Pancreatic Cancer

1. Pancreatic Cancer Niaz Adu, Elizabeth Davis, Deedy Johnson, Belinda Johnson and Susan Lacey

2. 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

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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.

9. 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

10. 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.

11. Statistical Chart

12. 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.

13. International Mortality

14. Nursing Diagnosis • Acute pain • Imbalanced nutrition: Less than body requirements • Nausea

15. 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-Fowler’s 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).

16. 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