Pancreatic Tumor

Pancreatic Cancers

Overview of Pancreatic Tumors

  • The pancreas is comprised of various cell types.

  • Pancreatic cancer is the 4th leading cause of cancer death in men and the 5th in women.

  • Diagnosis is rare before the age of 45, but the incidence increases with age, with slight decreases in Caucasian men and increases in African American men.

  • Risk factors include:

    • Smoking

    • Diet high in fatty foods and meats

    • Exposure to environmental toxins.

  • Between 85% to 95% of pancreatic tumors are cancerous.

Types of Pancreatic Cancer

Adenocarcinoma

  • Accounts for 85% to 95% of pancreatic tumors, characterized by cancer appearing anywhere in the pancreas but predominantly in the head.

  • The survival rate is low, with only 5% surviving for 5 years regardless of the diagnosis stage.

Associated Conditions

  • Diabetes Mellitus

  • Chronic pancreatitis

  • Hereditary pancreatitis

  • The pancreas can also be a site for metastasis.

Symptoms of Pancreatic Cancer

  • Classic signs include:

    • Pain

    • Jaundice

    • Pruritus (due to bile salt release)

    • Weight loss

    • Rapid weight loss

    • Severe pain that worsens in a supine position at night.

  • Common late-stage symptoms:

    • Ascites

    • Symptoms of insulin deficiency such as glucosuria, hyperglycemia, abnormal glucose tolerance tests (GTT), and diabetes mellitus (DM).

Risk Factors for Pancreatic Carcinoma

  • Predisposing factors include:

    • Age (over 50)

    • Average age of diagnosis is 55.

    • Male gender

    • Ethnicity: African American

    • Smoking history

    • Diets low in fruits and vegetables

    • Diets high in red meat

    • Obesity

    • Diabetes Mellitus

    • Chronic pancreatitis

    • Infection with H. pylori

    • Occupational exposure to chemicals

    • Personal or family history of pancreatic cancer

    • Gingivitis or periodontal disease potentially linked to chronic inflammation and bacterial strains.

    • Alcohol consumption.

Clinical Features and Signs

  • Symptoms often do not manifest until the cancer is advanced, including:

    • Pain in the upper abdomen radiating to the back, relieved by leaning forward

    • Loss of appetite

    • Nausea

    • Vomiting

    • Jaundice

    • Steatorrhea (fatty stools)

    • Depression

    • Trousseau Syndrome (recurrent thrombophlebitis).

Trousseau Syndrome Explained

  • Also known as Trousseau's Syndrome, it involves episodes of vessel inflammation due to recurrent blood clots (thrombophlebitis).

  • It is characterized by migratory thrombosis, especially in superficial veins and unusual sites, and is often associated with pancreatic, lung, and gastric cancers.

Diagnosis of Pancreatic Cancer

  • Diagnosis involves:

    • Detailed history and physical examination

    • Imaging tests:

    • Spiral CT (most accurate)

    • MRI

    • Endoscopic ultrasound (US) for small tumors

    • Fine-needle aspiration biopsy (FNAB)

    • US guided CT and ERCP (endoscopic retrograde cholangiopancreatography)

    • Blood tests:

    • CA 19-9 (cancer antigen)

    • CEA (carcinoembryonic antigen) - Note: these are non-specific tests for pancreatic cancer.

Treatment Options

Surgical Interventions

  • Surgery, particularly if the cancer is localized and resectable (typically in the head of the pancreas). Options include:

    • Whipple Procedure (pancreaticoduodenectomy)

    • Cholecystectomy

    • Partial gastrectomy

    • Resection of the head of the pancreas and proximal jejunum along with the distal common bile duct.

    • Anastomosis of the remaining pancreas and stomach to the jejunum.

    • There are many side effects associated with these procedures, and candidacy is determined on an individual basis.

Additional Treatments

  • Chemotherapy and radiation are generally ineffective, but agents include:

    • 5-FU

    • Leucovorin

    • Gemzar (often used for metastatic cases).

  • Radioactive seed implantation during surgery.

  • Nutritional support through supplements or Total Parenteral Nutrition (TPN).

Prognosis

  • Median survival post-diagnosis ranges from 3 to 6 months.

  • The survival rate is under 5% at the 5-year mark.

  • Approximately 60-80% of patients have locally advanced cancer due to its tendency to invade surrounding tissues.

Nursing Management

  • Focus on pain management and nutritional support.

  • Implement specialty mattresses and skincare protocols to address profound weight loss and muscle wasting:

    • Regular input and output (I&O) monitoring

    • Daily weight checks and laboratory tests

  • Pre-operative and post-operative educational support needs depend on the procedures.

  • Post-radiation, post-chemotherapy, and post-surgical care should be addressed.

  • Consideration for palliative care and decision-making assistance is also paramount.

Cystic Pancreatic Tumors

General Information

  • Cystic tumors constitute only 2% of pancreatic tumors and are characterized by fluid accumulation.

Classification of Cystic Tumors

  1. Mucinous Cystadenomas

    • Benign; lined by mucinous epithelium.

    • Comprise about 50% of all cystic tumors and may develop into cancer if untreated.

    • Occur mainly in females, with diagnosis typically made via CT scanning. Surgical removal is the preferred treatment.

  2. Serous Cystadenoma

    • Often benign, typically found in the head of the pancreas.

    • Demonstrates a honeycombed appearance on CT scans; treatment is usually watchful waiting unless symptomatic.

  3. Mucinous Ductal Ectasia

    • Characterized by cancer cells that produce thick mucus, often resulting in blockage of pancreatic ducts and recurrent pancreatitis.

    • Typically affects men over 60 and heavy smokers, with diagnosis made during ERCP. Treatment is surgical if health permits, otherwise conservative management is advised.

Endocrine Tumors

Overview

  • Pancreatic endocrine tumors arise from different pancreatic cells producing hormones; they may or may not be cancerous.

Types of Endocrine Tumors

  1. Insulinoma

    • Secretes insulin; only 10% are malignant.

    • Symptoms: Hypoglycemia, headache, confusion, vision abnormalities.

    • Diagnosis relies on laboratory tests, and treatment typically involves surgical removal or chemotherapy if complete removal is possible.

  2. Gastrinoma

    • Found in the pancreas or duodenum, producing excessive gastrin leading to peptic ulcers and Zollinger-Ellison syndrome.

    • Diagnosis through CT, PET scan, US, and serum gastrin levels.

    • Treatment includes high-dose proton pump inhibitors (PPIs), surgical removal, total gastrectomy, or chemotherapy when necessary. Fatal prognosis if cancerous.

  3. Vipoma

    • Produces vasoactive intestinal peptide (VIP); with 50-75% being cancerous, symptoms include massive diarrhea leading to malnutrition and electrolyte imbalances.

    • Diagnosis through elevated VIP levels and radiographs; treatment focuses on fluid and electrolyte replacement and temporary surgery, with chemotherapy generally ineffective and palliation emphasized.

  4. Glucagonoma

    • Characterized by excessive glucagon secretion, with 80% being malignant.

    • Symptoms: Diabetes mellitus and a distinct brownish-red skin rash, particularly affecting the groin area and moving to other body parts.

    • Diagnosis via high serum glucagon levels and imaging studies; treatment typically involves surgical removal if feasible, otherwise chemotherapy for symptom management and palliative care.

Conclusion

  • Understanding the various types of pancreatic cancers, their symptoms, diagnosis, treatment options, and nursing care is crucial in managing this severe form of cancer. Its complexity necessitates comprehensive knowledge for effective patient care and support.