The pancreas is a small organ about 6 inches long that lies behind the stomach and has three areas: a head, body and tail. It is responsible for making insulin and digestive enzymes. When cancer affects the pancreas, there are almost no symptoms until the cancer reaches late stages. According to The Merck Manuals Online Medical Library, pancreatic cancer accounts for 33,000 deaths a year in the United States.
Symptoms
By the time diagnosis is made, 90 percent of patients have tumors that have spread to other organs, states The Merck Manuals Online Medical Library. Long-standing diabetes, smoking and chronic pancreatitis or inflammation of the pancreas are risk factors. Signs of pancreatic cancer in later stages include jaundice, weight loss and abdominal pain. The abdominal pain can be searing and radiate to the back. Many patients develop diabetes because pancreatic cancer affects insulin production in the pancreas. Jaundice develops because of obstruction in the head of the pancreas.
Staging
Pancreatic cancer is staged according to the size and location of the tumor and distant spread of the tumor cells. Stage I pancreatic cancer is a localized tumor, which means the tumor is found only in the pancreas. In stage II, the tumor may have spread to surrounding organs and lymph nodes near the pancreas. With stage III, the tumor has spread to nearby blood vessels and possibly the lymph nodes. When the tumor is found in distant organs such as the liver or the lungs and has spread to the lymph nodes, it is considered stage IV pancreatic cancer. Eighty to 90 percent of pancreatic cancers are found in this late stage and cannot be surgically removed, notes Merck. Chemotherapy and radiation may be offered in late-stage cancer, but the survival rate is dismal---40 percent of patients have a two-year survival rate and 25 percent have a five-year survival rate, according to Merck.
End-of-Life Care
Many patients have less than six or seven months to live after diagnosis, reports Merck. According to the National Cancer Society, patients with late-stage pancreatic cancer have an overall survival rate of less than 1 percent at five years. Patients with late-stage pancreatic cancer can experience significant pain, therefore symptom relief is the focus of care during this time. Obstructive jaundice can cause pruritus or severe itching, and stent placements into the biliary tract may be necessary for relief. Other palliative measures include adequate pain control with narcotics. The pancreas may be unable to produce the necessary digestive enzymes and the patient may need to replete the enzymes orally with lipase tablets. Patients also may need insulin to control diabetes.
