Pancreatic Cancer

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Pancreatic Cancer

• Niaz Adu, Elizabeth Davis, Deedy Johnson, Belinda
  Johnson and Susan Lacey

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Pancreatic Cancer

• Pancreatic cancer occurs when cells in your
  pancreas develop genetic mutations. These
  mutations cause the cells to grow uncontrollably
  and to continue living after normal cells would
  die. These accumulating cells can form a tumor.
• Pancreatic cancer often has a poor prognosis,
  even when diagnosed early. Pancreatic cancer
  typically spreads rapidly and is seldom detected
  in its early stages, which is a major reason why
  it's a leading cause of cancer death. Signs and
  symptoms may not appear until pancreatic cancer
  is quite advanced and surgical removal isn't
  possible

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Types of Pancreatic Cancer

• Cancer that forms in the pancreas ducts
  (adenocarcinoma). Cells that line the ducts of
  the pancreas help produce digestive juices. The
  majority of pancreatic cancers are
  adenocarcinomas. Sometimes these cancers are
  called exocrine tumors.
• Cancer that forms in the hormone-producing cells.
  Cancer that forms in the hormone-producing cells
  of the pancreas is called endocrine cancer.
  Endocrine cancers of the pancreas are very rare.
• The types of cells involved in a pancreatic
  cancer help determine the best treatment.

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Risk Factors

• Smoking-Cigarette smoking nearly doubles one's
  risk, and the risk persists for at least a decade
  after quitting.
• Family history About 10 percent of patients with
  pancreatic cancer report a family history of the
  disease.
• Diet A diet high in meat and fats is possibly
  associated with a higher risk of pancreatic
  cancer
• Advancing age Most patients diagnosed with
  pancreatic cancer are between the ages of 60 and
  80.
• Race African-Americans are more likely to
  develop pancreatic cancer than other races
• Diabetes
• Environmental factors (ex. Asbestos)
• Gingivitis

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Clinical Manifestations

• Signs and symptoms of pancreatic cancer often
  don't occur until the disease is advanced. When
  signs and symptoms do appear, they may include
• Upper abdominal pain that may radiate to your
  back
• Yellowing of your skin and the whites of your
  eyes (jaundice)
• Loss of appetite
• Weight loss
• Depression
• Bowel Obstruction
• Nausea and vomiting
• weakness

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How is it diagnosed?

• Ultrasound- sound waves can be used to form
  images of the abdomen that identify the presence
  of a tumor. Ultrasound is performed by placing a
  probe on the surface of the abdomen while looking
  at the image on the screen. This procedure is
  noninvasive and painless.
• CT scans- generate two-dimensional images of the
  body that can show whether cancer has invaded
  other tissues or organs
• MRI- technology that uses magnetic fields and
  radio waves to create detailed images of the
  pancreas. Designed to be highly sensitive, this
  technology can identify small abnormalities.
• ERCP- a thin flexible tube (endoscope) is passed
  down the throat, through the stomach and into the
  upper small intestine and dye is injected into
  the pancreas
• PTC -In this procedure a thin needle is inserted
  into the liver to deliver dye to the bile ducts.
• Biopsy- a small tissue sample collected by
  fine-needle aspiration (FNA) is examined under a
  microscope by a pathologist.
• Endoscopic Ultrasound- an ultrasound probe is
  passed through an endoscope into the stomach.
  Sound waves are directed toward the pancreas and
  a computer translates them into images

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Treatment

•  Right now only cancer found in the early stage
  can be cured. Most pancreatic cancer is found in
  the advanced stage because of the lack of
  symptoms. Most treatments are aimed at
  controlling the disease and to help clients live
  longer. Average survival from diagnosis is around
  3 to 6 months 5-year survival is less than
  5.  Because of this there are many clinical
  trials. 
• Treatment depends on where in the pancreas the
  cancer is and how much it has spread.  It is
  treated with surgery, chemo, or radiation,
  sometimes a combination of these.
• Surgery provides the most effective treatment,
  only 15-20 of clients have tumors that are
  operable

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Types of Surgery

• Whipple procedure- if tumor is in the head,
  surgery removes the head of the pancreas and part
  of the small intestines, bile duct, and stomach.
• Distal pancreatectomy- surgery removes the body
  and the tail of the pancreas also removes the
  spleen
• Total pancreatectomy surgery removes the
  entire pancreas, part of the small intestine, a
  portion of the stomach, common bile duct,
  gallbladder, spleen, and nearby lymph nodes.
• Post surgery- client will be fed by IV and
  through feeding tubes they can slowly resume
  eating solid foods. Radiation is used often
  before and after surgery. Chemotherapy is mostly
  used after surgery. Some studies show this
  increases survival rates.

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Other Treatments

• Radiation -If used alone has little effective on
  survival but is used mostly to relieve pain. Last
  approximately 5 days a week for several
  weeks. External and internal radiation are used.
•  Chemotherapy -This can be done out treatment or
  in treatment because of severe side effects.
•  If cancer is locally advanced, then radiation
  with chemotherapy are used, and life span is
  approximately 6-12 months.
• Advanced cancer usually treated with chemotherapy
  agents alone

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Statistics in the U.S.

• Approximately 30,000 new cases of pancreatic
  cancer are diagnosed each year in the United
  States
• Because of the lethality of the disease, the
  number of deaths per year from pancreatic cancer
  is almost identical.
• The overall incidence of pancreatic cancer is
  approximately 8-10 cases per 100,000 persons per
  year.
• The incidence of pancreatic cancer in males has
  been slowly dropping over the past 2 decades,
  while the incidence in females has increased
  slightly.

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Statistical Chart
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Statistics Internationally

• Worldwide, pancreatic cancer ranks thirteenth in
  incidence but eighth as a cause of cancer death.
• The highest incidence rate is approximately 13
  cases per 100,000 persons per year in black males
  in the United States
• Native Hawaiian males and men of Korean, Czech,
  Latvian, and New Zealand Maori ancestry also have
  high incidence rates, ie, 11 cases per 100,000
  persons per year.
• Most other countries have incidence rates of 8-12
  cases per 100,000 persons per year.

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International Mortality
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Nursing Diagnosis

• Acute pain
• Imbalanced nutrition Less than body requirements
• Nausea

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Nursing Interventions

• Pain management is the priority intervention.
  Generally, large doses of opioids (for example,
  morphine) are given.
• Provide postoperative care as appropriate.
•          Monitor NG and surgical drainage
  (serosanguineous initially). Protect sites of
  anastomosis.
•          Place the client in semi-Fowlers
  position to facilitate lung expansion and to
  prevent stress on suture line.
•          Provide IV replacement of fluid and
  blood losses as appropriate.
• Assess breath sounds and respirations and
  facilitate deep breathing. Encourage use of
  incentive spirometer and administer oxygen as
  needed.
• Monitor glucose levels and administer insulin as
  prescribed.
• Provide nutritional support (for example, enteral
  supplements).

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Complications and Interventions

• Venous thromboembolism-The most common
  complication of pancreatic cancer. Monitor pulses
  and for areas of warmth and tenderness.
  Administer anticoagulants as prescribed.
• Fistulas-Possible complication of Whipple
  procedure due to breakdown of a site of
  ananstomosis.
• Peritonitis-Internal leakage of corrosive
  pancreatic fluid. Monitor for s/s of peritonitis
  such as elevated fever, WBC, abdominal pain,
  abdominal tenderness/rebound tenderness,
  alteration in bowel sounds, and shoulder tip
  pain. Provide antibiotics as prescribed