genetic counseling for relatives (BRCA, PALB2 mutations).

Quick Recap / High-Yield Points

  • Pancreatic cancer = highly aggressive, poor 5-year survival.

  • Major risks: smoking, alcohol, chronic pancreatitis, obesity, diabetes, processed meat diet, family/genetic syndromes.

  • Classic triad (head lesions): weight loss + epigastric/back pain + obstructive jaundice.

  • Work-up: ↑ CA 19-9, imaging (CT/MRI), confirm with biopsy.

  • Whipple is curative only if localized; otherwise systemic chemo + palliation.

  • Nursing: pain control, nutritional support, meticulous post-op monitoring, glycemic management, holistic & palliative focus.