Dr. F.W. Nugent is a medical oncologist specializing in gastrointestinal cancers with a special interest in pancreatic cancer. Dr. Nugent graduated from Middlebury College with a bachelors degree in religion before graduating from Albany Medical College. He presently serves as vice-chairman of medical oncology at the Lahey Clinic in Burlington, Massachusetts.
Dr. Keith E. Stuart is a medical oncologist specializing in the study and treatment of cancers involving the gastrointestinal tract, with a special interest in tumors involving the liver. He was educated at Harvard University (graduating magna cum laude) and Albert Einstein College of Medicine and did his medical training at the New England Deaconess Hospital.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Once pancreatic cancer is diagnosed, it is "staged." Pancreatic cancer is
broken into four stages with stage I being the earliest stage and stage IV being
the most advanced (metastatic disease). Unlike many cancers, however, patients
with pancreatic cancer are typically grouped into three categories: those with
local disease, those with locally advanced unresectable disease, and those with
metastatic disease. Initial therapy often differs for patients in these three
groups.
Patients with stage I and stage II cancers are thought to have local or
"resectable" cancer (cancer that can be completely removed with an operation).
Patients with stage III cancers have "locally advanced unresectable" disease. In
this situation, the opportunity for cure has been lost but local treatments such
as radiation remain options. In patients with stage IV pancreatic cancer,
chemotherapy is most commonly recommended as a means of controlling the symptoms
related to the cancer and extending life. Below, we will review common
treatments for resectable, locally advanced unresectable, and metastatic
pancreatic cancer.
What is the treatment for resectable pancreatic cancer?
If a pancreatic cancer is found at an early stage (stage I and stage II) and
is contained locally within or around the pancreas, surgery may be recommended.
Surgery is the only curative treatment for pancreatic cancer. The surgical
procedure most commonly performed to remove a pancreatic cancer is a
"Whipple"
procedure (pancreatoduodenectomy). It often comprises removal of a portion of
the stomach, the duodenum (the first part of the small intestine), pancreas,
bile ducts, lymph nodes, and gallbladder. It is important to be evaluated at a
hospital with lots of experience performing pancreatic cancer surgery because
the operation is a big one and evidence shows that experienced surgeons better
select people who can get through the surgery safely and also better judge who
will most likely benefit from the operation. In experienced hands, mortality
from the surgery itself is less than 4%.
After the Whipple surgery, patients typically spend about one week in the
hospital recovering from the operation. Complications from the surgery can
include blood loss (anemia), leakage from the reconnected intestines or ducts,
or slow return of bowel function. Recovery to presurgical health can often take
several months.
After patients recover from a Whipple procedure for pancreatic cancer,
treatment to reduce the risk of the cancer returning is a standard
recommendation. This treatment, referred to as "adjuvant therapy," has proven to
lower the risk of recurrent cancer. Typically six months of chemotherapy is
recommended, sometimes with radiation incorporated into the plan.
Unfortunately, only about 20 people out of 100 diagnosed with
pancreatic cancer are found to have a tumor amenable to surgical resection. The
rest have tumors that are too locally advanced to completely remove or have
metastatic spread at the time of diagnosis. Even among patients who are amenable
to surgery, only 20% live five years.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
Muscle spasms are involuntary muscle contractions that come on suddenly and are usually quite painful. Dehydration, doing strenuous exercise in a hot environment, prolonged muscle use, and certain diseases of the nervous system may cause muscle spasms. Symptoms and signs of a muscle spasm include an acute onset of pain and a possible bulge seen or felt beneath the skin where the muscle is located. Gently stretching the muscle usually resolves a muscle spasm.
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. The causes of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting.
Itching can be a common problem. Itches can be localized or generalized. There are many causes of itching to include: infection (jock itch, vaginal itch), disease (hyperthyroidism, liver or kidney), reactions to drugs, and skin infestations (pubic or body lice). Treatment for itching varies depending on the cause of the itch.
Jaundice is a yellowish staining of the skin and whites of the eyes (sclerae) with bilirubin, the pigment found in bile. Jaundice can be an indicator of liver or gallbladder disease, or it may result from the rupture of red blood cells (hemolysis).
Stool color is generally brown. When stool color changes, often, an individual becomes concerned. The presence of the bilirubin in bile is generally responsible for stool color. Bilirubin concentration can vary bile color from light yellow to almost black in color. Changes in bilirubin can cause stool to turn green, gray, or clay-like in color. Intestinal bleeding may turn stool black, tarry, red, maroon, or smelly stool. Medication and food may also affect stool color.
Helicobacter pylori (H. pylori) is a bacterium that causes chronic inflammation (gastritis) of the inner lining of the stomach in humans. This bacteria also is the most common cause of ulcers worldwide.
The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
Ascites, the accumulation of fluid in the abdominal cavity is most commonly caused by cirrhosis of the liver. Some of the other causes of ascites include portal hypertension, congestive heart failure, blood clots, and pancreatitis. The most common symptoms include increased abdominal girth and size, abdominal bloating, and abdominal pain. Treatment depends on the cause of ascites.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Obesity is the state of being well above one's normal weight. A person has traditionally been
considered to be obese if they are more than 20 percent over their ideal weight.
That ideal weight must take into account the person's height, age, sex, and
build.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Pancreatic cysts are collections of fluid within the pancreas. Some are benign, malignant, or pseudocysts. There are two major types of pancreatic cysts, inflammatory cysts and non-inflammatory cysts. Non-inflammatory cysts include: serous cyst adenomas, mucinous cyst adenomas, intraductal papillary mucinous neoplasm (IPMN), and solid pseudopapillary tumor of the pancreas. Symptoms of pancreatic cysts include abdominal pain, jaundice, fever, chills, and sepsis. Treatment depends on the type of cyst, and patient health.
Though it's difficult to say why some people develop cancer while others don't, research shows that certain risk factors increase a person's odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Smokeless tobacco can have negative health effects such as cancers, poor oral health (gum disease and tooth decay), infertility, pregnancy complications, and nicotine addiction.
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