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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

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.

Surgical removal of part of the pancreas and other tissues versus other treatments for patients with pancreatic cancer which invades the surrounding structures

The pancreas is an organ in the abdomen which secretes digestive juices for the digestion of food. It also harbours the insulin secreting cells which maintain the blood sugar levels. Pancreatic cancer is an aggressive cancer. Surgery to remove the cancer improves survival. However, a third of patients with pancreatic cancer have locally advanced cancer involving major blood vessels which are not usually removed because of the fear of increased complications after surgery. Such patients receive palliative treatment. Resection (removing part of an organ) of the pancreas has been suggested as an alternative to palliative treatment for patients with locally advanced pancreatic cancer. However, in this group of patients the benefits and harms of surgical resection versus other treatments are not clear. We set out to answer this question by performing a thorough search of the literature for studies which compared surgical removal with palliative treatments. We included only randomised controlled trials, studies which, if designed appropriately, can help avoid arriving at wrong conclusions. We searched the literature for all studies reported until December 2013. Two authors independently assessed the trials for inclusion and independently extracted data to minimise errors.

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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.

Surgical removal of part of the pancreas and other tissues versus other treatments for patients with pancreatic cancer which invades the surrounding structures

The pancreas is an organ in the abdomen which secretes digestive juices for the digestion of food. It also harbours the insulin secreting cells which maintain the blood sugar levels. Pancreatic cancer is an aggressive cancer. Surgery to remove the cancer improves survival. However, a third of patients with pancreatic cancer have locally advanced cancer involving major blood vessels which are not usually removed because of the fear of increased complications after surgery. Such patients receive palliative treatment. Resection (removing part of an organ) of the pancreas has been suggested as an alternative to palliative treatment for patients with locally advanced pancreatic cancer. However, in this group of patients the benefits and harms of surgical resection versus other treatments are not clear. We set out to answer this question by performing a thorough search of the literature for studies which compared surgical removal with palliative treatments. We included only randomised controlled trials, studies which, if designed appropriately, can help avoid arriving at wrong conclusions. We searched the literature for all studies reported until December 2013. Two authors independently assessed the trials for inclusion and independently extracted data to minimise errors.

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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 messenger molecule that helps coordinate the actions of various tissues; made in one part of the body and transported, via the bloodstream, to tissues and organs elsewhere 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: Malignant tumour of the pancreas, Cancer of the pancreas, Malignant tumor of the pancreas

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

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