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pancreatic health

Pancreatic tumor: treatment

Premise

Representing 95% of pancreatic neoplasms, malignant tumors of the exocrine pancreas - with pancreatic cancer on top - will be the topic of this article, dedicated to the treatment of pancreatic neoplasms .

Therapy Exocrine pancreatic tumors

The choice - by the Medical Staff - of the therapy to be adopted, in the presence of a malignant tumor of the exocrine pancreas, depends on various factors, including: the site of the tumor mass, the type of tumor, the stage and the degree of the neoplasm malignant (presence of metastases, progression of the disease etc.) and, finally, the general state of health of the patient (age, presence of other pathologies etc.).

Currently, the therapeutic options available to an individual suffering from a malignant pancreatic cancer of the exocrine pancreas are:

  • Surgical removal of the tumor mass,
  • Radiotherapy,
  • The chemotherapy
  • A symptomatic therapy adapted to the patient.

SURGERY

Surgical removal of a malignant pancreatic tumor of the exocrine pancreas is a very delicate operation, generally only possible in the early stages of the disease (I and II in particular), and only if the tumor mass occupies surgically accessible sites .

Removing a tumor from the pancreas means not only removing the tumor mass, but also the part of the gland affected by the neoplasm.

There are various types of surgery; the choice of the type of intervention depends exclusively on the location of the tumor:

  • If the tumor mass resides on the head of the pancreas, the operation involves the removal of the latter, combined with the removal of the duodenal "C". The procedure in question is called duodenocephalopancreatectomy.

    The execution of duodenocephalopancreatectomy always involves the subsequent surgical union (in technical jargon, we speak of anastomosis ) of the stomach at fasting, in order to restore the continuity of the digestive tract (which ceases when the elimination of duodenal "C"). The aforementioned surgical union of the stomach to fasting is a surgical operation, known as gastro-jejunostomy .

    There is an alternative to duodenocephalopancreatectomy: it is the so-called Whipple procedure . Briefly, the Whipple procedure is a duodenocephalopancreatectomy which also involves the removal of the portion of the stomach, connected to the duodenal "C" (in essence, therefore, there is the removal of an additional portion of the digestive system).

    Just like duodenocephalopancreatectomy, Whipple's procedure is also followed by gastro-jejunostomy.

  • If the tumor mass resides on the body or on the tail of the pancreas, the intervention involves the removal of one of these two portions. The procedure in question is called distal pancreatectomy .

    Because very often tumors located on the tail of the pancreas also affect the spleen (due to the contiguity between the two organs), surgeons are usually forced to combine pancreatic distomy with removal of the spleen ( splenectomy ). The absence of the spleen carries a greater risk of infection, therefore the persons concerned must provide to undergo several vaccinations and periodic blood tests.

    According to reliable statistical studies, distal pancreatectomy is feasible on a few occasions, to be precise only in 5% of patients with a malignant tumor on the body or on the tail of the pancreas.

  • If the tumor mass involves the whole pancreas or at least a large part of it, the operation involves the removal of the entire gland. The procedure in question is called total pancreatectomy .

    The absence of the pancreas leads to the lack of production of insulin and digestive enzymes (eg, amylases, lipases, etc.); therefore patients without pancreas, due to a total pancreatectomy, must undergo, for the rest of their lives, insulin replacement therapy and enzyme replacement therapy (clearly based on pancreatic digestive enzymes).

  • If the tumor mass present on the pancreas also affects the adjacent vena porta and / or mesenteric vein, the operation involves removing the portion of pancreas involved and part of the aforementioned venous vessels. The procedure in question is known as pancreasectomy with resection of the portal vein and / or mesenteric vein .

    Pancreaectomy with resection of the portal vein and / or mesenteric vein is always accompanied by the reconstruction of one or both of these venous vessels.

Regardless of the type of intervention adopted, the surgical removal of a malignant tumor of the exocrine pancreas represents a major surgery operation.

Major surgery operations are characterized by a non-negligible probability of complications (about 40%).

Among the complications that can arise specifically from the removal of a malignant tumor of the exocrine pancreas, we note: the pancreatic fistula, deep vein thrombosis, the development of a pulmonary infection or heart problems, the development of an internal infection abdomen and, finally, post-operative internal bleeding with massive blood loss.

Which professional figures involve the surgical removal of a malignant tumor of the exocrine pancreas?

Given the delicacy of the operation, the surgical removal of malignant tumors of the exocrine pancreas requires the collaboration of various professional figures - including surgeons, anesthesiologists, gastroenterologists, endocrinologists, radiologists, nutritionists and infectivologists - with adequate experience (in the case of surgeons, for example, an adequate experience is given by the execution of 2-3 operations per month).

How should the diet be after surgery?

Nutritional guidelines in the short term and in the long term

Short term:

  • The oral diet must initially be based on liquid substances; the use of solid foods must wait a few days.
  • Make small, but frequent meals.
  • Avoid fatty foods and fried foods.
  • Initially, limit the consumption of raw fruits and vegetables; after the first post-operative period, there is greater freedom.

Long term:

  • Continue to avoid foods that are too fatty and fried; for some patients, there is greater freedom, but it is a real rarity.
  • As a source of lipids, consume only healthy foods such as olive oil, peanut oil, canola oil, walnuts, avocado, etc.
  • Eat plenty of fruits and vegetables.
  • Take pancreatic enzymes (enzyme replacement therapy), if the pancreas functions are extremely reduced.
  • Practice moderate physical activity at least 30 minutes a day. Some patients may even try their hand at heavier exercise (eg weight training).

