SIGNS OF PANCREATIC CANCER

Sometimes called a " silent killer "  because early cancer often does not cause symptoms

SIGNS OF PANCREATIC CANCER

Pancreatic cancers crapper arise from both the secreter and endocrine portions of the pancreas. Of pancreatic tumors, 95% develop from the secreter assets of the pancreas, including the ductal epithelium, acinar cells, connective tissue, and lymphatic tissue. Approximately 75% of every pancreatic carcinomas become within the head or neck of the pancreas, 15-20% become in the body of the pancreas, and 5-10% become in the tail.

Typically, pancreatic cancer first metastasizes to regional lymph nodes, then to the liver, and, inferior commonly, to the lungs. It crapper also directly assail surrounding visceral organs much as the duodenum, stomach, and colon or distribute to some surface in the abdominal decay via peritoneal spread. Ascites haw result, and this has an ominous prognosis. Pancreatic cancer haw spread to the skin as painful nodular metastases. Pancreatic cancer uncommonly metastasizes to bone. It is rare for pancreatic cancer to spread to the brain. It can, however, produce meningeal carcinomatosis.

SIGN AND SYMPTOMS

Pancreatic cancer is sometimes titled a "silent killer" because early pancreatic cancer ofttimes does not drive symptoms, and the later symptoms are usually non-specific and varied. Therefore, pancreatic cancer is ofttimes not diagnosed until it is advanced. Common symptoms include:

Pain in the bunk abdomen that typically radiates to the back (seen in carcinoma of the body or tail of the pancreas)

Loss of craving and/or sickness and vomiting.

Significant weight loss

Painless jaundice (yellow skin/eyes, dark urine) when a cancer of the head of the pancreas (about 60% of cases) obstructs the common bile funiculus as it runs finished the pancreas. This may also drive pale-colored stool and steatorrhea.

Trousseau sign, in which blood clots form spontaneously in the portal blood vessels, the deep veins of the extremities, or the ostensible veins anywhere on the body, is sometimes related with pancreatic cancer.

Diabetes mellitus, or elevated blood sugar levels. Many patients with
pancreatic cancer develop diabetes months to even years before they are diagnosed with pancreatic cancer, suggesting that new start diabetes in an elderly individual may be an early warning clew of pancreatic cancer.

Clinical depression has been reported in association with pancreatic cancer, sometimes presenting before the cancer is diagnosed. However, the mechanism for this association is not known.

Pancreatic cancer treatment

Peak incidence in fifth and sixth decades , unfortunately usually .............

TREATMENT

Treatment for pancreatic cancer depends on a number of factors. Among these are the type, size, and extent of the growth as well as the patient's age and general health. A treatment plan is tailored to sound apiece patient's needs.

Cancer of the pancreas is curable only when it is institute in its earliest stages, before it has spread. Otherwise, it is rattling arduous to cure. However, it crapper be treated, symptoms crapper be relieved, and the quality of the patient's chronicle crapper be improved.

Because pancreatic cancer is oft times modern when it is prototypal found, rattling some pancreatic tumors crapper be removed by surgery. The standard machine is called a pancreaticoduodenectomy (Whipple procedure).

This surgery should be finished at centers that perform the machine frequently. Some studies declare that surgery is best performed at hospitals that do more than five of these surgeries per year.

When the tumor has not distribute out of the pancreas but cannot be removed, radiation therapy and chemotherapy unitedly may be recommended.

When the tumor has distribute (metastasized) to another organs much as the liver, chemotherapy lonely is usually used. The standard chemotherapy drug is gemcitabine, but another drugs may be used. Gemcitabine crapper support approximately 25% of patients.

Patients whose tumor cannot be totally removed, but who hit a closure of the tubes that instrumentation bile (biliary obstruction) must hit that closure relieved.
There are mostly two approaches to this:
1.surgery.
2.Placement of a tiny metal plaything (biliary stent) during ERCP

Radiation therapy (also called radiotherapy) uses high-powered rays to damage cancer cells and kibosh them from growing. Radiation is usually given 5 days a week for 5 to 6 weeks. This schedule helps to protect connatural tissue by spreading out the total dose of radiation. The patient doesn't need to meet in the hospital for irradiation therapy.

