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Pancreatic Cancer Treatment In India

Treatment and Diagnosis:

If a patient has symptoms that suggest pancreatic cancer, the doctor asks about the patient's medical history. The doctor may perform a number of procedures, including one or more of the following:

• Physical exam -- The doctor examines the skin and eyes for signs of jaundice. The doctor then feels the abdomen to check for changes in the area near the pancreas, liver, and gallbladder. The doctor also checks for ascites, an abnormal buildup of fluid in the abdomen.
• Lab tests -- The doctor may take blood, urine, and stool samples to check for bilirubin and other substances. Bilirubin is a substance that passes from the liver to the gallbladder to the intestine. If the common bile duct is blocked by a tumor, the bilirubin cannot pass through normally. Blockage may cause the level of bilirubin in the blood, stool, or urine to become very high. High bilirubin levels can result from cancer or from noncancerous conditions.
• CT scan (Computed tomography) -- An x-ray machine linked to a computer takes a series of detailed pictures. The x-ray machine is shaped like a donut with a large hole. The patient lies on a bed that passes through the hole. As the bed moves slowly through the hole, the machine takes many x-rays. The computer puts the x-rays together to create pictures of the pancreas and other organs and blood vessels in the abdomen.
• Ultrasonography -- The ultrasound device uses sound waves that cannot be heard by humans. The sound waves produce a pattern of echoes as they bounce off internal organs. The echoes create a picture of the pancreas and other organs inside the abdomen. The echoes from tumors are different from echoes made by healthy tissues.

The ultrasound procedure may use an external or internal device, or both types:

• Transabdominal ultrasound: To make images of the pancreas, the doctor places the ultrasound device on the abdomen and slowly moves it around.
• EUS (Endoscopic ultrasound): The doctor passes a thin, lighted tube (endoscope) through the patient's mouth and stomach, down into the first part of the small intestine. At the tip of the endoscope is an ultrasound device. The doctor slowly withdraws the endoscope from the intestine toward the stomach to make images of the pancreas and surrounding organs and tissues.
• ERCP (endoscopic retrograde cholangiopancreatography) -- The doctor passes an endoscope through the patient's mouth and stomach, down into the first part of the small intestine. The doctor slips a smaller tube (catheter) through the endoscope into the bile ducts and pancreatic ducts. After injecting dye through the catheter into the ducts, the doctor takes x-ray pictures. The x-rays can show whether the ducts are narrowed or blocked by a tumor or other condition.
• PTC (percutaneous transhepatic cholangiography) -- A dye is injected through a thin needle inserted through the skin into the liver. Unless there is a blockage, the dye should move freely through the bile ducts. The dye makes the bile ducts show up on x-ray pictures. From the pictures, the doctor can tell whether there is a blockage from a tumor or other condition.
• Biopsy -- In some cases, the doctor may remove tissue. A pathologist then uses a microscope to look for cancer cells in the tissue. The doctor may obtain tissue in several ways. One way is by inserting a needle into the pancreas to remove cells. This is called fine-needle aspiration. The doctor uses x-ray or ultrasound to guide the needle. Sometimes the doctor obtains a sample of tissue during EUS or ERCP. Another way is to open the abdomen during an operation.

Staging

When pancreatic cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out the size of the tumor in the pancreas, whether the cancer has spread, and if so, to what parts of the body.

The doctor may determine the stage of pancreatic cancer at the time of diagnosis, or the patient may need to have more tests. Such tests may include blood tests, a CT scan, ultrasonography, laparoscopy, or angiography. The test results will help the doctor decide which treatment is appropriate

Treatment

Many people with pancreatic cancer want to take an active part in making decisions about their medical care. They want to learn all they can about their disease and their treatment choices. However, the shock and stress that people may feel after a diagnosis of cancer can make it hard for them to think of everything they want to ask the doctor. Often it helps to make a list of questions before an appointment. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some patients also want to have a family member or friend with them when they talk to the doctor-to take part in the discussion, to take notes, or just to listen.

Cancer of the pancreas is very hard to control with current treatments. For that reason, many doctors encourage patients with this disease to consider taking part in a clinical trial. Clinical trials are an important option for people with all stages of pancreatic cancer.

At this time, pancreatic cancer can be cured only when it is found at an early stage, before it has spread. However, other treatments may be able to control the disease and help patients live longer and feel better. When a cure or control of the disease is not possible, some patients and their doctors choose palliative therapy. Palliative therapy aims to improve quality of life by controlling pain and other problems caused by this disease.

The doctor may refer patients to an oncologist, a doctor who specializes in treating cancer, or patients may ask for a referral. Specialists who treat pancreatic cancer include surgeons, medical oncologists, and radiation oncologists. Treatment generally begins within a few weeks after the diagnosis. There will be time for patients to talk with the doctor about treatment choices, get a second opinion, and learn more about the disease.

Getting a Second Opinion

Before starting treatment, a patient may want a second opinion about the diagnosis and the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if the patient requests it. Gathering medical records and arranging to see another doctor may take a little time. In most cases, a brief delay to get another opinion will not make therapy less helpful.

There are a number of ways to find a doctor for a second opinion:

• The doctor may refer patients to one or more specialists. At cancer centers, several specialists often work together as a team.
• A local medical society, a nearby hospital, or a medical school can usually provide the name of specialists

Preparing for Treatment

The doctor can describe treatment choices and discuss the results expected with each treatment option. The doctor and patient can work together to develop a treatment plan that fits the patient's needs.

Treatment depends on where in the pancreas the tumor started and whether the disease has spread. When planning treatment, the doctor also considers other factors, including the patient's age and general health.

