pancreas cancer treatment in iran

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pancreas cancer treatment in iran

Pancreatic Cancer Treatment in Iran

Treatment options for people with cancer of the pancreas are surgery, chemotherapy, targeted therapy, and radiation therapy. You’ll probably receive more than one type of treatment. The treatment that’s right for you depends mainly on the following:

The location of the tumor in your pancreas
Whether the disease has spread
Your age and general health
At this time, cancer of the pancreas can be cured only when it’s found at an early stage (before it has spread) and only if surgery can completely remove the tumor. For people who can’t have surgery, other treatments may be able to help them live longer and feel better.

 

Overview

The pancreas is a gland about 6 inches long, shaped like a thin pear. It lies between the stomach and the spine. It has two main jobs in the body—to make juices that help digest (break down) food and to make hormones, such as insulin and glucagon, that helps control blood sugar levels. Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas.

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Surgery for Pancreatic Cancer

Two general types of surgery can be used for pancreatic cancer:

  • Potentially curative surgery is used when the results of exams and tests suggest that it’s possible to remove (resect) all the cancer.
  • Palliative surgery may be done if tests show that the cancer is too widespread to be removed completely. This surgery is done to relieve symptoms or to prevent certain complications like a blocked bile duct or intestine, but the goal is not to cure the cancer.

Staging laparoscopy

To determine which type of surgery might be best, it’s important to know the stage (extent) of the cancer. But it can be hard to stage pancreatic cancer accurately just using imaging tests. Sometimes laparoscopy is done first to help determine the extent of the cancer and if it can be resected.

For this procedure, the surgeon makes a few small incisions (cuts) in the abdomen (belly) and inserts long, thin instruments. One of these has a small video camera on the end so the surgeon can see inside the abdomen andlook at the pancreas and other organs. Biopsysamples of tumors and other abnormal areas can show how far the cancer has spread.

Potentially curative surgery

Studies have shown that removing only part of a pancreatic cancer doesn’t help patients live longer, so potentially curative surgery is only done if the surgeon thinks all of the cancer can be removed.

This is a very complex surgery and it can be very hard for patients. It can cause complications and might take weeks or months to recover from fully. If you're thinking about having this type of surgery, it’s important to weigh the potential benefits and risks carefully.

Fewer than 1 in 5 pancreatic cancers appear to be confined to the pancreas at the time they are found. Even then, not all of these cancers turn out to be truly resectable (able to be completely removed). Sometimes after the surgeon starts the operation it becomes clear that the cancer has grown too far to be completely taken out. If this happens, the operation may be stopped, or the surgeon might continue with a smaller operation with a goal of relieving or preventing symptoms (see “Palliative surgery” below). This is because the planned operation would be very unlikely to cure the cancer and could still lead to major side effects. It would also lengthen the recovery time, which could delay other treatments.

Surgery offers the only realistic chance to cure pancreatic cancer, but it doesn’t always lead to a cure. Even if all visible cancer is removed, often some cancer cells have already spread to other parts of the body. These cells can grow into new tumors over time, which can be hard to treat.

Curative surgery is done mainly to treat cancers in the head of the pancreas. Because these cancers are near the bile duct, they often cause jaundice, which sometimes allows them to be found early enough to be removed completely. Surgeries for other parts of the pancreas are described below, and are done if it’s possible to remove all of the cancer.

Whipple procedure (pancreaticoduodenectomy)

This is the most common operation to remove a cancer in the head of the pancreas.

During this operation, the surgeon removes the head of the pancreas and sometimes the body of the pancreas as well. Nearby structures such as part of the small intestine, part of the bile duct, the gallbladder, lymph nodes near the pancreas, and sometimes part of the stomach are also removed. The remaining bile duct and pancreas are then attached to the small intestine so that bile and digestive enzymes can still go into the small intestine. The end pieces of the small intestine (or the stomach and small intestine) are then reattached so that food can pass through the digestive tract (gut).

Most often, this operation is done through a large incision (cut) down the middle of the belly. Some doctors at major cancer centers also do the operation laparoscopically, which is sometimes known as keyhole surgery (see What’s New in Pancreatic Cancer Research?).

