End stage pancreatic cancer, or stage IV, spreads to distant parts of the body, like the liver, lungs, or bowel, stomach, or spleen. According to mayoclinicproceedings.com, approximately 70 to 80 percent of pancreatic cancer patients present with metastatic disease. Pancreatic cancer is the fifth leading cause of cancer-related mortality with an estimated 33,370 deaths due to this disease in 2007, according to cancersupportivecare.com. Almost all patients with pancreatic cancer die, usually within six months of diagnosis.
Epigastric Pain
According to pancreascancerinfo.com, end stage pancreatic cancer pain usually occurs in the upper abdomen, or epigastrium, dull and boring in quality and radiates to the back. Abdominal pain results from tumor pressing on organs and nerves. Pain manifests continuously or sporadically and exacerbates by eating or lying down, especially at night. It can be gnawing, aching, cramping or a stabbing pain. According to "Harrison's Principles of Internal Medicine," characteristically, the pain improves when the patient bends forward.
Gastric Outlet Obstruction
A common manifestation of end stage pancreatic cancer, gastric outlet obstruction results from a tumor growing into the duodenum. In a 2001 article in the journal "Surgical Endoscopy," Dr. Y.T. Wong notes that gastric outlet obstruction is seen in 15 percent of patients with pancreatic cancer. Dr. Wong goes on to explain that traditionally, it was treated by gastric bypass between the stomach and small bowel, but the 30-day mortality rate in these patients has been reported to be 70 percent. The preferred treatment for biliary obstruction in pancreatic cancer is endoscopic duodenal stenting. Patients who undergo duodenal stenting are observed overnight and given a Gastrografin swallow the next day to confirm the patency of the stent. They are able to tolerate a liquid diet immediately and go home the next day.
Cachexia
According to "Harrison's Principles of Internal Medicine," weight loss seen in most pancreatic cancer patients results from anorexia, although malabsorption may also contribute. A variety of tumor-derived factors and host-derived factors cause the altered metabolism, which results in a vicious cycle that cannot be reversed.
Deep Venous Thrombosis
According to "Harrison's Principles of Internal Medicine," approximately 15 percent of patients who develop deep venous thrombosis or pulmonary embolism have cancer. Deep venous thrombosis in combination with visceral carcinoma, especially pancreatic cancer, is also called Trousseau's syndrome.
References
- Cancer of the pancreas
- Pancreatic Cancer: End Stage
- Treatment Options for Hepatobiliary and Pancreatic Cancer
- "Harrison's Principles of Internal Medicine"; Dennis Kasper, M.D.; 2005
- "Surgical Endoscopy"; Gastric Outlet Obstruction Secondary to Pancreatic Cancer; Dr. Y.T. Wong; 2002; 16: 310–312
