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Cancer Of The Pancreas
Health statistics show that Pancreatic Cancer is at the lower end of the top 10 common cancers. However, it is the 4th leading cause of cancer deaths in the world and in the Philippines.
Experts say most patients with this type of cancer are dead within six months or sooner after the diagnosis is made because of the nature of this malignancy.
Since 90 of the pancreatic cancer has adenocarcinoma as the cell type, which is fatal disease, it is not easy to detect and therefore usually diagnosed late and, cure is attained only by an extensive surgery.
In most hospitals and medical centers outside of the major cities in the Philippines, the multidisciplinary competence of a Pancreas Cancer Team capable of implementing such an extensive surgery is not always available including the administration of therapeutic agents before the main treatment and additional treatment for cancer and critical care system.
The pancreas (Lapay in Filipino) is an abdominal organ that is located behind the stomach and is surrounded by other organs, including the spleen, liver and small intestine. The pancreas is about 6 inches (15.24 centimeters) long, oblong and flat. It plays an important role in digestion and in regulating blood sugar.
The main functions of the pancreas are to produce Insulin (a hormone that lowers a type of glucose, a type of blood sugar, in the blood) and to provide enzymes used in digestion.
What are the symptoms that we should look out for? Early symptoms are usually non-specific, no more than a vague and dull upper abdominal pain at the epigastric are o sikmura. Unexplained loss of appetite and weight follow. These patients are most commonly above 40 years old and diagnosed and even treated as Acid Peptic Disease, Chronic Gastritis or even Gastroesophageal Reflux.
Another symptom is painless jaundice (yellowish discoloration of the eyes) associated with passage of tea-colored urine and grayish white (alcoholic) stools when imme3diately noticed are early signs. Generalized pruritus or pangangati ng katawan without wheal formation may develop with jaundice. Sometimes, despite absence of a strong family history of Diabetes, many of these patients with Pancreas Cancer may have elevated levels of blood sugar. Progressive, severe back pain, incidental findings of lung and or liver nodules, a palpable, fixed, epigastric mass are indicative of late stage of the disease and is most likely beyond cure. Tumors of the Pancreas located in the body and tail are either incidentally seen on routine imaging of the abdomen or, in most cases, late findings as well.
Abdominal Ultrasound of the Liver, Gallbladder, Biliary Tree and Pancreas usually the first imaging test that may confirm the presence of a Pancreatic mass. World consensus of experts recommend Abdominal CT-Scan using specifically the so called Pancreas Protocol that aims not only to diagnose Pancreas Cancer but also accurately measure resectability.
The Medical City Clark Department of Radiology is a pioneer in Region 3 insofar as Pancreas Protocol CT-Scan is concerned. This is the gold standard diagnostic tool for Pancreas Tumors. Contrast Magnetic Resonance Imaging (MRI) with or without MRCP (Magnetic Resonance Cholangiopancreatograhy) may also be done as a complementary study. PET-CT-Scan is usually employed in cases where distant metastases o kumalat na sa ibang bagahagi ng katawan is suspected.
Among the laboratory (blood) tests, only CA 19-9, so far, is most useful for Pancreas Cancer. It is important for prognosis and for surveillance after definitive management. The other tests are indicated for assessment of the liver, renal, cardiac, pulmonary and hematologic functions depending whether the patient is a candidate for curative or palliative management.
The Medical City Clark Cancer Center management for Pancreas Cancer is always a MULTIDISCPLINARY TEAM approach. Each team is composed of an expert surgeon in Pancreas, Liver and Biliary Tree (HB Surgeon), a Medical Oncologist, a Cardiologist, a Gastroenterologist/Endoscopist, an Anesthesiologist & Pain Specialists, and a Nutrition Medicine Specialist. Depending on the associated medical illness/ess and the team’s management plan, an Endocrinologist, an Interventional Radiologist, a Radio-Oncologist, and a Palliative Medicine Specialist may be on board the team. After the initial history and physical examination, the appropriate diagnostic tests are done. The Multi-disciplinary Team is convened to discuss the case and arrive at a high level consensus consisting of the best options of management for the patient considering all perspectives. Such perspectives include the overall condition of the patient, associated medical illnesses (surgical) risks associated with the interventions, quality of life, expected outcome, and of course, the expense or financial burden to the family.
Complete resection or desired surgical procedure if a considerable survival benefit is anticipated in patients with pancreatic cancer is achieved in only 30% of cases. Majority of those operated will undergo adjuvant chemotherapy or depending on the stage of the disease. Adjuvant means additional treatment given to patients after primary treatment to reduce recurrence.
CAN WE QUANITFY THIS IN YEARS? Medium term survival is also about 30%. But unfortunately, long term survival is still in a dismal rate of less than 10%. Quality of life however is much better among those who underwent multi-disciplinary management than those nothing was done. Even among those where the disease has already gone beyond cure, prolongation of good quality of life is still achievable through multi-disciplinary palliative therapy.
The key to a comprehensive management with patient satisfaction regardless of stage of the disease is the multi-disciplinary team management. This is exactly what The Medical City Clark Center offers to all patients who may have been afflicted with this lethal malignancy.
Cenon R. Alfonso, MD, FPSGS, FPCS, FPALES is a Hepatopancreatobiliary Surgeon who is currently the Chief of HPB Section of the Department of Surgery of The Medical City Pasig. He is also a practicing HPB Surgeon and holds regular clinic in The Medical City Clark concurrently holding the position of the President and Chief Executive Officer of the same institution. Clinic Schedule: Wednesday (8:30 am to 2:00 pm) and Saturday (10:00 am to 2:00 pm) at Room 0228.
– Dr. Cenon R. Alfonso