Chemotherapy uses drugs to kill cancer cells. The student may use meet one take or a combination. Chemotherapy may be given by mouth or by injection into a muscle or vein. The drugs start the bloodstream and travel through the body. Chemotherapy is usually given in cycles; a communication punctuation followed by a recovery period, then added communication period, and so on.

Management of discompose and another symptoms is an important conception of treating modern pancreatic cancer. Hospice crapper support with discompose and symptom management, and wage psychological support for patients and their families during the illness.

Pancreas cancer diagnosis

There is  an strong association with diabetes ,high fat diet and smoking 

Pancreas cancer diagnosis

To diagnose pancreatic cancer, the student does a complete physical exam and asks about the patient's individualized and kinsfolk medical history. In constituent to checking general signs of health (temperature, pulse, murder pressure, and so on), the student usually orders blood, urine, and crap tests. The student may also communicate for a "barium swallow," or "upper GI series." For this test, the patient drinks a metal resolution before x-rays of the upper digestive system are taken. The metal shows an summary of the pancreas on the x-rays.

An angiogram, a primary x-ray of murder vessels.

CT scans, x-rays that give detailed pictures of a cross- section of the pancreas. These pictures are created by a computer.

Transabdominal ultrasound to view the pancreas. In this procedure, an helper that sends out high-frequency good waves, which cannot be heard, is passed over the abdomen. The good waves echo off the pancreas. The echoes modify a represent on a screen that looks like a television.

ERCP (endoscopic recap cholangiopancreatogram), is a primary x-ray of the ordinary bile duct. For this test, a long, flexible tube (endoscope) is passed down the patient's throat finished the stomach and into the diminutive intestine. A dye is injected into the ordinary bile duct, and x-rays are taken. The student crapper also look finished the endoscope and take paper samples.

Endoscopic ultrasound is a relatively new procedure that crapper be used to diagnose pancreatic cancer. For the procedure, an endoscope is passed in the aforementioned artefact as for ERCP; however, on the modify of the endoscope is an ultrasound enquiry which scans the pancreas for cancers. Because the ultrasound enquiry is closer to the pancreas than with transabdominal ultrasound, it is possible to identify diminutive cancers within the pancreas. The cancers also crapper be biopsied finished the endoscope.

A biopsy is the only sure artefact for the student to know whether cancer is present. In a biopsy, the student removes some paper from the pancreas. It is examined under a microscope by a pathologist, who checks for cancer cells.

Sometimes an activeness titled a laparotomy may be needed. During this operation, the student crapper look at organs in the cavum and crapper remove tissue. The laparotomy helps the student watch the stage, or extent, of the disease. Knowing the initiate helps the student organisation treatment.

Pancreas cancer

PANCREAS CANCER

Pancreatic cancer is the ordinal directive cause of death among both men and women, comprising 6% of every cancer-related deaths. The incidence of pancreatic cancer has risen tardily over the years. The disease is notoriously difficult to diagnose in its early stages. At the time of diagnosis, 52% of every patients hit distant disease and 26% hit regional spread. The qualifying 1-year activity is only 24% and the overall 5-year activity rate for this disease is inferior than 5%. 

About 95% of exocrine pancreatic cancers are adenocarcinomas . The remaining 5% allow adenosquamous carcinomas, signet ring radiophone carcinomas, hepatoid carcinomas, colloid carcinomas, dedifferentiated carcinomas, and dedifferentiated carcinomas with osteoclast-like giant cells. Exocrine pancreatic cancers are far more common than endocrine pancreatic cancers (also known as island radiophone carcinomas), which make up most 1% of amount cases.

In spite of the limited growth size the majority of pancreatic head cancers (80%) are not suitable for resection at the instance of diagnosis. 

This is cod to modern local growth extension (40%) or the presence of distant metastatic disease (40%) mostly cod to liver metastases of para-aortic lymphadenopathy.

CAUSES

Overall, estimates inform that 40% of pancreatic cancer cases are spasmodic in nature. Another 30% are related to smoking, and 20% haw be related with fare factors. Only 5-10% are hereditary in nature. Fewer than 5% of all pancreatic cancers are related to inexplicit habitual pancreatitis.

SMOKING

Smoking is the most ordinary environmental venture bourgeois for pancreatic carcinoma.

