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1. Pancreatic Cancer Advances in Treatment Assignment
Pancreatic Cancer Advances in Treatment AssignmentPancreatic Cancer Advances in
Treatment AssignmentTreatment options for acute and chronic diseases continue to
advance in efforts to cure diseases or manage symptoms and improve quality of life. While
working in healthcare, it is important to be able to research treatment options to
understand the different treatments or questions patients may need to consider.Select 1
disease directly related to one of the body systems reviewed in this module. Research and
select a peer reviewed article written within the past 5 years discussing treatment options
for the selected disease and write a 1-page (minimum) Annotated Bibliography. For
annotated bibliographies, use standard APA format for the citations, then add a brief entry,
including:2 to 4 sentences to summarize the main idea(s) of the source including a brief
summary of the disease and treatment option(s).1 or 2 sentences to assess and evaluate the
source including if this information is reliable and discuss if the source is objective or
biased.1 or 2 sentences to reflect on the source including how this information can benefit a
patient and your understanding of the selected disease.Use APA formatting for your
citations and references. For more information on APA, navigate to the Resources tab in this
course.ORDER NOW FOR CUSTOMIZED, PLAGIARISM-FREE PAPERSQUICK LESSON
Pancreatic Cancer Description/Etiology Pancreatic cancer (PC) is difficult to diagnose in its
early stages and is almost always fatal. The characteristics and clinical manifestations of PC
depend on whether the tumor is located in the head, body, or tail of the pancreas, and if
exocrine or endocrine gland tissue is involved. Exocrine cells and ducts compose most of the
pancreas, producing digestive enzymes and carrying them to the small intestine. Exocrine
PC is the most common type of PC, accounting for 95% of PC cases, with adenocarcinoma
representing 95% of exocrine tumors. Endocrine cells represent a very small portion of the
pancreas, are grouped in clusters called islets, and release the hormones insulin and
glucagon into the blood. Endocrine tumors are uncommon, are classified as functioning (i.e.,
producing hormones [e.g., insulin, glucagon]) and nonfunctioning, and have a much better
prognosis than pancreatic adenocarcinoma. The exact etiology of most cases of PC is
unknown, but some are believed to result at least in part from inherited or acquired genetic
mutations. Patients with PC often already have metastatic disease at the time of diagnosis,
not only because malignant cells travel easily throughout the peritoneal cavity, but because
the initial clinical manifestations of PC are nonspecific and diagnosis is often delayed. There
is no effective screening test for PC. PC usually first metastasizes to the regional lymph
nodes, then to the liver and, on occasion, to the lungs. PC can also directly invade

2. surrounding organs (e.g., duodenum, stomach, colon) and metastasize to any surface in the
abdominal cavity via peritoneal spread. ICD-9 157.9 ICD-10 C25 Authors Tanja Schub, BS
Cinahl Information Systems, Glendale, CA Mary Woten, RN, BSN Cinahl Information
Systems, Glendale, CA Reviewers Morgan Nicole Holle, RN, BSN, OCN Cinahl Information
Systems, Glendale, CA Obiamaka Oji, DNP, APRN, FNP-BC Cinahl Information Systems,
Glendale, CA Nursing Practice Council Glendale Adventist Medical Center, Glendale, CA
Editor Diane Pravikoff, RN, PhD, FAAN Cinahl Information Systems, Glendale, CA PC is
staged using the tumor, node, metastasis (TNM) staging system. Treatment and prognosis
vary according to tumor type and stage. If the tumor is resectable, surgery is standard
treatment for both exocrine and endocrine PC. Neoadjuvant chemotherapy with radiation
therapy prior to surgery can be beneficial in patients with PC, particularly in those with
borderline resectable tumors. Resection is most often curative in patients with PC in the
head of the pancreas; these patients are more likely to be diagnosed early because of the
close proximity of the malignancy to the bile duct causes earlier onset of symptoms (e.g.,
pruritus, urine darkening, stool changes. Surgical intervention for PC in other parts of the
pancreas can be attempted if complete tumor removal is considered possible; these surgical
procedures are pancreaticoduodenectomy (also called the Pancreatic Cancer Advances in
Treatment AssignmentWhipple procedure; i.e., removal of the head and body of the
pancreas, gallbladder, and part of the stomach, small intestine, common bile duct, and
lymph nodes; surgically connecting the bile duct to the duodenum), distal pancreatectomy
(i.e., removal of the tail and/or body of the pancreas and/or spleen), and total
pancreatectomy (i.e., removal of the entire pancreas and spleen). Adjuvant postoperative
chemotherapy can increase survival by up to 3 months; adjuvant radiation therapy is not of
benefit for most patients. Surgical intervention for palliation to relieve bile duct blockage
has been widely replaced by endoscopic metal or plastic stent placement. Radiation
therapy, chemotherapy (e.g., gemcitabine for exocrine PC; streptozotocin for both
functioning and nonfunctioning types of endocrine PC), or both can be used to treat
nonresectable PC or as adjuvant treatment to surgery. Pain management, nutritional , and
other palliative care interventions are essential to improve quality of life (QOL), and referral
to hospice is usual. July 6, 2018 Published by Cinahl Information Systems, a division of
EBSCO Information Services. Copyright©2018, Cinahl Information Systems. All rights
reserved. No part of this may be reproduced or utilized in any form or by any means,
electronic or mechanical, including photocopying, recording, or by any information storage
and retrieval system, without permission in writing from the publisher. Cinahl Information
Systems accepts no liability for advice or information given herein or errors/omissions in
the text. It is merely intended as a general informational overview of the subject for the
healthcare professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA
91206 Facts and Figures PC is the tenth most common cancer diagnosed in the United
States but the fourth leading cause of cancer death, accounting for 7% of all cancer-related
deaths (Dragovich et al., 2017). The American Cancer Society (ACS) estimates that55,440
new cases of PC will be diagnosed and 44,330 people will die of the disease in the U.S. in
2018 (ACS, 2018). In most countries, the incidence of PC is 8–12 cases per 100,000 per year.