A Whipple procedure is a very complex operation that requires a surgeon with a lot of skill and experience. It carries a relatively high risk of complications that can be life threatening. When the operation is done in small hospitals or by doctors with less experience, as many as 15% of patients may die as a result of surgical complications. In contrast, when the operation is done in cancer centers by surgeons experienced in the procedure, fewer than 5% of patients die as a direct result of surgery.

To have the best outcome, it’s important to be treated by a surgeon who does many of these operations and to have the surgery at a hospital where many of them are done. In general, people having this type of surgery do better when it's done at a hospital that does at least 15 to 20 Whipple procedures per year.

Still, even under the best circumstances, many patients have complications from the surgery. These can include:

  • Leaking from the various connections between organs that the surgeon has to join
  • Infections
  • Bleeding
  • Trouble with the stomach emptying after eating
  • Trouble digesting some foods (which might require taking some pills to help with digestion)
  • Weight loss
  • Changes in bowel habits
  • Diabetes

Distal pancreatectomy

In this operation, the surgeon removes only the tail of the pancreas or the tail and a portion of the body of the pancreas. The spleen is usually removed as well. The spleen helps the body fight infections, so if it’s removed you’ll be at increased risk of infection with certain bacteria. To help with this, doctors recommend that patients get certain vaccines before this surgery.

This surgery is used to treat cancers found in the tail and body of the pancreas. Unfortunately, many of these tumors have usually already spread by the time they are found and surgery is not always an option.

Total pancreatectomy

This operation removes the entire pancreas, as well as the gallbladder, part of the stomach and small intestine, and the spleen. This surgery might be an option if the cancer has spread throughout the pancreas but can still be removed. But this type of surgery is used less often than the other operations because there doesn’t seem to be a major advantage in removing the whole pancreas, and it can have major side effects.

It’s possible to live without a pancreas. But when the entire pancreas is removed, people are left without the cells that make insulin and other hormones that help maintain safe blood sugar levels. These people develop diabetes, which can be hard to manage because they are totally dependent on insulin shots. People who have had this surgery also need to take pancreatic enzyme pills to help them digest certain foods.

Before you have this operation, your doctor will recommend that you get certain vaccines because the spleen will be removed.

Palliative surgery

If the cancer has spread too far to be removed completely, any surgery being considered would be palliative (intended to relieve symptoms). Because pancreatic cancer can spread quickly, most doctors don’t advise major surgery for palliation, especially for people who are in poor health.

Sometimes surgery might be started with the hope it will cure the patient, but once it begins the surgeon discovers this is not possible. In this case, the surgeon might do a less extensive, palliative operation known as bypass surgery to help relieve symptoms.

Cancers growing in the head of the pancreas can block the common bile duct as it passes through this part of the pancreas. This can cause pain and digestive problems because bile can’t get into the intestine. The bile chemicals will also build up in the body, which can cause jaundice, nausea, vomiting, and other problems. There are two main options to relieve bile duct blockage in this situation:

Stent placement

The most common approach to relieving a blocked bile duct does not involve actual surgery. Instead, a stent (small tube, usually made of metal) is put inside the duct to keep it open. This is usually done through an endoscope (a long, flexible tube) while you are sedated. Often this is part of an endoscopic retrograde cholangiopancreatography (ERCP). The doctor passes the endoscope down the throat and all the way into the small intestine. Through the endoscope, the doctor can then put the stent into the bile duct. The stent can also be put in place through the skin during a percutaneous transhepatic cholangiography (PTC). (See Tests for Pancreatic Cancer.)

The stent helps keep the bile duct open even if the surrounding cancer presses on it. But after several months, the stent may become clogged and may need to be cleared or replaced. Larger stents can also be used to keep parts of the small intestine open if they are in danger of being blocked by the cancer.

A bile duct stent can also be put in to help relieve jaundice before curative surgery is done (which would typically be a couple of weeks later). This can help lower the risk of complications from surgery.

Bypass surgery

In people who are healthy enough, another option for relieving a blocked bile duct is surgery to reroute the flow of bile from the common bile duct directly into the small intestine, bypassing the pancreas. This typically requires a large incision (cut) in the abdomen, and it can take weeks to recover from this. Sometimes surgery can be done through several small cuts in the abdomen using special long surgical tools. (This is known as laparoscopic or keyhole surgery.)

