Stage 4 pancreatic cancer
The term cancer refers to a new growth which will invade surrounding tissues, metastasize i.e., spread to other organs and may eventually lead to the patients death if untreated. A tumor is not necessarily a cancer. The word tumor simply refers to a mass. For example, a collection of pus is by definition a tumor. A cancer is a particularly threatening type of tumor. Cancer of the pancreas is a disease in which cancer malignant cells are found in the tissues of the pancreas. The pancreas is about 6 inches long and is shaped something like a thin pear, wider at one end and narrowing at the other. The pancreas lies behind the stomach, inside a loop formed by part of the small intestine. The broader right end of the pancreas is called the head, the middle section is called the body, and the narrow left end is the tail.
The pancreas has two basic jobs in a human body. It produces juices that help breakdown of the food and hormones, such as insulin that regulate how the body stores and uses food. The area of the pancreas that produces digestive juices is called the exocrine pancreas. Cancer of the pancreas is hard to find because the organ is hidden behind other organs. Organs around the pancreas include the stomach, small intestine, bile ducts i.e., tubes through which bile, a digestive juice made by the liver, flows from the liver to the small intestine, gallbladder, the liver, and the spleen.
STAGES OF CANCER OF THE PANCREAS:
Once cancer of the pancreas is found, more tests will be done to find out if the cancer has spread from the pancreas to the tissues around it or to other parts of the body. This is called staging. The following stages are used for cancer of the pancreas:
STAGE I: This the earliest stage of cancer. The cancer is completely inside the pancreas itself, or has started to spread just to the tissues next to the pancreas, such as the small intestine, the stomach, or the bile duct. In the Tumor, Node Metastasis, in short TNM staging system, stage 1 cancers can be bigger or smaller than 2 cm, but there is no cancer in the lymph nodes or cancer spread.
STAGE II: Cancer has started to spread to nearby tissues around the pancreas. It may be in stomach, spleen, or colon, but has not entered the lymph nodes. Lymph nodes are small, bean shaped structures that are found throughout the body; they produce and store infection fighting cells. This means that, although the cancer has been growing locally, there is a chance that it may not have spread through the blood or lymph systems.
STAGE III: The Cancer itself can be any size and may have grown into the tissues surrounding the pancreas. The cancer may or may not have spread to nearby lymph nodes. It may have spread into other body organs through the lymph system.
STAGE IV PANCREATIC CANCER: Pancreatic cancer is considered stage IV, if it has spread to distant locations in the body, such as, the liver, lungs, or adjacent organs including the stomach, spleen and or the bowel. Sometimes it can only be determined that a pancreatic cancer is in stage IV once surgery is completed.
The treatment may be one of the following:
1. Surgery or other treatments to reduce symptoms.
2. Treatments for pain.
3. Clinical trials of chemotherapy or biological therapy.
Patients diagnosed with stage IV pancreatic cancer can be broadly divided into two groups:
1. Stage IVA pancreatic cancer is locally confined, but involves adjacent organs or blood vessels, thereby hindering surgical removal. Stage IVA pancreatic cancer is also referred to as localized or locally advanced.
2. Stage IVB pancreatic cancer has spread to distant organs, most commonly the liver. Stage IVB pancreatic cancer is also called metastatic.
The goal of treatment for patients with localized IVA disease is to induce a remission, or a disease free period that may last months or years. Management of patients with stage IVB disease is often aimed at controlling symptoms and pain from the cancer.
Stage IV pancreatic cancer is generally not removable by surgery and is therefore rarely curable and often difficult to control. A surgical procedure may be possible to reduce symptoms and improve quality of life in some patients, but the recommended treatment for advanced pancreatic cancer is typically chemotherapy. The standard chemotherapy drug for the treatment of pancreatic cancer is Gemzar.
The following is a general overview of the treatment for Stage IV pancreatic cancer. Treatment may consist of surgery, radiation, chemotherapy, biological therapy, or a combination of these treatment techniques. Multi modality treatment, is treatment using two or more techniques, is increasingly recognized as an important approach for improving a patients chance of cure or prolonging survival.
Treatment for stage IVA pancreatic cancer may include palliative surgery, chemotherapy, which is chemotherapy and radiation delivered together. Chemotherapy is the use of anti cancer drugs to destroy cancer cells throughout the body. Radiation therapy uses high energy X-rays to kill cancer cells at the location in the body where the X-rays are focused. Occasionally, a surgical bypass procedure may alleviate complications of the cancer, such as, jaundice, intestinal obstruction, or pain, thereby improving quality of life.
III. Treatment of Non Localized Stage IVB Metastatic Pancreatic Cancer:
The majority of patients with stage IV cancer have metastatic disease i.e. Stage IVB, which means the cancer, has spread to distant locations in the body that often includes the liver and other areas of the abdominal cavity. To kill cancer cells that have spread in the body, a systemic treatment is necessary, which is typically chemotherapy. Patients with metastatic pancreatic cancer have been considered incurable and rarely survived more than one year. However, patients are offered treatment with chemotherapy for the purpose of prolonging their life and alleviating symptoms from progressive cancer. Sometimes, management of patients with stage IVB pancreatic cancer is focused on reducing pain and maintaining nutrition. Pain relief can be achieved by destroying the nerves that provide sensation in the area around the pancreas. This is usually performed by injection of alcohol or other chemicals either through the skin or during an open abdominal operation.
IV.CHEMOTHERAPY:
Chemotherapy involves the use of anti cancer drugs to destroy cancer cells throughout the body. Chemotherapy is considered a systemic therapy because the drug circulates throughout the body and can kill cancer cells that have spread to locations distant from where the cancer started. Chemotherapy is commonly used to treat both locally advanced Stage IVA and metastatic Stage IVB pancreatic cancer.
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