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Stage 4 Pancreatic Cancer

Stage 4 Pancreatic Cancer

Stage IV pancreatic cancer is the deadliest form of cancer. Chemotherapy and surgical treatments are mostly futile and decrease the quality of life for the patient. Read on to know more about stage 4 if this dreaded cancer.
Batul Nafisa Baxamusa
Last Updated: Feb 14, 2018
Nurse Going Over Reports
Pancreatic cancer is the cancer of the pancreas. Pancreas is a large organ that lies horizontally behind the stomach. Pancreas secrete digestive juices and hormones that regulate the metabolism of sugars. When the cells of pancreas develop genetic mutations, it leads to uncontrollable growth of cells. These cells continue to live even after the normal cells die and these accumulated cells form a tumor. Pancreatic cancer is seldom detected in its early stages. The symptoms do not appear until the cancer has reached its advanced stage. Many medical practitioners have difficulty in detection of cancer in the first stage to contain its spread. Stage 4 is the most dangerous stage, where it can even lead to death.

Stage IV Pancreatic Cancer: Overview

The fourth most common cause for death is pancreatic cancer. This cancer is known to have poor prognosis. The survival rate is 25% for 1-year and just 6% for 5-year, in case of metastatic cancer. The localized cancer has better survival rate at approximately 20% for 5-year. In stage IV cancer, the tumor is no longer localized and spreads to other parts like the stomach, spleen, and bowel. It can also spread to distant organs like lungs and liver. Stage IV pancreatic cancer is divided into two groups:

Stage IVA:
It is locally confined, involving adjacent organs and blood vessels. This causes difficulty in surgically removing the cancer. This stage is known as localized or locally advanced stage.

Stage IVB:
The cancer spreads to distant organs. This stage is also known as metastatic stage.

Symptoms of Pancreatic Cancer

As mentioned earlier, symptoms appear when the disease has reached its advanced stage. It is therefore known as a 'silent killer'. Symptoms if any exhibited are varied and nonspecific in nature. These symptoms include:
  • Upper abdominal pain that can be felt in the back.
  • Jaundice
  • Trousseau sign (spontaneous blood clot formation anywhere on the body)
  • Weight loss
  • Nausea
  • Loss of appetite
  • General weakness
  • Tiredness
  • Depression
  • Swollen gallbladder
  • Diabetes
Risk Factors

The risk factors that increase a persons chances of suffering from cancer of the pancreas are:
  • Smoking
  • Obesity
  • Family history of chronic inflammation of pancreas.
  • Hereditary factor
  • Old age, as people over the age of 60-70 years are more prone to pancreatic cancer
  • Chronic pancreatitis
  • Diets that are high in sugar drinks and red meat
  • Diets that are low in fruits and vegetables
Diagnosis

The doctor may recommend the following tests if he suspects cancer in the pancreas:

Ultrasound:
High frequency sound waves help create images of the pancreas. It helps determine if there is any blockage in the bile system and the blockage area is identified.

CT Scan:
This test is recommended for people who have sudden, unexplained weight loss and abdominal pain. CT scans reveal, blockage of bile or pancreatic ducts or evidence of cancer spread beyond the pancreas.

Biopsy:
A small sample of the pancreas is obtained and checked under the microscope to be sure of pancreatic cancer.

Liver function test:
This test is used to find a combination of results that indicate obstruction in the bile duct.

Treatment Options
The aim of treating pancreatic cancer is controlling the symptoms and pain due to the abnormal growth of cells. Patients may undergo palliative surgeries and doctors may try to relieve symptoms of jaundice, pain, nausea and vomiting due to bile duct blockage.

The palliative surgeries include:
  • Biliary Bypass: If the cancer blocks the common bile duct and builds up bile in the gallbladder, the doctors cut the gallbladder or the bile duct and attach it to the small intestine. This helps make a new pathway for the flow of bile juices around the blocked area.
  • Endoscopic Stent Placement: A stent is placed through a catheter, to drain the bile outside the body or around the blocked area to drain the bile into the small intestine.
  • Gastric Bypass: The doctors attach the stomach directly to the small intestine so that a patient can continue to eat normally, if the cancer blocks the flow of food from the stomach.
Patients are treated with chemotherapy drugs to treat stage 4 pancreatic cancer.
  • 5-Fluorouracil or 5-FU: This group of drugs is known as anti-metabolites. They prevent the synthesis of DNA and RNA, which stops cell growth.
  • Irinotecan: These group of chemotherapy drugs are known as topoisomerase inhibitors. They inhibit the cancer cells from growing further.
  • Oxaliplatin: These chemotherapy drugs belong to the alkylating agents. They stop the cells from growing and kill the cancerous cells.
  • Gemcitabine: These belong to the group of chemotherapy drugs known as anti-metabolites. They prevent the synthesis of DNA and RNA, killing the cells.
  • Capecitabine: These also belong to the anti-metabolites group. They also prevent cells from making DNA and RNA and stop cell growth. Capecitabine gets converted to 5-flurouracil in the body.
  • Erlotinib: Targeted therapy drug blocks the growth and spread of cancer by interfering with molecules that cause normal cells to become cancer cells. Erlotinib is an epidermal growth factor receptor (EGFP) tyrosine kinase inhibitor.
People suffering from stage IV pancreatic cancer often suffer from immense, unbearable pain. To ease the pain doctors often carry out surgeries to cut off few nerves that carry pain sensations. Doctors inject alcohol into the area around certain nerves in the abdomen to block the feeling of pain. Morphine, opioid and narcotics are given to relieve the pain. Acetaminophen and non-steroidal anti-inflammatory drugs are also prescribed to ease the pain. Many patients are advised radiation therapy to shrink the tumor, thus relieving some of the pain.

Stage 4 pancreatic cancer is a very dangerous disease. The life expectancy is considerably low. Not only the patient, but his entire family goes through a tough time. People often go through stages of denial and disbelief. The person who is dying has to face not only the physical pain and the constant thought of death, but also see his loved ones suffering. If any person you know is facing this terminal cancer, extend your full support and make their last days worthwhile. Never lose hope till the end or it will be very difficult for the sufferer to spend their last days.