Approximately 75% of PCs occur in the head or neck of the pancreas, 15–20% occur in the

3. body of the pancreas, and 5–10% occur in the tail of the pancreas. The median age at
diagnosis of PC is 69 years in Whites and 65 years in Blacks. At diagnosis, 20% of patients
have localized, potentially resectable disease, 40% have locally advanced disease, and40%
have distant metastases at the time of diagnosis. The overall median survival is 4–6 months;
survival is lower in patients with significant weight loss, lower performance status, and
metastasis to the liver. Patients who have undergone successful resection have a median
survival of 12-19 months, and a 5-year survival of 15-20%. Pancreatic Cancer Advances in
Treatment Assignment(Dragovich et al., 2017) Risk Factors Smoking appears to be the most
prominent risk factor for PC; risk for developing PC is increased at least 2-fold in current
smokers and 30% of PCs are thought to be related to smoking. Chronic pancreatitis confers
a 26-fold increased risk for PC. Between 5% and 10% of patients with PC have a family
history of the disease. Additional risk factors include older age; male gender; being a Black
person living in the U.S.; diabetes mellitus (DM); low vitamin D levels; a diet high in fat
and/or meat; using smokeless tobacco; inherited genetic mutations such as family
syndromes involving BRCA2, p16, or PRSS1 mutations; exposure to maternal smoking in
utero or as a young child; overweight and obesity; physical inactivity; consumption of 3 or
more alcoholic beverages per day; sarcoidosis; chronic hepatitis; infection with
Helicobacter pylori; and occupational exposure to certain chemicals (e.g., beta-
naphthylamine,benzidine). Signs and Symptoms/Clinical Presentation The clinical
presentation of patients with PC can include jaundice, pruritus, upper abdominal and/or
back pain, nausea/vomiting, loss of appetite, severe weight loss, weakness, fatigue, sleep
disturbance,and an impaired sense of well-being.Additionally, endocrine tumors can cause
obstructive symptoms, gastrointestinal tract bleeding, or abdominal masses; functioning
endocrine tumors hypersecrete insulin or glucagon and can cause hypoglycemia, glucose
intolerance, hypokalemia, and Cushing’s syndrome. Patients can also demonstrate anxiety
and depression. Assessment › Physical Findings of Particular Interest • Dark-colored urine,
clay-colored stools, and yellow skin and sclera indicate jaundice • Physical examination of
the abdomen can reveal tenderness and/or a well-defined mass in the subumbilical or left
hypochondrial region; ascites and enlargement of the liver, gallbladder, and/or spleen can
be present › Laboratory Tests • Pancreatic Cancer Advances in Treatment
AssignmentTumor markers CA 19-9 and carcinoembryonic antigen (CEA) are elevated in
advanced PC; a CA 19-9 value > 100 U/ mL strongly indicates PC, and levels are monitored
for response during treatment; genetic testing can reveal PC-related mutation • Serum
levels of bilirubin, alkaline phosphatase, and gamma-glutamyltranspeptidase (GGT) are
significantly elevated in patients with obstructive jaundice • Serum levels of albumin
and/or cholesterol can indicate malnutrition; liver, kidney, and/or bone marrow function
tests can reveal underlying abnormalities • Glucosuria, hyperglycemia, and impaired
glucose tolerance can be present • Histologic analysis of biopsied tumor specimen confirms
the diagnosis › Other Diagnostic Tests/Studies • Multiphase thin-cut spiral CT scan with
radiocontrast will show abnormalities that indicate PC; CT scan can provide information
that assists with biopsy, staging, and identification of metastasis; endoscopic ultrasound
identifies smaller tumors than CT scan and can also be helpful in identifying area(s) for
biopsy and in staging • Endoscopic retrograde cholangiopancreatography (ERCP) will

4. identify bile/pancreatic duct obstruction in jaundiced patients and resolve obstruction by
stent placement • MRI or PET scan will identify metastasis; angiography will identify
vascular abnormalities that prohibit surgical resection Treatment Goals › Provide
Symptomatic Relief and Reduce Risk of Treatment-RelatedComplications • Monitor all
physiologic systems for underlying conditions and PC complications; frequently assess for
pain, pruritus, and other discomfort; provide prescribed treatment –For information about
management of pain (which can be severe and debilitating) in patients with PC, see Quick
Lesson About … Pancreatic Cancer and Pain • Promote optimum hydration and nutrition;
