Pancreatic Cancer, Exocrine Health Article

Alternative and complementary therapies

Acupuncture or hypnotherapy may be used in addition to standard therapies to help relieve the pain associated with pancreatic cancer. Because of the poor prognosis associated with pancreatic cancer, some patients may try special diets with vitamin supplements, certain exercise programs, or unconventional treatments not yet approved by the FDA. Patients should always inform their doctors of any alternative treatments they are using as they could interfere with standard therapies. As of 2000, the National Cancer Institute (NCI) was funding phase III clinical trials of a controversial treatment for pancreatic cancer that involves the use of supplemental pancreatic enzymes (to digest cancerous cells) and coffee enemas (to stimulate the liver to detoxify the cancer). These theories remain unproven and the study is widely criticized in the medical community. It remains to been seen whether this method of treatment has any advantage over the standard chemotherapeutic regimen in prolonging patient survival or improving quality of life.

Coping with cancer treatment

Patients should discuss with their doctors any side effects they experience from treatment. Many drugs are available to relieve nausea and vomiting associated with cancer treatments and for combating fatigue. Special diets or supplements, including pancreatic enzymes, may be recommended if patients are experiencing digestive problems. Insulin or other medication may be prescribed if patients develop diabetes as a result of partial or total removal of their pancreas.

Clinical trials

A large number of clinical trials are underway to assess the therapeutic effect of new chemotherapy regimens and several new immunotherapies. Gemcitabine is being tested in combination with irinotecan (CPT-11) in patients with metastatic pancreatic disease. Other agents under investigation are DX-8951f and R115777. Some drugs are being tested in combination with radiation therapy or with biological therapies. Two preliminary studies using the vaccine G17DT showed a significant improvement in the survival of patients with advanced pancreatic cancer. The monoclonal antibody cetuximab (IMCC225) in combination with gemcitabine also showed positive preliminary results. There are trials available for patients with all stages of pancreatic cancer. Patients can find out which trials they are eligible for by talking with their doctors. Information about ongoing trials can be found at <http://cancernet.nci.nih.gov/trialsrch.shtml>. Many treatments given during clinical trials are considered experimental by health insurance companies and may not be covered by certain health plans. Patients should discuss their options with their doctor and health insurance provider.

Prevention

Although the exact cause of pancreatic cancer is not known, there are certain risk factors that may increase a person's chances of developing the disease. Quitting smoking will certainly reduce the risk for pancreatic cancer and many other cancers. The American Cancer Society recommends a diet rich in fruits, vegetables, and dietary fiber in order to reduce the risk of pancreatic cancer. According to the National Cancer Institute, workers who are exposed to petroleum and other chemicals may be at greater risk for developing the disease and should follow their employer's safety precautions. People with a family history of pancreatic cancer are at greater risk than the general population, as a small percentage of pancreatic cancers are considered hereditary.

Special concerns

Pain control is probably the single greatest problem for patients with pancreatic cancer. As the cancer grows and spreads to other organs in the abdomen, it often presses on the surrounding network of nerves, which can cause considerable discomfort. In most cases, pain can be alleviated with analgesics or opioids. If medication is not enough, a doctor may inject alcohol into the abdominal nerve area to numb the pain. Surgical treatment of the affected nerves is also an option.

Pancreatic cancer patients frequently have difficulty maintaining their weight because food may not taste good or the pancreas is not releasing enough enzymes needed for digestion. Therefore, supplements of pancreatic enzymes may be helpful in restoring proper digestion. Other nutritional supplements may be given orally or intravenously in an effort to boost calorie intake. However, cachexia (severe muscle breakdown) caused by certain substances that the cancer produces, remains a significant problem to treat.

Patients with pancreatic cancer may experience anxiety and depression during their diagnosis and treatment. Statistics on the prognosis for the disease can be discouraging, however, there are many new treatments on the horizon that may significantly improve the outcome for this disease. Many patients find it helpful to join support groups where they can discuss their concerns with others who are also coping with the illness.

See Also Drug resistance; Gastrointestinal cancers; Nutritional support; Pain management; Pancreatic cancer, endocrine; Immunologic therapies; Cigarettes; smoking cessation

Resources

BOOKS

Beger, Hans G., et al., ed. The Pancreas. 2 vols. Oxford: Blackwell Science Ltd., 1998.

Reber, Howard A. ed. Pancreatic Cancer: Pathogenesis, Diag nosis, and Treatment. Totowa: Humana Press, 1998.

Teeley, Peter, and Philip Bashe. The Complete Cancer Survival Guide. New York: Doubleday, 2000.

PERIODICALS

Bornman, P.C., and I.J. Beckingham. "ABC of Diseases of Liver, Pancreas, and Biliary System. Pancreatic Tumours." British Medical Journal 322, no. 7288 (24 March 2001):721-3.

Haut, E., A. Abbas, and A. Schuricht. "Pancreatic Cancer: The Role of the Primary Care Physican." Consultant 39, no. 12 (December 1999): 3329.

Parks, R.W., and O.J. Garden. "Ensuring Early Diagnosis in Pancreatic Cancer." Practitioner 244, no. 1609 (April 2000): 336-8, 340-1, 343.

ORGANIZATIONS

CancerNet. National Cancer Institute, 9000 Rockville Pike, Bldg.31, Rm.10A16, Bethesda, Maryland, 20892. (800) 422-6237. <http://wwwicic.nci.nih.gov>

Hirshberg Foundation for Pancreatic Cancer Research. 375 Homewood Rd., Los Angeles, CA 90049. (310) 472-6310. <http://www.pancreatic.org>

National Pancreas Foundation. PO Box 935, Wexford, PA 15090-0935. <http://www.pancreasfoundation.org>

Pancreatic Cancer Action Network. PO Box 1010, Torrance, CA 90505. (877) 272-6226. <http://www.pancan.org>

OTHER

University of Texas MD Anderson Cancer Center. Pancreatic Tumor Study Group. 20 July 2001 <http://www.mdanderson.org/DEPARTMENTS/pancreatic/>

"What You Need To Know About Cancer of the Pancreas." National Cancer Institute. December 12, 2000. 20 July 2001 <http://cancernet.nci.nih.gov/wyntk_pubs/pancreas.htm>

Johns Hopkins Medical Institutions. 20 July 2001 <http://www.path.jhu.edu/pancreas>

Memorial Sloan-Kettering Cancer Center. Patient Information on Pancreatic Cancer. 20 July 2001 <http://www.mskcc.org/patients_n_public/about_cancer_and_treatment/cancer_information_by_type/pancreatic_cancer/index.html>

Lata Cherath Ph.D.

Elizabeth Pulcini, M.Sc.