Having a stent placed is often easier and the recovery is much shorter, which is why this is done more often than bypass surgery. But surgery can have some advantages, such as:

  • It can often give longer-lasting relief than a stent, which might need to be cleaned out or replaced.
  • It might be an option if a stent can’t be placed for some reason.
  • During surgery, the surgeon may be able to cut some of the nerves around the pancreas or inject them with alcohol. Because pancreatic cancer often causes pain if it reaches these nerves, this procedure may reduce or get rid of any pain caused by the cancer.

Sometimes, the end of the stomach is disconnected from the duodenum (the first part of the small intestine) and attached farther down the small intestine during this surgery as well. This is known as a gastric bypass. This is done because over time the cancer might grow large enough to block the duodenum, which can cause pain and vomiting and often requires urgent surgery. Bypassing the duodenum before this happens can sometimes help avoid this.

Bypass surgery can still be a major operation, so it’s important that you are healthy enough to tolerate it and that you talk with your doctor about the possible benefits and risks before you have the surgery.

10 common Questions about this cancer

1How long does a person live after being diagnosed with pancreatic cancer?
The median survival for untreated advanced pancreatic cancer is about 3 1/2 months; with good treatment this increases to about eight months, though many will live much longer. We have encountered nine and eleven and twelve year survivors. Perhaps it is a good place to discuss what the term median means.
2How serious is cancer in the pancreas?
About 95% of people with pancreatic cancer die from it, experts say. It's so lethal because during the early stages, when the tumor would be most treatable, there are usually no symptoms. It tends to be discovered at advanced stages when abdominal pain or jaundice may result.
3Can cancer of the pancreas be treated?
Surgery is usually the only way pancreatic cancer can be completely cured. However, as the condition is usually advanced by the time it's diagnosed, surgery is not always suitable. If your cancer has spread to other areas of the body, surgically removing the tumour won't cure you.
4Can you live without a pancreas?
It's possible to live without a pancreas. But when the entire pancreas is removed, people are left without the cells that make insulin and other hormones that help maintain safe blood sugar levels. These people develop diabetes, which can be hard to manage because they are totally dependent on insulin shots.
5Does pancreatic cancer spread quickly?
Pancreatic cancers often first spread within the abdomen (belly) and to the liver. They can also spread to the lungs, bone, brain, and other organs. These cancers have spread too much to be removed by surgery.
6What are the early warning signs of pancreatic cancer?
Signs and Symptoms of Pancreatic Cancer Jaundice and related symptoms. Jaundice is yellowing of the eyes and skin. ... Belly or back pain. Pain in the abdomen (belly) or back is common in pancreatic cancer. ... Weight loss and poor appetite. ... Nausea and vomiting. ... Gallbladder or liver enlargement. ... Blood clots. ... Diabetes.
7What are the final stages of pancreatic cancer?
Symptoms of Pancreatic Cancer But as the cancer grows and spreads, pain often develops in the upper abdomen and sometimes spreads to the back. The pain may become worse after the person eats or lies down. Other symptoms may include jaundice, nausea, loss of appetite, weight loss, fatigue,and weakness.
8What is the #1 cause of pancreatic cancer?
Factors that may increase your risk of pancreatic cancer include: Chronic inflammation of the pancreas (pancreatitis) Diabetes. Family history of genetic syndromes that can increase cancer risk, including a BRCA2 gene mutation, Lynch syndrome and familial atypical mole-malignant melanoma (FAMMM) syndrome.
9Why does pancreatic cancer kill so quickly?
Why does pancreatic cancer kill so quickly? Pancreatic cancer is typically diagnosed at a late stage because it doesn't cause symptoms until it's too late. Weight loss, abdominal pain, jaundice [a yellowing of the skin due to toxic buildup in the liver]—those are the most common symptoms.
10Is pancreatic cancer always terminal?
Pancreatic tumors are hard to detect early and are not easily treated with surgery or chemotherapy once they spread to other organs. Pancreatic ductal adenocarcinoma, the most common type of pancreatic cancer, is a notoriously lethal disease. ... Just 7% of people with pancreatic cancer survive more than five

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