Pancreatic Cancer

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Pancreatic cancer is quite uncommon. About 1300 people a year get the disease. Most are over 70 years old. Pancreatic cancer has usually spread to the body when the disease is detected. Then there is a treatment that can slow down and relieve the disease for some time but it cannot be rid of.

What is pancreatic cancer?

Cancer of the pancreas means that a cancerous tumor has formed in the pancreas, which is also called the pancreas.

Pancreatic cancer can spread to, for example, lymph nodes, the liver, the peritoneum, or the lungs. It is common for the disease to spread at an early stage before it begins to produce symptoms. Then you can’t get rid of the disease.

All tumors of the pancreas are not cancer. There may be tumors that have not yet developed into cancer and even benign tumors.

The most common form of pancreatic cancer is called ductal adenocarcinoma. Then the disease begins in the passage through which the pancreas runs through. This article is about ductal adenocarcinoma.

This is how the pancreas works

The pancreas is located near the stomach. The pancreas forms the pancreas. The pancreas contains enzymes that help break down food. The pancreas also forms the hormones insulin and glucagon. They are needed for metabolism, primarily to regulate blood sugar levels.

What are the symptoms of pancreatic cancer?

Initially, pancreatic cancer does not produce any symptoms or unclear symptoms that may also be due to many other diseases.

Jaundice

A common early symptom of pancreatic cancer is jaundice. Here are some typical signs of jaundice:

  • The urine becomes darker.
  • The whites of the eyes and the skin turn yellow.
  • It can start to scratch the skin a lot.

Jaundice in cancer of the pancreas is because the cancerous tumor compresses the bile duct. Then the bile cannot drain into the duodenum. Instead, it remains in the liver. From the liver, the bile dye bilirubin flows directly into the blood and causes the skin and eyes to turn yellow and it begins to itch on the body.

For the most part, jaundice has completely different causes than pancreatic cancer, such as gallstones or hepatitis. Hepatitis is an inflammation of the liver caused by viruses.

Pain and discomfort in the stomach and back

It can hurt high up in the stomach and out to the back. You may also feel discomfort in the upper abdomen and feel unwell.

But it is much more common that the symptoms have causes other than pancreatic cancer.

Involuntary weight loss and decreased appetite

You may involuntarily lose weight. This may be because the cancer tumor prevents the body from absorbing nutrition properly. You may also lose the desire to eat. It is not known what this is due to.

The symptoms need not be due to pancreatic cancer. They are common even in other stomach or intestinal disorders.

When and where should I seek care?

Contact a health care center if you think you have pancreatic cancer. You can contact many receptions by logging in.

When it is in a hurry

If you get yellow eye whites or yellow skin at the same time as you get a fever and chills, contact a health care center or on-call reception straight away. If this is not possible, seek medical attention at an emergency room.

Investigations

You can tell your doctor about your complaints and how long you have had them. The doctor also feels on the stomach.

Several of the symptoms of pancreatic cancer are the same as in many other diseases. Therefore, the investigation of your complaints may, for example, begin with the colon being x-rayed or the stomach being examined with gastroscopy.

Ultrasound examination in jaundice

If you have jaundice, an ultrasound examination can show if there is anything that prevents the bile from flowing between the liver and the duodenum.

Computed tomography and magnetic camera examination

An examination with computed tomography can often give an answer as to whether you have a cancerous tumor in the pancreas and whether it has spread. Sometimes a magnetic camera examination is also needed.

Blood sample

You may submit different blood tests. They can show how the liver works or if there are tumor markers in the blood. Tumor markers are substances secreted by tumors. In pancreatic cancer, it is common to have more of the tumor marker CA19-9 in the blood. It may also be due to other diseases that are not cancer, but the measurement value is helpful when the doctor is to make a diagnosis based on the studies that have been done.

Tissue Samples

If you are to be treated with cytostatic drugs, a tissue sample is needed. The tissue sample can provide more information on how the cancer cells behave. This way you can get a cytostatic treatment that is as effective as possible.

It is often an x-ray that takes the tissue sample, also called biopsy. You get local anesthesia. Then the doctor uses ultrasound to guide a needle through the skin of the stomach and into the tumor. The doctor takes a small sample of the tumor through the needle. 

If you are going to have surgery, you usually do not need a tissue sample.

You may be examined according to a standardized course of care

You are offered an examination according to a standardized course of care if the doctor suspects that you may have pancreatic cancer. Standardized care processes are a way of organizing the investigation so that it goes as quickly as possible. Among other things, there are times set for the examinations you may need.

The doctor who writes the referral will tell you why you should be examined according to a standardized course of care and what it means.

It is often quick to get calls for examinations in a standardized course of care. It is good if you are clear about how the staff most safely reach you so that you do not miss any time.

Treatment for the cancer tumor can be removed

You can be operated on so that you get rid of the cancerous tumor if it has not spread and if you feel well otherwise. Sometimes the operation is supplemented with cytostatic treatment.

