Radiographic studies are often useful modalities as well for diagnosis. These would include the CT scan, transcutaneous ultrasonography, endoscopic ultrasonography, MRI, ERCP, and PET scan. (Anand, 2007) Choice of which to utilize would be case and physician dependent. Common appearance would be the identification of a mass on the pancreas or dilatation of the biliary tree in the area particularly proximal where the ducts pass the pancreatic head.
Once imaging is complete further confirmation of diagnosis and assessment for management may be done with ultrasound-guided fine-needle aspiration and a preoperative staging laparoscopy. Considerations for these invasive procedures, as with surgery if needed, would most likely depend on blood test results, as should the patient have anemia and thrombocytosis, blood loss and impaired balance in coagulation are a concern. Treatment rests in the decision as to whether the case is surgical or too widespread.
Before surgery, the resectability of malignant pancreatic tumors needs should be assessed. Should the mass be localized to a resectable area, a Whipple procedure or pancreaticoduodenectomy is an option, depending on skill of the surgeon handling the case, the overall health of the patient involved and the patient’s decision as to his exercise of informed consent. For widespread disease, chemotherapy is the next option and the 2 most active agents have been 5-fluorouracil (5-FU) and gemcitabine.
(Vulfovich & Rocha-Lima 2008) Pain relief is also important in these patients. Combinations of narcotic analgesics with tricyclic antidepressants or antiemetics sometimes increase the efficacy of analgesia. Biliary obstruction from pancreatic cancer is also best palliated with the use of endoscopic insertion of stents. Unfortunately, prognosis is not good as it is usually fatal. The mean survival for patients with unresectable disease remains 4-6 months, with a 5-year survival rate of less than 3%.
The median survival for patients who undergo successful resection (only 20% of patients) is approximately 12-19 months, with a 5-year survival rate of 15-20%. The prognosis may be attributed to the fact that diagnosis is usually late where 52% of all patients have distant disease and 26% have regional spread. Given its prognosis, best treatment would be prevention. Due to its proven association, smoking would be the most significant reversible risk factor for pancreatic cancer. Studies estimate that it may be responsible for up to 30% of cases.
(Oliveira-Cunha et al. , 2007) Alcohol although in itself is not a risk, may lead to chronic pancreatitis. Hence, prevention of pancreatitis through limitation of alcohol intake may prove to be beneficial as well. REFERENCES Anand , M. K. N. (2007) Pancreas, Adenocarcinoma. Retrieved March 23, 2007, from Emedicine: Medscape’s Continually Updated medical Reference Website: http://emedicine. medscape. com/article/370909-overview Brender MD, E. (2007). Pancreatic cancer. The Journal of the American Medical Association, 2007;297:330. Michaud, D. et al. (2007)
A Prospective Study of Periodontal Disease and Pancreatic Cancer in US Male Health Professionals JNCI Journal of the National Cancer Institute. 99(2):171-175; doi:10. 1093/jnci/djk021 Oliveira-Cunha MD. , M et al. (2007) Molecular diagnosis in pancreatic cancer. JNCI Journal of the National Cancer Institute 2007 99(2):171-175; doi:10. 1093/jnci/djk021 Vulfovich, M. & Rocha-Lima, C. (2008) Novel Advances in Pancreatic Cancer Treatment. Retrieved March 23, 2007, from Medscape Med Students Website: http://www. medscape. com/viewarticle/577641