HJNO Jan/Feb 2023

54 JAN / FEB 2023 I  HEALTHCARE JOURNAL OF NEW ORLEANS ONCOLOGY DIAL GUE COLUMN ONCOLOGY Introduction THE PANCREAS is an organ that is located behind the stomach. Its normal function is to make hormones that regulate glucose (blood sugar) levels and produce digestive juices that help the body break down food. More than 57,000Americans develop can- cer of the pancreas each year; it is the fourth leading cause of cancer-related death in the United States. The most common is cancer of the exocrine pancreas that originates in the pancreatic ducts. The ducts are responsible for carrying pancreatic juice to the intestines. This type of pancreatic cancer, called “pan- creatic ductal adenocarcinoma,” will be dis- cussed in this article. Risk factors • Male gender. • Age >45. • Tobacco exposure: more than 25% per- cent of pancreatic cancers are caused by tobacco exposure, including ciga- rettes, cigars, chewing tobacco, and likely e-cigarettes (“vaping”). Exposure to second-hand smoke also increases a person’s risk. • Overweight, obesity (20%). • Heavy alcohol consumption. • Diabetes. • Chemicals, pesticides, and radiation exposure. • Chronic inflammation of the pancreas. • Liver damage. • Positive family history of pancreatic cancer related to hereditary syndromes. Example: BRCA1/2 or PALB2 mutation gene. Symptoms • Weight loss. • Jaundice (skin turning yellow due to bilirubin) . • Pain in the abdomen and lower back is sometimes associated with “spontane- ous bruises.” • Fatigue, lack of appetite, nausea, diar- rhea, bloating. Diagnosis • CT scans of the chest, abdomen, and pelvis with pancreatic protocol to de- termine if the pancreatic mass can be removed by surgical oncology. • CA 19-9 is a blood test and tumor mark- er of pancreatic cancer to confirm eleva- tion of the same supporting a diagnosis of pancreatic cancer. • Biopsy is a tissue sample of the pan- creatic mass or a metastatic lesion seen in the CT scans to confirm pancreatic cancer. This procedure can be done with imaging guidance, including CT scans, endoscopic ultrasound (EUS), or endo- scopic retrograde cholangiopancreatog- raphy (ERCP). Staging Depending on the results of CT scans with IV contrast pancreatic protocol, the staging of pancreatic cancer will be: • Resectable (stage I-II): usually, the cancer does not compromise pancreas veins and arteries. • Borderline resectable (stage III): usually, the cancer does compromise pancreas veins and arteries. • Unresectable (stage IV): cancer has spread to other organs like the liver, lungs, lymph nodes, or bones. Sometimes minimally invasive surgery Pancreatic Adenocarcinoma