A diagnosis of any cancer can cause an overwhelming, stressful and emotional reaction. Making it even more daunting is trying to think of what to do first while simultaneously processing the reality of it all. WINGS OF HOPE offers the following resources to supplement your understanding of pancreatic cancer, diagnosis and treatment options and procedures, statistics and other information.
If you or a loved one is diagnosed with Pancreatic Cancer, I urge you to reach out to me. As a Nurse Practitioner and coordinator for the Pancreatic Cancer Multidisciplinary Clinic (MDC) at the University of Colorado Hospital, I am your first point of contact. Our MDC allows a patient with Pancreatic Cancer to see all the providers who treat this disease (Medical Oncologists, Radiation Oncologists and Surgical Oncologists) over a one-day visit. I will walk you through the details of the day and can even order and coordinate any workup that needs to be done (for example, cancer staging CT scan or biopsy). My direct phone number is 720-848-8096 and our website is: https://medschool.cuanschutz.edu/surgery/multidisciplinary-clinics/pancreas-and-biliary-cancer/about.
Navigating the healthcare system is overwhelming and difficult. Let me help! The multidisciplinary approach to care provides patients with the most up-to-date and evidence-based treatment to provide the best care for the highest chance of success and cure of disease. The University of Hospital is the only NCI (National Care Institute) dedicated Pancreatic Cancer Center in Colorado and 1 of 30 NCCN (National Comprehensive Cancer Network) Member Institutions in the US. We are grateful we have partnered up with the Wings of Hope foundation, who helps raise money for Pancreatic Cancer research at the University of Colorado Hospital. As a team, we are here for you with total dedication to fight this disease. Sincerely and with gratitude, Cheryl Meguid, DNP
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Cancer is a disease that harms us not just physically, but also emotionally and mentally. It stresses us out and causes us to feel depressed at the fact that however well we maintained our body, we still run the risk of having to deal with this devastating disease. With so many different forms of cancer, we consider ourselves extremely lucky to not get it in our lifetimes. But for those of us who do get it, if we are able to catch it in the initial stages, it means we have a fighting chance of survival.
If we either ignore the signs, get misdiagnosed, or even don’t see the symptoms of it, the tumor progresses making it near impossible to be even able to try and fight it.
Pancreatic cancer is a silent killer. We don’t see the symptoms in the early stages because it’s like they’re not even there. When symptoms like change in the color of the urine occur, it’s understandable to mistake that it happens due to a change in diet, or that you may have drunk less water than usual. But these are signs that you should not ignore because it’s better to nip it in the bud when you go to a doctor to find out if our symptoms have any underlying dangerous causes.
Here are some of the symptoms that you can look out for and consult a doctor if even one or more of these things happen.
1. You have yellowing or itchy skin
One of the first signs of pancreatic cancer is the fact that you start seeing changes happening to your body that generally happen to a person suffering from jaundice. Your eyes and skin start to take on a yellowish hue due to the increase of bilirubin which gets converted into bile. Its role is essentially breaking down fats and exiting your body through your stool. The problem arises when it can’t come out and so it builds up inside the body. This causes the color change and if that weren’t enough, it causes the skin to be irritated and you have the need to scratch. Look for brown colored urine as well since it’s a result of this build-up. This is the best time to go consult a doctor as it’s one of the first symptoms to show up.
2. You feel unusually nauseated
Your hormones and enzymes that the pancreas releases is designed to make the digestion process smooth. But when the tumor in the pancreas starts to take effect, more serious problems arise. The hormones and enzymes that are released create an acid that helps in the digestion of food. When you’re hungry and you feel and hear that growling of your stomach, that’s the acid trying to find food to digest. If you have cancer, the acid builds up and blocks one end of the stomach making it difficult for the food to pass through. That’s when you start to feel sick in the stomach and this results in feeling nauseous, causing you to want to vomit.
3. You are losing weight rapidly
When you keep feeling nauseous and are constantly vomiting, your appetite starts to fall drastically. With not enough intake of nutrients that you’d get from your food, you start to feel weak and when your body can’t process the right carbohydrates and fats, you start to lose an unhealthy amount of weight. A side effect of losing that weight is that when the cancer is under control, you could rapidly gain weight since it wasn’t lost by the burning of fats but rather due to water and nutrient loss.
4. You have severe diarrhea
In a very rare strain of pancreatic cancer, there is a tumor called the VIPoma tumor. It causes the release of certain hormones which then, in turn, release water into the digestive tract. Normal digestion happens when just enough water goes into the intestines to digest the food.
