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Pancreatic Cancer

A disease in which malignant (cancer) cells are found in the tissues of the pancreas.

PubMed Health Glossary
(Source: NIH - National Cancer Institute)

Types of Pancreatic Cancer

What works? Research summarized

Evidence reviews

Venous Thromboembolism: Reducing the Risk of Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital

Venous thromboembolism (VTE) is a term used to include the formation of a blood clot (a thrombus) in a vein which may dislodge from its site of origin to travel in the blood, a phenomenon called embolism. A thrombus most commonly occurs in the deep veins of the legs; this is called deep vein thrombosis. A dislodged thrombus that travels to the lungs is known as a pulmonary embolism.

Celiac plexus block (CPB) in patients with unresectable pancreatic cancer‐related pain

Abdominal pain is a major symptom in patients with inoperable pancreatic cancer and is often difficult to treat. Celiac plexus block (CPB) is a safe and effective method for reducing this pain. It involves the chemical destruction of the nerve fibres that convey pain from the abdomen to the brain. We searched for studies comparing CPB with standard analgesic therapy in patients with inoperable pancreatic cancer. We were interested in the primary outcome of pain, measured on a visual analogue scale (VAS). We also looked at the amount of opioid (morphine‐like drugs) patients took (opioid consumption) and adverse effects of the treatment. Six studies (358 participants) comparing CPB with standard therapy (painkillers) met our inclusion criteria. At four weeks pain scores were significantly lower in the CPB group. Opioid consumption was also significantly lower than in the control group. The main adverse effects were diarrhoea or constipation (this symptom was significantly more likely in the control group, where opioid consumption was higher). Endoscopic ultrasonography (EUS)‐guided CPB is becoming popular as a minimally invasive technique that has fewer risks, but we were not able to find any RCTs assessing this method (current medical literature on this subject is limited to studies without control groups). Although the data on EUS‐guided CPB and pain control are promising, we await rigorously designed RCTs that may validate these findings. We conclude that, although statistical evidence is minimal for the superiority of pain relief over analgesic therapy, the fact that CPB causes fewer adverse effects than opioids is important for patients.

Palliative biliary stents for obstructing pancreatic cancer

The majority of patients with cancer of the pancreas are diagnosed only after blockage of the bile ducts has occurred. Surgical by‐pass (SBP) or endoscopic stenting (ES) of the blockage are the treatment options available for these patients. This review compares 29 randomised controlled trials that used surgical by‐pass, endoscopic metal stents or endoscopic plastic stents in patients with malignant bile duct obstruction. All included studies contained groups where cancer of the pancreas was the most common cause of bile duct obstruction. This review shows that endoscopic stents are preferable to surgery in palliation of malignant distal bile duct obstruction due to pancreatic cancer. The choice of metal or plastic stents depends on the expected survival of the patient; metal stents only differ from plastic stents in the risk of recurrent bile duct obstruction. Polyethylene stents and stainless‐steel alloy stents (Wallstent) are the most studied stents.

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Summaries for consumers

Celiac plexus block (CPB) in patients with unresectable pancreatic cancer‐related pain

Abdominal pain is a major symptom in patients with inoperable pancreatic cancer and is often difficult to treat. Celiac plexus block (CPB) is a safe and effective method for reducing this pain. It involves the chemical destruction of the nerve fibres that convey pain from the abdomen to the brain. We searched for studies comparing CPB with standard analgesic therapy in patients with inoperable pancreatic cancer. We were interested in the primary outcome of pain, measured on a visual analogue scale (VAS). We also looked at the amount of opioid (morphine‐like drugs) patients took (opioid consumption) and adverse effects of the treatment. Six studies (358 participants) comparing CPB with standard therapy (painkillers) met our inclusion criteria. At four weeks pain scores were significantly lower in the CPB group. Opioid consumption was also significantly lower than in the control group. The main adverse effects were diarrhoea or constipation (this symptom was significantly more likely in the control group, where opioid consumption was higher). Endoscopic ultrasonography (EUS)‐guided CPB is becoming popular as a minimally invasive technique that has fewer risks, but we were not able to find any RCTs assessing this method (current medical literature on this subject is limited to studies without control groups). Although the data on EUS‐guided CPB and pain control are promising, we await rigorously designed RCTs that may validate these findings. We conclude that, although statistical evidence is minimal for the superiority of pain relief over analgesic therapy, the fact that CPB causes fewer adverse effects than opioids is important for patients.

Palliative biliary stents for obstructing pancreatic cancer

The majority of patients with cancer of the pancreas are diagnosed only after blockage of the bile ducts has occurred. Surgical by‐pass (SBP) or endoscopic stenting (ES) of the blockage are the treatment options available for these patients. This review compares 29 randomised controlled trials that used surgical by‐pass, endoscopic metal stents or endoscopic plastic stents in patients with malignant bile duct obstruction. All included studies contained groups where cancer of the pancreas was the most common cause of bile duct obstruction. This review shows that endoscopic stents are preferable to surgery in palliation of malignant distal bile duct obstruction due to pancreatic cancer. The choice of metal or plastic stents depends on the expected survival of the patient; metal stents only differ from plastic stents in the risk of recurrent bile duct obstruction. Polyethylene stents and stainless‐steel alloy stents (Wallstent) are the most studied stents.

Comparison of the stomach‐preserving 'Whipple' operation with the classic 'Whipple' operation for patients with cancer of the pancreas or the periampullary region (the point at which the ducts from the liver and pancreas enter the small intestine)

Pancreatic cancer is a leading cause of cancer death. Two surgical procedures can lead to a cure: the classic Whipple operation, in which part of the pancreas, the gallbladder, the duodenum, the pylorus (outlet of the stomach) and the distal (lower) part of the stomach are removed, and the so‐called pylorus‐preserving pancreaticoduodenectomy, or pylorus‐preserving Whipple operation, in which the stomach and the pylorus are not removed.

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Terms to know

Endocrine Glands
A group of specialized cells that release hormones into the blood. For example, the islets in the pancreas, which secrete insulin, are endocrine glands.
Exocrine Glands
An organ that makes one or more substances, such as sweat, tears, saliva, or milk. Exocrine glands release the substances into a duct or opening to the inside or outside of the body.
Hormones
A chemical produced in one part of the body and released into the blood to trigger or regulate particular functions of the body. For example, insulin is a hormone made in the pancreas that tells other cells when to use glucose for energy. Synthetic hormones, made for use as medicines, can be the same or different from those made in the body.
Neuroendocrine Cells
Cells that release hormones into the blood in response to stimulation of the nervous system.
Pancreas
An organ that makes insulin and enzymes for digestion. The pancreas is located behind the lower part of the stomach and is about the size of a hand.

More about Pancreatic Cancer

Photo of an adult

Also called: Cancer of the pancreas

Other terms to know: See all 5
Endocrine Glands, Exocrine Glands, Hormones

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