Pancreatic cancer overview and clinical aspects

Pancreatic Cancer

Etiology:

The most common cause of pancreatic cancer is smoking which accounts for 25 -- 30% of cases (Surveillance, Epidemiology and End Results Program). Other factors include hereditary pancreatic cancers, adults with diabetes of minimum duration two years, hereditary pancreatic, and a history of other family cancers (GUT. Guidelines for the management of patients with pancreatic cancer periampullary and ampullary carcinomas). The Consensus Guidelines of the International Association of Pancreatology advises that patients with a genetic history of pancreatic cancer should be referred to specialist centers where they can receive diagnosis of pancreatic diseases, genetic counseling, and advice on secondary screening (Ulrich et al., 2001).

Pathology:

Most pancreatic cancers (about 90%) originate in the ductal region and are usually discovered when they are locally advanced. They are called ductal adenocarcinoma. Others (80-90%) occur in the head of the gland (GUT). Lymph node metastasis is common as well as perineural infiltration and vascular invasion. Pancreatic cancer is graded into different stages in order to distinguish and treat them.

Clinical features

Aside from the associated features mentioned before such as late onset diabetes mellitus or acute pancreatitis, other pointers include marked and rapid weight loss, persistent back pain, jaundice, vomiting, malaise, ascetisis, enlarged lymph node (Virchow's node), and abdominal mass. These associations (excepting vomiting and malaise) usually indicate an incurable situation, whilst jaundice can indicate recovery or fatality depending on its region and spread (GUT).

Investigation:

Persons with suspected cancer should be tested with ultrasound of the liver, bile duct, and pancreas. Success of ultrasound is as high as 80 -- 95%. Ultrasound is, however, harder to use in body and tail and here, the second step would involve using computerized tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), and/or magnetic resonance (MR) as well as magnetic resonance angiography (MRA), all of which will use electronic means to accurately identify and localize the tumor in the majority of grade B. cases (GUT).

Sometimes, endosonography and/or laparoscopy with laparoscopic ultrasonography are used.

Diagnosis also involves obtaining a tissue diagnosis during endoscopic procedures especially for patients who are slated for palliative forms of treatment and/or patients who have a mass in the pancreas. However, failure to procure tissue diagnosis should not prevent continuance with surgery.

Treatment:

Treatment is largely palliative with the intent to mitigate and relieve symptoms. Stenting or surgical bypass is used with similar results in both and advantages and disadvantages in either case. Stenting is commonly used with patients who have serious comorbid disease and cannot receive surgery. Duodenal obstruction is treated surgically. Resectional surgery is used to treat the cancer, whilst endoscopic or percutaneous biliary stenting is employed to relieve jaundice.

Chemotherapy and radiotherapy are widely used as both palliative treatment and supplementary to surgery, although far more evidence-based tests need to be conducted on the latter to substantiate their efficacy (Neoptolemos et al., 2001).

Other Aspects of Medical Management

Caretakers work on reliving pain through various means. Attention is also given to diets particularly using pancreatic enzyme supplements lipid supplements both of which may provide better quality of life and prolong survival.

Aside from pain, patients also commonly experience depression. This too is treated. A support community is crucial.

Incidence and Mortality Rates of Pancreatic Cancer

Pancreatic cancer is the sixth most common cancer death in the U.S.A. (GUT), and it is generally higher in Western or industrialized countries. Whilst rare before 45, 80% of cases occur between 60 -- 80 years-old. Pancreatic cancer is uncommonly difficult to treat; consequently, statistics of incidence and mortality are usually associated. Whilst men were more generally prone to the cancer, the Surveillance, Epidemiology, and End Results (SEER) has demonstrated that both genders are now equally prone to displaying it.

Exc. 2.

Although I did not find any specific news article within the last seven years that resulted in a medical error, I did find an article printed recently that stated that a large number of heart patients fatally harm themselves from medication errors, even if they have extra help form pharmacists due to the fact that they turn to online, or other sources for help. These include newspapers, magazines, and other websites that, sometimes, end up incorrectly counseling these patients. Most errors were mild, but some were life-threatening.

Apparently, medication errors harm at least 1.5 million people a year in the U.S., according to the Institute of Medicine of the National Academies. People commonly connect medication errors to practitioners, but actually they can come from external sources, too. And, frequently, those most vulnerable are patients who have low-health literacy, are gullible to accepting data from news sites and sources at random, tend to have more trouble understanding and managing their health, and who have cognitive problems.