The hormone that is tricked by the tumor into releasing water then starts to send more water than required to the intestines to break down the food after having gone through the other processes. As a result, you start to experience severe diarrhea which could later cause more health complications apart from the cancer itself.
5. You have extreme belly and back pain
Generally, back and belly pain can have a multitude of causes from period cramps to excessive lifting of heavy stuff to even having slept incorrectly. But when you’re already facing nausea and weight loss, it is better to double check whether this pain is rooted in the fact that a tumor is growing in the pancreas.
The bigger the tumor grows in the pancreas, the more pressure it puts on other organs surrounding it. When the organs are stressed, it puts pressure on the lungs, stomach and worse, the spine. It will press against the nerves and even small movements will feel like fire burning inside your body.
6. You have diabetes
With the growth of the tumor, the pancreas is unable to produce as much insulin as the body requires to be able to break down and release the sugar into the bloodstream. Even if sugar is released into the blood, there is not enough insulin to keep the sugar from increasing and when you have high blood sugar, your need to urinate will also increase. You will also feel increasingly hungry and thirsty.
We are aware that the body undergoes many changes due to the environment, weather, food, intake of certain substances, and even how much sleep we get. Sometimes the symptoms we see that come from that change can be attributed to something simple and in our control. But sometimes we run out of luck and they become warning signs for something more dangerous.
It’s important to keep track of all the changes in your body and even if one of these symptoms turn up, a doctor has to be consulted. Prevention is better than cure and in the case of pancreatic cancer, recognition in the early stage is much better than searching for a cure after it has reached the point of no return.
Disclaimer : This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
The human immune system is not only smart, but also very powerful, protecting us from a host of harmful invaders that can lead to illness.
Until recently, the human immune system was often thwarted by cancer cells and their ability to grow and spread seemingly unchecked.
But in the last two decades, inroads made in immunotherapy—treatments designed to harness a patient’s own immune system to unmask and destroy these deadly cancer cells—have led to some remarkable successes. Already, some patients with melanoma, non-small cell lung cancer, bladder cancer, kidney cancer, stomach cancer, liver cancer, head and neck cancers, and lymphoma are seeing its benefits, and the approach is showing promise in small cell lung cancer and ovarian cancer.
So far, most cancer patients, especially those with pancreatic cancer, don’t see any benefit. The reasons are numerous.
For example, one of the challenges to pancreatic cancer immunotherapy approaches has been the tumor’s ability to evade the immune response. Specifically, pancreatic tumors can prevent the recruitment of T cells, immune cells that could otherwise recognize and attack the cancer cells as foreign. Early detection of the disease has also been difficult, and currently there is still a less than optimal response to standard treatments. KRAS, one of the primary mutations found in pancreatic cancer, is considered “undruggable,” a term used to describe proteins that can’t be targeted with drugs, though significant research is underway to meet this challenge.
However, there have been recent events that have brightened the prospect of immunotherapy for pancreatic cancer. In a first-of-its-kind of decision earlier this year, the U.S. FDA approved Keytruda for the treatment of solid tumors exhibiting high microsatellite instability mismatch-repair deficiency. Although only about 3 to 4 percent of pancreatic cancer patients fit this profile, it can be a potential game-changer for them, explains Luis A. Diaz, M.D., Head of the Division of Solid Tumor Oncology in the Department of Medicine at Memorial Sloan Kettering Cancer Center in New York.
However, “more than 95 percent of pancreas cancer patients still are unable to take advantage of immunotherapy,” he says. “Immunotherapy as we know it today has not made a lot of advances or had a lot of success for them. We absolutely need to get a better handle on the biology of the disease, especially the surrounding tumor stroma. Once we understand more, immunotherapy trials may show better results.”
Although pancreas cancer does indeed present numerous challenges, Diaz is adamant that “no one is giving up, and we can build upon some prior success.” He adds, “But we need to get a lot more creative and not simply repeat mistakes. Because that is what will ultimately benefit our patients.”
Indeed, there are numerous trials underway exploring the use of novel antibodies that cut the brakes on the immune system, as well as vaccine approaches and genetically reprogramming immune cells so they can fight cancer, among other efforts.
Diaz emphasized that patients who are newly diagnosed with pancreatic cancer should always be considered for clinical trials. “There are clinical trials in different classes of agents, and also, patients who are now being referred for immunotherapy trials,” he says, although at this time there is not a standard treatment immunotherapy.