give prescribed parenteral fluids, enteral feedings, and pancreatic enzymes, as ordered •
Follow facility pre- and post-treatment protocols if patient becomes a candidate for surgery,
radiation therapy, and/or chemotherapy; reinforce pre- and post-treatment education and
verify completion of facility informed consent documents; closely monitor the patient post-
treatment for adverse effects and complications (see Red Flags , below) › Pancreatic Cancer
Advances in Treatment AssignmentEducate and Promote Emotional Well-Being • Assess the
anxiety level and coping ability of the patient and family; educate and encourage discussion
about the disease process, treatment options, and end-of-life issues, as appropriate •
Request referral to a dietitian for nutrition evaluation/education; to a mental health
clinician for counseling on coping strategies; and to a social worker for identification of
resources for in-homeservices, hospice, Internet information, and groups Food for
Thought › Carcinogenesis of PC begins roughly 10 years prior to the onset of symptoms ›
Among the potential PC treatment strategies under investigation is the use of
nanotechnology to improve drug delivery › Vitamin intake—particularly of Vitamins D and
B12—may decrease risk for PC (Liu et al, 2018) › Early diagnosis and treatment of PC are
associated with improved prognosis, but early diagnosis is difficult and there is currently a
lack of biomarkers available to aid in the identification of patients with early-stage PC.
Researchers in a recent study identified 38 microRNAs (i.e., short, noncoding RNAs that play
important roles in cancer development and metastasis) in whole blood that are significantly
dysregulated in patients with PC, and they constructed 2 diagnostic panels of microRNAs
that can have the potential to identify patients with early-stage PC. Additional research is
needed to confirm the diagnostic utility of these panels (Schultz et al., 2014) › Researchers
found that serum tumor marker levels of CA 19-9, lactic dehydrogenase (LDH) and CEA had
significant prognostic roles on survival in patients diagnosed with metastatic PC receiving
gemcitabine-basedchemotherapy (Tas et al., 2014) › In a 2014 study, researchers concluded
that baseline hemoglobin-a1c levels are significantly higher in patients diagnosed with
pancreatic ductal adenocarcinoma versus benign pancreatic disease and seem to affect
overall survival (Fan et al., 2014) Red Flags › Pancreaticoduodenectomy carries a significant
risk for complications, including leaking from new surgical connections, delayed gastric
emptying, bleeding, and infection. Surgery for PC should be performed only in facilities that
perform at least 15-20 procedures annually › Monitor patients with endocrine PC for
hyperinsulinism that leads to severe hypoglycemia, and immediately administer prescribed
oral or parenteral glucose What Do I Need to Tell the Patient/Patient’s Family? › Pancreatic
Cancer Advances in Treatment AssignmentContinued medical surveillance is essential, and
end-of-life issues should be addressed References 1. American Cancer Society. (2018).

5. Pancreatic cancer. Retrieved May 29, 2018, from
http://www.cancer.org/acs/groups/cid/documents/webcontent/003131-pdf.pdf (GI) 2.
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cancer. Medscape. Retrieved May 29, 2018, from
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Wild, A. T., Su, Z., Hacker-Prietz, A., Kumar, R., … Herman, J. M. (2014). Baseline hemoglobin-
a1c impacts clinical outcomes in patients with pancreatic cancer. Journal of the National
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(exocrine). In F. F. Ferri (Ed.), 2018 Ferri’s clinical advisor: 5 books in 1 (pp. 941-942).
Philadelphia, PA: Elsevier. (GI) 5. Karakas, Y., Lasin, S., & Yalcin, S. (2018). Recent advances
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(2018). Vitamin intake and pancreatic cancer risk reduction: A meta-analysis of
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doi:10.1097/MD.0000000000010114 (M) 7. National Comprehensive Cancer Network.
(2018). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Pancreatic
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Institute for Health and Care Excellence. (2018). Pancreatic cancer in adults: Diagnosis and
management. NICE guideline [NG85]. Retrieved May 29, 2018, from
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doi:10.1097/NCC.0000000000000463 Pancreatic Cancer Advances in Treatment
Assignment