People do not need to ask all of their questions or understand all of the answers at one time. They will have other chances to ask the doctor to explain things that are not clear and to ask for more information

Methods of Treatment

People with pancreatic cancer may have several treatment options. Depending on the type and stage, pancreatic cancer may be treated with surgery, radiation therapy, or chemotherapy. Some patients have a combination of therapies.

Surgery may be used alone or in combination with radiation therapy and chemotherapy.

The surgeon may remove all or part of the pancreas. The extent of surgery depends on the location and size of the tumor, the stage of the disease, and the patient's general health.

• Whipple procedure: If the tumor is in the head (the widest part) of the pancreas, the surgeon removes the head of the pancreas and part of the small intestine, bile duct, and stomach. The surgeon may also remove other nearby tissues.
• Distal pancreatectomy: The surgeon removes the body and tail of the pancreas if the tumor is in either of these parts. The surgeon also removes the spleen.
• Total pancreatectomy: The surgeon removes the entire pancreas, part of the small intestine, a portion of the stomach, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes.

Sometimes the cancer cannot be completely removed. But if the tumor is blocking the common bile duct or duodenum, the surgeon can create a bypass. A bypass allows fluids to flow through the digestive tract. It can help relieve jaundice and pain resulting from a blockage.

The doctor sometimes can relieve blockage without doing bypass surgery. The doctor uses an endoscope to place a stent in the blocked area. A stent is a tiny plastic or metal mesh tube that helps keep the duct or duodenum open.

After surgery, some patients are fed liquids intravenously (by IV) and through feeding tubes placed into the abdomen. Patients slowly return to eating solid foods by mouth. A few weeks after surgery, the feeding tubes are removed.

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. A large machine directs radiation at the abdomen. Radiation therapy may be given alone, or with surgery, chemotherapy, or both.

Radiation therapy is local therapy. It affects cancer cells only in the treated area. For radiation therapy, patients go to the hospital or clinic, often 5 days a week for several weeks.

Doctors may use radiation to destroy cancer cells that remain in the area after surgery. They also use radiation to relieve pain and other problems caused by the cancer.

Chemotherapy is the use of drugs to kill cancer cells. Doctors also give chemotherapy to help reduce pain and other problems caused by pancreatic cancer. It may be given alone, with radiation, or with surgery and radiation.

Chemotherapy is systemic therapy. The doctor usually gives the drugs by injection. Once in the bloodstream, the drugs travel throughout the body.

Usually chemotherapy is an outpatient treatment given at the hospital, clinic, doctor's office, or home. However, depending on which drugs are given and the patient's general health, the patient may need to stay in the hospital.

Surgery

Surgery for pancreatic cancer is a major operation. Patients need to stay in the hospital for several days afterward. Patients may feel weak or tired. Most need to rest at home for about a month. The length of time it takes to regain strength varies.

The side effects of surgery depend on the extent of the operation, the person's general health, and other factors. Most patients have pain for the first few days after surgery. Pain can be controlled with medicine, and patients should discuss pain relief with the doctor or nurse.

Removal of part or the entire pancreas may make it hard for a patient to digest foods. The health care team can suggest a diet plan and medicines to help relieve diarrhea, pain, cramping, or feelings of fullness. During the recovery from surgery, the doctor will carefully monitor the patient's diet and weight. At first, a patient may have only liquids and may receive extra nourishment intravenously or by feeding tube into the intestine. Solid foods are added to the diet gradually.

Patients may not have enough pancreatic enzymes or hormones after surgery. Those who do not have enough insulin may develop diabetes. The doctor can give the patient insulin, other hormones, and enzymes.

Radiation Therapy

Radiation therapy may cause patients to become very tired as treatment continues. Resting is important, but doctors usually advise patients to try to stay as active as they can. In addition, when patients receive radiation therapy, the skin in the treated area may sometimes become red, dry, and tender.

Radiation therapy to the abdomen may cause nausea, vomiting, diarrhea, or other problems with digestion. The health care team can offer medicine or suggest diet changes to control these problems. For most patients, the side effects of radiation therapy go away when treatment is over

Chemotherapy

The side effects of chemotherapy depend mainly on the drugs and the doses the patient receives as well as how the drugs are given. In addition, as with other types of treatment, side effects vary from patient to patient.

Systemic chemotherapy affects rapidly dividing cells throughout the body, including blood cells. Blood cells fight infection, help the blood to clot, and carry oxygen to all parts of the body. When anticancer drugs damage healthy blood cells, patients are more likely to get infections, may bruise or bleed easily, and may have less energy. Cells in hair roots and cells that line the digestive tract also divide rapidly. As a result, patients may lose their hair and may have other side effects such as poor appetite, nausea and vomiting, diarrhea, or mouth sores. Usually, this side effect goes away gradually during the recovery periods between treatments or after treatment is over. The health care team can suggest ways to relieve side effects

Side Effects of Treatment

Because cancer treatment may damage healthy cells and tissues, unwanted side effects are common. These side effects depend on many factors, including the type and extent of the treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. The health care team will explain possible side effects and how they will help the patient manage them.

Pain Control

Pain is a common problem for people with pancreatic cancer. The tumor can cause pain by pressing against nerves and other organs.

The patient's doctor or a specialist in pain control can relieve or reduce pain in several ways:

• Pain medicine -- Medicines often can relieve pain. (These medicines may make people drowsy and constipated, but resting and taking laxatives can help.)
• Radiation -- High-energy rays can help relieve pain by shrinking the tumor.
• Nerve block -- The doctor may inject alcohol into the area around certain nerves in the abdomen to block the feeling of pain.
• Surgery -- The surgeon may cut certain nerves to block pain.

The doctor may suggest other ways to relieve or reduce pain. For example, massage, acupuncture, or acupressure may be used along with other approaches to help relieve pain. Also, the patient may learn relaxation techniques such as listening to slow music or breathing slowly and comfortably

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