“It would be arrogant to say that immunotherapy won’t work in pancreatic cancer because the truth is we don’t know,” Diaz adds. “What I do know is there is an active effort to really understand the immunotherapy problem in this disease and to try to put a treatment strategy in place.”
For pancreatic cancer, immunotherapy approaches generally fall into four main categories; checkpoint inhibitors, therapeutic vaccines, adoptive T cell transfer, and monoclonal antibodies.
As the source of insulin that helps in the regulation of blood sugar and of enzymes that help break down fats, carbohydrates, and proteins, the pancreas is a key part of the digestive system.
So it’s not so surprising that cancer of the pancreas can bring with it significant nutritional challenges. Successfully addressing these challenges, however, brings multiple rewards: it can enable and enhance treatment, boost day-to-day well-being, and support healthy recovery.
When assembling a team to tackle your pancreatic cancer, a dietitian should be one of your first recruits, according to Maria Petzel, RD, CSO, LD, CNSC, a senior clinical dietitian at the MD Anderson Cancer Center. Ideally, he or she should have a CSO after their name, signifying they have received oncology nutrition certification, with more than 2,000 hours of clinical oncology experience under their belt. That experience comes in handy when assessing the needs of each patient, which differ from person to person, based on factors such as their body type, treatment history, surgical history, and amount of fat in their diet.
For pancreatic cancer patients it is important that the dietitian is well-educated in enzymes. Pancreatic enzymes help break down fats, proteins, and carbohydrates. A deficit of pancreatic enzymes can affect digestion, cause uncomfortable side effects, and weight loss. Symptoms of inadequate enzyme production include excessive gas, bloating, or indigestion after meals and changes in bowel movements such as light colored or yellow stools or stools that are frequent, floating, oily, or loose.
Fun Fact: A normally functioning pancreas secretes about eight cups of enzyme-containing pancreatic juice into the duodenum daily.
“Inadequate enzyme production can be fixed with pancreatic enzyme replacement therapy (supplementing with prescription enzymes), but it’s not a one-size-fits-all solution,” Petzel says. “Pancreatic cancer patients need to have someone on their healthcare team who can help individuals figure out what brand and dose works best to help minimize symptoms and get maximal digestion and absorption.”
Weight loss due to pancreatic cancer is common, but its causes can be complicated. Some are related to the tumor itself, in which case surgery, chemotherapy, or radiation treatment can help. Others, however, are a result of such treatment.
Nausea, loss of appetite, or the change in taste that often accompany chemo or radiation therapy can be combated through diet and pharmaceutical strategies. These are most successful when tailored to each patient, Petzel explains. One person’s diarrhea could be caused by fat malabsorption due to pancreatic enzyme insufficiency, while another may be suffering the effects of lactose intolerance, bacterial overgrowth, chemotherapy, or dumping syndrome from surgical resection. Enzyme replacement may solve the problem for some patients, while a low-fat, low-fiber, and/or dairy-free diet might do the trick for others.
Maintaining a healthy weight for pancreatic cancer patients can be critical to the success of their treatment. “We know that patients who are able to maintain weight are more likely to get their scheduled doses of treatment,” Petzel adds.
Here is some general advice Petzel offers for patients:
Additional nutritional advice can be found on the Academy of Nutrition and Dietetics Oncology Nutrition website. The American Institute for Cancer Research also provides some culinary inspiration in its recipe archives.
For other dietary suggestions, read the Managing Pancreatic Cancer article “How to Eat After a Whipple Procedure.”
As research for the treatment of pancreas cancer develops, fewer patients are being treated with single-modality therapy. Instead, most patients are being treated with a combination of surgery, chemotherapy and/or radiation therapy. This often makes navigating the healthcare system difficult and overwhelming. In a traditional medical environment, patients are often seen by different specialists over the course of several weeks. The Pancreas and Biliary Multidisciplinary Clinic at the CU Cancer Center is designed so that patients are seen by our team of specialists over one day with the goal of having a treatment plan by the end of the visit. This multidisciplinary approach to care provides patients with the most up-to-date and evidence-based treatment to provide the best care for the highest chance of success and cure of disease.
- Cheryl Meguid, DNP, ACNP
Pancreas and Biliary Cancer Clinic Coordinator
To learn more about the Pancreas and Biliary Cancer Multidisciplinary Clinic or schedule an appointment:
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