The pancreas is an organ located in the rearmost part of the abdomen, approximately 15 cm long, and its front face is completely covered by the stomach, duodenum and large intestine (colon). Although it has many important functions, it plays an important role in digesting food and keeping blood sugar balanced. Although pancreatic cancers develop in every region of the organ, they most commonly develop in the head region. Again, they originate from the most common secretory cells and are called adenocarcinoma.
Pancreatic Cancer Risk Factors
Although the cause of the disease is unknown, it is more common in smokers and obese individuals. . The cause of pancreatic cancer in almost 30% of patients is smoking. Pancreatic cancer due to adult type diabetes is controversial. Pancreatic cancer may develop in a very small number of patients after soy extraction. Pancreatic cancer is more common in men than women, and the risk increases with age. The average age is 63 for men and 67 for women.
Symptoms of Pancreatic Cancer
Weight loss, abdominal pain, jaundice, loss of appetite, nausea and vomiting, It may occur with psychological disorders such as weakness, fatigue, diarrhea, indigestion, back pain, putty-colored stools, pallor, and sudden onset of diabetes and depression without any family history. The patient loses weight as a result of insufficient food intake along with bloating, indigestion and loss of appetite. Jaundice is the most common and earliest symptom. It initially appears in the eyes, then yellowing of the skin occurs, followed by the urine color darkening to 'tea-colored urine', and finally resulting in a light color of the stool, described as 'glazier's paste'. The cause of jaundice is the prevention of excretion of bilirubin produced in the liver as a result of obstruction of the bile duct by pancreatic cancer.
Diagnosis in Pancreatic Cancer
Diagnosis may be difficult as the disease occurs with insidious symptoms. . Serum bilirubins, alkaline phosphatase, liver transaminases and tumor markers such as CEA, CA 19-9 and CA 125 were increased. There is bilirubin positivity in the urine.
Ultrasonography: Almost always the first examination method to be used. is. It provides information about the presence of a hard or cystic mass in the pancreas, the size of the mass, the relationship of the mass with other surrounding structures and its proximity to vascular structures.
Computed tomography (CT) and magnetic resonance imaging (MRI): MR imaging is the same way. It is important in the differential diagnosis of the tumor. These two examinations can be used together when necessary to ensure that the correct results are obtained for the surgical decision to be given to the patient and that the staging of the tumor is made correctly.
Treatment in Pancreatic Cancers
What stage is the pancreatic tumor in? It is determined what the relationship is with neighboring organs, especially whether it has spread to neighboring vessels and/or distant organs, and the chance of surgical removal is evaluated. Surgery cannot be performed on advanced stage tumors. Along with chemotherapy to be applied to these patients, some interventions can be applied to improve the comfort of life by correcting existing jaundice, providing nutritional support, and reducing pain. For this purpose, endoscopy is performed through the mouth through the stomach, placing a tube (stent) that allows passage to the bile duct, draining bile out of the abdominal skin with a catheter inserted into the intra-hepatic bile ducts with the help of a needle (PTK), advanced pain management techniques, tumors that cause obstruction in the duodenum. Methods such as inserting a stent by entering this part through the mouth with an endoscopic method are used.
Surgical Treatment in Pancreatic Cancer
Surgical removal of the tumor is the only chance of cure for these patients. In pancreatic head tumors, the surgery becomes more complicated as it is not possible to surgically remove only the head part of the pancreas. In Whipple surgery; Along with the head of the pancreas, the gallbladder, a part of the main bile duct, the duodenum, a part of the stomach and the surrounding lymph nodes are removed as a block.
In the pancreatic cancer operation (whipple surgery), a very long and various organs are removed. During or shortly after this surgery, in which the patient is removed and continuity is restored, the patient may experience death or bleeding, and stitches must be performed to ensure the continuity of the digestive system. Bad situations (morbidity) such as leakage from work (fistula) may be encountered. The accepted mortality rate in the world is 5% and below. Again, the accepted rate in the world for complications occurring after surgery is 15-20%. In our country's conditions, these rates are 5-10% mortality and 20-25% morbidity rates.
Other Treatment in Pancreatic Cancers
Radiation Therapy: Highly effective treatment to kill cancer cells. It involves the use of high-energy beams. Radiation therapy only affects the cells in the treated area. Radiation is the application of external beams through a machine. Radiotherapy is used alone or in combination with chemotherapy instead of surgery, especially if the location and size of the tumor makes surgery difficult or in cases where surgery cannot be performed. Radiotherapy can be used in combination with chemotherapy to shrink the tumor before surgery. In some cases, radiotherapy may be given to prevent recurrences after surgery.
Chemotherapy: It is the use of anticancer drugs to kill cancer cells. In pancreatic cancer, drug treatment called chemotherapy can be applied, taking into account the general condition of the patients before or after surgery. Chemotherapy may be used along with radiotherapy to shrink the tumor before surgery or as primary treatment instead of surgery. Surgery and radiotherapy have no place in widespread advanced disease.
Prevention: For protection, one should stay away from tobacco, have a balanced diet, exercise regularly and get rid of excess weight.
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