RADIOTHERAPY

Radiation therapy consists of exposing the tumor mass to a certain dose of high-energy ionizing radiation (X-rays), with the aim of destroying the neoplastic cells.

In case of malignant tumors of the exocrine pancreas, radiotherapy may represent:

  • A form of post-surgical treatment . In these situations, there is also talk of adjuvant radiotherapy . The purpose of adjuvant radiotherapy is to destroy the tumor cells that the surgery has not removed with X-rays;
  • A form of pre-surgical treatment . In such circumstances, radiotherapy is called neoadjuvant radiotherapy . The purpose of neoadjuvant radiotherapy is to reduce the size of the tumor mass, to facilitate the surgical removal that will be held later;
  • A form of treatment combined with chemotherapy and an alternative to surgery . The combination of radiotherapy and chemotherapy is called chemoradiotherapy .

    Chemoradiotherapy replaces (in scope) surgery, when it is impractical.

CHEMOTHERAPY

To learn more: Pancreatic cancer treatment drugs

Chemotherapy consists of the administration, intravenously or orally, of drugs capable of killing rapidly growing cells, including cancer cells.

Depending on the characteristics of the exocrine pancreatic malignant tumor, the attending physician can decide whether to opt for:

  • Post-surgical chemotherapy or adjuvant chemotherapy . The purpose is the same as for adjuvant radiotherapy: to destroy the tumor cells that the surgeon was unable to remove;
  • Pre-surgical chemotherapy or neoadjuvant chemotherapy . The objective is the same as that of neoadjuvant radiotherapy: reducing the size of the tumor mass, to facilitate subsequent surgical removal;
  • Chemotherapy combined with radiotherapy or chemoradiotherapy . It is the form of chemotherapy that was mentioned in the previous sub-chapter, dedicated to radiotherapy; therefore, it is applied in place of surgery, when the latter is impractical.

In people with a malignant tumor of the exocrine pancreas at a very advanced stage, chemotherapy can also be a form of symptomatic therapy, to alleviate the symptoms and prolong as much as possible for the survival of the patient.

Chemotherapy used in the presence of malignant tumors of the exocrine pancreas:
  • Gemcitabine
  • Fluorouracil
  • Capecitabine
  • FOLFIRINOX

SYMPTOMATIC THERAPY

Symptomatic therapy of malignant tumors of the exocrine pancreas is a form of treatment aimed at alleviating symptoms and prolonging patients' lives as much as possible.

In general, doctors opt for symptomatic therapy, when surgery is impractical (because it would not give results) and the only therapeutic options are chemotherapy and radiotherapy.

Symptomatic therapy of malignant tumors of the exocrine pancreas includes:

  • The aforementioned administration of chemotherapy against pain;
  • The administration of non-opiate analgesics, such as paracetamol and NSAIDs. Analgesics are pain medications;
  • The administration of opioid analgesics, such as codeine or fentanyl;
  • Surgical application of a biliary or duodenal stent . The biliary stent and the duodenal stent serve, respectively, to free the bile ducts and free the duodenum, in all those circumstances in which the tumor mass obstructs the aforementioned passages;
  • Biliary bypass surgical procedures or duodenal bypass . The biliary bypass consists of connecting the bile ducts to the small intestine, while the duodenal bypass consists of connecting the stomach to the small intestine. Thanks to the first procedure, doctors circumvent an obstacle that prevents the bile ducts from discharging bile into the duodenum; by the second procedure, on the other hand, they bypass an impediment that does not allow food to pass through the duodenum.

    Clearly, in the case of malignant tumors of the exocrine pancreas, the obstacle is the tumor mass.

In common parlance, the symptomatic treatments that can be adopted in the presence of a malignant tumor of the exocrine pancreas are also called palliative care .

According to the WHO (World Health Organization), palliative care represents an approach aimed at improving the quality of life of patients suffering from an incurable disease and of the families of these unfortunate individuals, through the prevention and relief of suffering by means of optimal treatment of pain and other symptoms.

Prognosis

Malignant tumors of the exocrine pancreas tend to have a poor prognosis in almost all patients. In this regard, it is recalled that the 5-year survival rate from the diagnosis is approximately 6% (ie only 6 patients out of 100 are still alive after 5 years from the diagnosis of the neoplasm).

The high mortality rate of malignant tumors of the exocrine pancreas is due above all to late diagnosis, a problem linked to the absence of symptoms that characterizes the beginnings of neoplasia.

In this regard, interesting clinical studies report that, at the time of finding a pancreatic carcinoma (the main malignant tumor of the exocrine pancreas), the latter is:

  • Circumscribed to the pancreas in only about 15% of cases;
  • Spread to the regional lymph nodes (ie neighboring) in 25% of cases;
  • Cause of distant metastasis in 60% of cases.

In the presence of a pancreatic cancer that has already given metastasis, the average survival is only about 5 months.

Prevention

As long as the triggering causes are not clear, preventing malignant tumors of the exocrine pancreas with absolute certainty is impossible.

CAN YOU DO SOMETHING?

Do not smoke (or quit smoking, if you are a smoker), control body weight and adopt a healthy lifestyle, which includes a diet rich in fruits and vegetables, are the main recommendations, provided by doctors, to reduce the risk of getting malignant exocrine pancreatic cancer.

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