People who respiration have at small a 2-fold increased venture for pancreatic cancer. Current smokers with over a 40 pack-year story of smoking haw have up to a 5-fold process venture of the disease. Smokeless baccy also increases the venture of pancreatic cancer. It takes 5-10 years of discontinued smoking to reduce the increased venture of smoking to approximately that of nonsmokers.

DIETARY FACTORS

Alcohol consumption does not materialize to be an independent venture bourgeois for pancreatic cancer unless it is related with habitual pancreatitis.

In a number of studies, obesity, especially central, has been related with a higher incidence of pancreatic cancer. The incidence is lower in those with a diet rich in fresh fruits and vegetables. Fruits and vegetables rich in folate and lycopenes (such as tomatoes) haw be especially good at reducing the venture of nonindustrial pancreatic cancer. Red meat consumption, especially processed, is related with a higher venture of pancreatic cancer. Poultry and dairy product consumption does not process the venture of this disease. Supplemental antioxidants much as vitamin C or E do not materialize to decrease the venture of pancreatic cancer or other gastrointestinal cancers and haw actually be related with excess mortality.

DIABETES MELLITUS

Numerous studies have examined the qualifying venture of pancreatic cancer in persons with diabetes mellitus.

CHRONIC PANCREATITIS

Long-standing habitual pancreatitis is a substantial venture bourgeois for the utilization of pancreatic cancer. A multicenter study of more than 2000 patients with habitual pancreatitis showed a 26-fold process in the venture of nonindustrial pancreatic cancer. This venture increased linearly with time, with 4% of patients who had habitual pancreatitis for 20 years' duration nonindustrial pancreatic cancer.

GENETIC FACTORS

The inherited disorders that process the venture of pancreatic cancer allow hereditary pancreatitis, multiple endocrine neoplasia , hereditary nonpolyposis rectal cancer , inherited adenomatous polyposis  and gatherer syndrome, inherited atypical multiple mole melanoma  syndrome, von Hippel-Lindau syndrome , and germ line mutations in the BRCA1 and BRCA2 genes. Hereditary pancreatitis has been related with a additive venture of nonindustrial pancreatic cancer at 40%.12  MEN-1 and VHL are other genetic syndromes related with pancreatic endocrine tumor development.

Colorectal cancer diagnosis

Low fiber and high fat diets may be important to cause cancer 

RECTAL CANCER DIAGNOSTIC INVESTIGATIONS

PHYSICAL EXAMINATION

An exam of the body to analyse general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

DIGITAL RECTAL EXAM

An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the modify conception of the rectum to wager for lumps or anything else that seems unusual. In women, the vagina haw also be examined.

PROCTOSCOPY

An exam of the rectum using a proctoscope, inserted into the rectum. A proctoscope is a thin, tube-like instrument with a reddened and a lense for viewing. It haw also hit a agency to remove tissue to be checked under a microscope for signs of disease.

COLONOSCOPY

A machine to look inside the rectum and colon for polyps (small pieces of bulging tissue), abnormal areas, or cancer. A colonoscope is a thin, tube-like instrument with a reddened and a lense for viewing. It haw also hit a agency to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.

BIOPSY

The remotion of cells or tissues so they should be viewed under a microscope to analyse for signs of cancer. Tumor tissue that is removed during the biopsy haw be checked to wager if the patient is probable to hit the gene modification that causes HNPCC. This haw help to organisation treatment. The following tests haw be used:

Reverse-transcription polymerase chain reaction (RT-PCR) test: A work test in which cells in a distribution of tissue are studied using chemicals to look for destined changes in the scheme or function of genes.

Immunohistochemistry study: A work test in which a substance such as an antibody, dye, or radioisotope is added to a distribution of tissue to test for destined antigens. This type of think is used to tell the difference between different types of cancer.

CARCINOEMBRYONIC ANTIGEN ASSAY

A test that measures the level of CEA in the blood. CEA is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it could be a sign of rectal cancer or another conditions.

Colorectal cancer symptoms

High fat leads to an increase in bile acid production and bile acids are promoters of carcinogenesis

Symptoms of colorectal cancer

Cancer often has no specific symptoms, so it is important that people limit their risk factors and undergo appropriate cancer screening. Most cancer screening is specific to certain age groups and your primary-care student will undergo what screening to action depending on your age. People with risk factors for cancer (for example, smokers, heavy alcohol use, high sun exposure, genetics) should be acutely alive of potential cancer symptoms and be evaluated by a physician if any develop.

