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Pancreatic Cancer is the second most common cause of death from cancer of the gastrointestinal tract. It usually presents late and as a result the majority of affected patients are not suitable for surgical resection. Surgery offers the only realistic chance of cure.
In the recent past improved radiological imaging techniques, more accurate staging, better surgery and the use of chemotherapy have improved the otherwise poor outlook for many. Risk factors for developing the condition are age, smoking, certain occupations and type II diabetes
- Abdominal Pain (often radiating into the back)
- Weight Loss
- Poor Appetite
- Development of Type II diabetes
- CT/ MRI scan or more rarely ultrasound scan of the abdomen
- Endoscopic Ultrasound
- PET scan
- CA 19-9 blood test
For those patient considered to have disease that is curative (i.e. removable by surgery) after radiological investigation accurate staging is essential. A laparoscopy may be carried out to ensure that disease otherwise undetected by radiological means, is not present in the abdominal cavity. This may be combined with an internal ultrasound scan.
Definitive surgical treatment, where possible, is with a Whipple’s operation. This involves removal of the pancreatic head, gall bladder and part of the bile duct system, stomach and duodenum. Reconstruction of the drainage of the biliary system (bile), stomach (acid and food) and pancreas (pancreatic juice) is achieved by joining these structures to three different parts of the small bowel.
For those that have pancreatic cancer that cannot be removed with a view to cure, surgery still has a place in palliating the disease process. Surgical bypass to the outflow of the stomach or biliary system may be required but is less often required these days owing to the success of stents (self expanding metal cages) deployed using endoscopy which allow stomach and liver drainage to be restored.
Both radiotherapy and chemotherapy have a place in the palliative treatment of inoperable pancreatic cancer.