Approximately one in five people can be offered an attempt at surgery. Sometimes it is only during the operation that cancer has spread. Then the surgery is interrupted and you receive curative treatment with cytostatics instead.

It is important that you are prepared

Before an operation, careful preparation is needed. For example, the heart and lungs need to be examined so that the doctor can make sure your body is able to cope with the operation.

You also need to talk to the doctor a lot before making a decision about surgery so that you feel prepared and motivated. Both the surgery and the time after the surgery are demanding and there is a risk of various complications. There is also a risk that the disease will return, despite the operation.

Stop smoking before surgery

You who smoke have much to gain from quitting. Those who are going to have surgery reduce the risk of complications and recover sooner afterward. Stop smoking completely, if you can. Otherwise, pause. You can get help to quit smoking if you need to. 

The surgery

The most common operation involves the surgeon removing the part of the pancreas where the cancer tumor is located. In addition, the surgeon removes the gallbladder, part of the bile duct and duodenum. It is also common for the lower half of the stomach to be removed. All lymph nodes near the cancerous tumor must be removed. Thereafter, the pancreas, the bile duct, and the stomach are connected to the small intestine. You are anesthetized when you are operated on.

Two weeks in hospital

After the operation, you remain approximately 10-12 days in the hospital. You may need to stay longer if there is any complication. For example, you may get an infection in the operating wound or in the stomach. You also need to stay longer if you have difficulty eating.

Sometimes you may need help at home for a while after the surgery. Then you and the staff plan for it before printing.

Return visit after one month

Most people may come on an initial visit about a month after their stay in the hospital. The doctor is examining you. Sometimes an X-ray examination may be needed. You will know what the analysis shows of what was removed. This is important for continued treatment.

Then it varies how often and how long you need to make a return visit. This depends, among other things, on what type of pancreatic cancer has been removed and how you feel.

Treatment with cytostatics

You may need treatment with cytostatics after surgery. There are different types of cytostatic drugs. They are cell-inhibiting drugs that reduce the risk of the disease coming back, also called relapse. You receive treatment at the hospital at regular intervals for six months. Between treatment sessions, you can be at home. It varies from person to person how many treatment sessions are needed.

Sometimes, cytostatic treatment for pancreatic cancer is also needed before surgery to shrink the cancer tumor to make it easier to operate.

Life after surgery

The surgery to remove the cancer tumor affects how the body works.

Help with digestion

The weeks after surgery can be stressful, including adjusting the food so that you don’t lose too much weight. You may meet a dietician who can ensure that you get nutritional solutions or nutritional drinks that you can supplement your meals with if needed.

It is common to lose a lot of weight in connection with the disease. But eventually, the weight usually increases again, even though you may not regain the weight you had before the illness.

You may need to change your eating habits so that you eat smaller portions but more times a day than you did before. It is good if the food is not too fatty. Fat foods can make you feel bad if your body’s ability to handle fat has been impaired. In the future, you will need to take medicines with digestive enzymes when you eat.

Some suffer from diabetes

You can get diabetes if you have surgery for pancreatic cancer. This is because some of the cells in the pancreas that produce insulin are also removed when you are operated on. Insulin is a hormone that is important for regulating blood sugar levels. You may need treatment with blood sugar lowering tablets if you get diabetes. Some people need treatment with insulin.

Different types of help and support

You recover better if you move after the surgery. A physical therapist or physiotherapist can advise you on physical activities and support based on your situation.

You may also need other rehabilitation to make life work as well as possible. Rehabilitation means different kinds of help and support, depending on how you feel, how you feel and how you want it.

Treatment if the cancer tumor cannot be removed

It is common for the disease to have already spread when it is detected. Then it can not get rid of. Most often, you cannot get rid of the disease if it comes back after you have had surgery. It is called a relapse when the disease returns. 

Then you can instead get a treatment that can slow down cancer for a while and that relieves pain. It is called palliative care. The purpose of the care is that you should be able to have a good and active a life as possible in every way with the disease.

Treatment that can curb the disease

Cytostatic therapy can curb the disease for a limited time in about two out of three people. The treatment is demanding. Therefore, it depends on how you feel if you can get curative treatment with cytostatic drugs. Braking cytostatic treatment you get in hospital. Between the treatment sessions, you do not need to be in the hospital.

Treatments that relieve pain

When the disease is no longer curable, you receive treatment that relieves. On the Help and Support page, you can read more about what help you can get if you need psychological, existential or social support.

Here are examples of bodily disorders and what treatment is available:

If you are in pain

There are many types of effective help if you are in pain. There are pain-relieving drugs in the form of tablets or patches where the medicine is taken up through the skin. Pain relief is also available as a drop directly into the blood.

Radiation therapy can help if the disease causes you pain in the skeleton.

Weight loss, nausea, and constipation

The disease can cause you to lose your appetite and lose weight. You may feel sick and vomit. You may also have trouble with constipation.

Help against weight loss

A dietitian can give you dietary advice and make sure you get special nutritional drinks against weight loss. You can get a nutritional solution that drips directly into your blood if you need it.