Local symptoms are more likely if the growth is located fireman to the anus. There haw be a change in viscus habit (new-onset constipation or symptom in the absence of another cause), and a feeling of incomplete defecation (tenesmus) and change in diameter of stool; tenesmus and change in stool shape are both characteristic of rectal cancer. Lower gastrointestinal bleeding, including the passage of gleaming red murder in the stool, haw inform colorectal cancer, as haw the increased presence of mucus. Melena, black stool with a tarry appearance, normally occurs in bunk gastrointestinal injury (such as from a duodenal ulcer) but is sometimes encountered in colorectal cancer when the disease is located in the first of the super bowel.

A growth that is super enough to modify the entire lumen of the viscus haw cause viscus obstruction. This situation is characterized by constipation, abdominal pain, abdominal distension and vomiting. This occasionally leads to the obstructed and distended viscus perforating and causing peritonitis.

Certain topical personalty of colorectal cancer embellish when the disease has embellish more advanced. A super growth is more likely to be detected on feeling the abdomen, and it haw be detected by a student on physical examination. The disease haw assail another organs, and haw cause murder or expose in the urine (invasion of the bladder) or vaginal discharge (invasion of the female reproductive tract).

If a growth has caused chronic occult bleeding, iron deficiency anemia haw occur; this haw be old as fatigue, palpitations and detected as pallor (pale attendance of the skin). Colorectal cancer haw also lead to weight loss, mostly due to a decreased appetite.

More unusual constitutational symptoms are an unexplained feverishness and one of several paraneoplastic syndrome. The most common paraneoplastic syndrome is thrombosis, usually unfathomable vein thrombosis.

Colorectal cancer most commonly spreads to the liver. This haw go unnoticed, but super deposits in the liver haw cause jaundice and abdominal pain (due to stretching of the capsule). If the growth deposit obstructs the bile duct, the jaundice haw be accompanied by another features of biliary obstruction, much as discolour stools.

Rectal cancer treatment

TREATMENT

Treatment options includes

PREOPERATIVE PREPARATION
Mechanical cleansing of bowel through purgatives ,enemas or whole gut irrigation.
Antibiotics like gentamicin plus metronidazole before surgery.
Blood and electrolytes deficiencies are corrected.
An indwelling catheter is inserted into bladder.

SURGERY
Surgery is the important communication for every stages of rectal cancer, though irradiation and/or chemotherapy are often recommended in combination. Some patients who undergo surgery for rectal cancer require a imperishable colostomy ,a surgically created opening in the abdominal wall finished which squander is excreted. If you hit a colostomy, our specially drilled nurses module support you learn how to manage the colostomy and incorporate it into your lifestyle. Depending on the location, initiate and size of your tumor, your doctor module vanish your cancer with one of the following methods:

Tumor Excision : This surgical move is used for rattling primeval initiate cancers. It involves inserting a tube finished the rectum into the colon and removing the cancer, rather than making a revilement in the abdominal wall. If the cancer is found in a polyp, the procedure is titled a polypectomy.

Resection and anastomosis :This move is used for larger and more modern cancers and involves removing the assets if the rectum containing the cancer, as well as the fatty tissue that surrounds the rectum and contains the lymph nodes. Afterwards, the student module forge the colon to the remaining rectum or the anus, during a procedure titled an anastomosis.


Resection and colostomy : This move is used when the rectum cannot be sewn backwards together. In these cases, a colostomy is performed, in which an opening right of the embody for squander to pass finished is created, titled a stoma. A bag is then settled around the stoma to collect the waste. The colostomy haw be temporary, though if the entire rectum is removed, it is permanent. Our specially drilled nurses module support you learn how to manage your colostomy and incorporate it into your lifestyle.

Radiation therapy : Radiation therapy is the ingest of X-rays or other high-energy rays to blackball cancer cells and shrink tumors. Radiation haw become from a organisation right the embody or external irradiation therapy, or from putting materials that include irradiation finished thin plastic tubes, titled interior irradiation therapy, in the intestine area. Radiation can be used lonely or in addition to surgery and chemotherapy.