Help against nausea

There are medicines for nausea. Nausea may be due to the cancerous tumor displacing the duodenum so that the food cannot pass. Then the duodenum can be widened with a small tube, also called a stent. It is inserted using gastroscopy. It is also possible to perform an operation to transfer part of the intestine past the cancer tumor so that the food can pass.

Helps against constipation

If you get constipation, it may be because you need more fluid. It is good if you can drink more water and have the opportunity to move. Morphine or other morphine-like drugs can also cause you to become constipated. You should have access to laxative against constipation if you get morphine. 

Fatigue

You may feel very tired and that it does not help to rest. It is common in cancer and is called fatigue. Fatigue can have several causes. For example, you may have an infection or need more nutrition. You may have anemia. Then you can get iron medicine or a blood transfusion if needed. Fatigue can also be due to a depression that you need treatment for.

Physical activity can alleviate fatigue. Touch yourself the way you can and do. Avoid resting for a long time. Rather take several short rests.

Fluid in the stomach

Fluid can accumulate in the stomach so that it becomes larger. Sometimes liquid drugs help. The fluid can also be drained through a needle inserted into the stomach. Then you get local anesthesia first.

Jaundice and itching

Jaundice can, among other things, cause it to start itching a lot on the body. This is because the cancerous tumor blocks the bile duct. Most often it helps to get a small tube inserted into the bile duct. The tube is called a stent and allows the bile to drain into the duodenum as it should. The tube is inserted during an ERCP examination.

It usually takes a few weeks before jaundice disappears after the tube is inserted. Sometimes there is a stop in the pipe. You notice it by becoming more yellow again or getting a fever and chills which are signs of infection. You may then need a new ERCP examination to replace or clean the tube.

Also liquor can relieve it if it continues to itch even if you have had a stent inserted. Lubricate with moisturizing cream if you have dry skin. It can also itch less if you shower cool. Medicines with antihistamines can relieve itching if neither cream nor other agents help.

Relieving care at home, in hospital or hospice

You can get soothing care at home, in a hospital, or at a so-called hospice. It depends on what care you need and what you want yourself. You can read more in the text about palliative care.

Getting a cancer message

There are many ways to respond to a cancer message. You may need plenty of time to talk to your doctor and other healthcare professionals about what the message means. If possible, please let a relative accompany you. The related person can act as a support and help to remember what has been said.

You have the right to understand

You can also ask to have the information written down so you can read it peacefully. Ask questions if you don’t understand. You have the right to receive information in your own language. You also have the right to receive interpreting assistance if you have a hearing impairment.

In many hospitals, there are special nurses called contact nurses who can provide support and also help with various practical things.

For many, it usually feels easier once treatment has begun and they know what is going to happen.

You can get support in several places

The contact nurse or the hospital’s curator can help you if you need to talk more or have questions.

You can contact Cancer Counseling, the Cancer Foundation or, for example, a patient association. Palema is a patient association for people with cancer of the pancreas, liver or esophagus.

Children also need to know

A minor child has the right to receive information and support based on his or her own needs if a relative is ill. It is the responsibility of care. If you want to tell the child yourself, you can get help with what you have to say. Often it is good to make children as involved as possible, no matter how big or small they are. That doesn’t mean you have to tell everything.

Be involved and influence your care

You have the right to be involved in your care whenever possible. The healthcare staff should tell you what treatment options are available. They should make sure you understand what the different options mean, what side effects are available and where you can get treatment. That way you can help decide which treatment is right for you.

You decide on the care plan

You can make a care plan together with the contact nurse, the doctor and other staff. The care plan should answer questions that are important to you.

New medical assessment

You can get a  new medical assessment if you are unsure if you are receiving the care and treatment that is best for you. You will then see another doctor, usually at another specialist clinic. Ask your doctor if you want to know more about how to get a new medical assessment.

Support if you are related

It can feel difficult to be close to someone who is sick. It is common to want to support while you have a strong concern and feel bad.

If you have other people in your area, try letting them support you. It can be family members, friends or acquaintances. Often it will be easier for them to help you if you tell them how it feels and shows if you are worried or sad.

You can get help from the contact nurse or a curator at the hospital if you are close and need supportive calls.

What is the cause of pancreatic cancer?

The cause of the disease is not entirely clear. In most people, it is probably a coincidence. But there are risk factors:

The risk of getting pancreatic cancer increases with age.

Smoking doubles the risk of pancreatic cancer. Sniffing can also increase risk.

The disease can be hereditary if you have several closes, genetic relatives who have had pancreatic cancer. You can then get a genetic examination to see if you inherited the risk. Five out of a hundred people who get pancreatic cancer have an inherited increased risk of the disease.

Prolonged inflammation of the pancreas can increase the risk of getting the disease. You can get such inflammation if, for example, you have been drinking a lot of alcohol for several years. It is also called chronic inflammation. 

Being overweight involves a certain increased risk.

Diabetes involves a certain increased risk.

The studies conducted so far have not been able to show that the risk of the disease is affected by physical activity and what you eat.

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