Radiation therapy haw be used after surgery to blackball any remaining areas of cancer or before surgery to shrink the tumor. Radiation also can be used to prevent cancer from coming backwards to the place it started and to assuage symptoms of modern cancer.

CHEMOTHERAPY AND IMMUNOTHERAPY

Chemotherapy is the ingest of drugs to blackball cancer cells. Chemotherapy haw be taken by pill, or it haw be put into the embody by inserting a harry into a vein. A patient haw be presented chemotherapy finished a tube that module be mitt in the vein while a small viscus gives the patient constant communication over a period of weeks. Chemotherapy is titled a systemic communication because the take enters the bloodstream, travels finished the body, and can blackball cancer cells right the rectum. If the cancer has spread, the patient haw be presented chemotherapy directly into the artery going to the newly infected part of the body. If the student removes every the cancer that can be seen at the time of the operation, the patient haw be presented chemotherapy after surgery to blackball any cancer cells that are left. Chemotherapy presented after an operation to a person who has no cancer cells that can be seen is titled adjuvant chemotherapy.

Immunotherapy also titled biological therapy, tries to attain your embody fisticuffs against your cancer. It uses materials made by the embody or made in a work to boost, direct, or restore the body's uncolored defenses against disease.

Colorectal cancer

COLORECTAL CANCER  

In western countries ,colorectal cancer ranks second to lung cancer in incidence and mortality rates.Adenomas are probably te precursors of most,if not all ,colorectal cancers.Multiple synchronous colonic cancers,i.e two or more carcinomas occurring simultaneously,are found in 5% of patients.Metachronous cancers is a new primary lesion in a patient who has had a previous resection for cancer.The risk of metachronous tumors reaches 25% after 20 years of follow-up.The incidence f colonic cancer appears to be rising,especially cancer of the right side of the colon and of the sigmoid colon.

Invasive cancers that are confined within the wall of the colon (TNM stages I and II) are curable with surgery. If untreated, they spread to regional lymph nodes (stage III), where up to more than 70% are curable by surgery and chemotherapy. Cancer that metastasizes to distant sites (stage IV) is usually not curable, although chemotherapy can modify survival, and in thin cases, surgery and chemotherapy together have seen patients through to a cure. Radiation is used with rectal cancer.

ETIOLOGY

Rectal cancer usually develops over several years, prototypal growing as a precancerous growth called a polyp. Some polyps have the knowledge to turn into cancer and begin to acquire and penetrate the wall of the rectum. 

The actual cause of rectal cancer is unclear.

However, the following are venture factors for nonindustrial rectal cancer: 

Genetics : Family cancer syndrome.

Environmental : Low fibre ,high fat diet.

Inflammatory bowel disease.

Polyposis syndrome.

Personal history of colon polyps or colon cancer.

Precarcinomatous conditions

(a) adenoma.

(b) papiloma.

Family history is a bourgeois in determining the venture of rectal cancer. If a family history of colorectal cancer is present in a first-degree relative (a parent or a sibling), then endoscopy of the colon and rectum should begin 10 years before the geezerhood of the relative's diagnosis or at geezerhood 50 years, whichever comes first.

An ofttimes forgotten venture factor, but perhaps the most important, is the lack of screening for rectal cancer. Routine cancer screening of the colon and rectum is the prizewinning artefact to prevent rectal cancer. 

STAGING OF COLORECTAL CARCINOMA BASED ON DUK's CLASSIFICATION ,WITH SURVIVAL RATES AFTER SURGERY

DUK'S GRADE        SPREAD                                                5 YEAR SURVIVAL

A                        Confined to bowel wall                               90%

B                        Spread through the bowel wall                    70%

C                        Spread to lymph nodes                             30%

Stage D was added to Duk's classification later,based on clinical rather than pathological evidence.

Stage D implies distant metastases.

COMPLICATIONS

These include obstruction, perforation (direct perforation of the tumor ) ,obstruction ,perfortion into an adjacent organ with development of a fistula.e.g colovesical , and symptoms relating to direct extension.

PROGNOSIS

This depends on the degree of differentiation of the tumor ,the completeness of excision and the degree of spread.Examination of the resection margins ( proximal.distal and circumferential ) to assess completeness of excision is required.The extent of spread through the bowel wall and the presence of lymph node metastases are other major prognostic indicators.The extent of spread is given by the Duk's classification,whih is also related to prognosis.