Pancreatic cancer

Symptoms Of Pancreatic Cancer

Most people don’t experience early signs of pancreatic cancer. The doctor may suspect pancreatic cancer if the patient has recently developed diabetes or pancreatitis (a painful condition due to the inflammation of the pancreas). As the disease progresses, people may notice symptoms like:

• Pain in the upper abdomen, radiating to the back

• Jaundice (yellowing of the skin and the whites of the eyes)

• Tiredness and fatigue

• Loss of appetite

• Light-colored stools

• Dark-colored urine

• Loss of weight

• Formation of blood clots in the body

• Dry and itchy skin

• Worsening diabetes or a new diagnosis

• Nausea and vomiting

Some symptoms of pancreatic neuroendocrine cancer may be different from the traditional pancreatic cancer symptoms because some PNETs overproduce hormones. These symptoms include:

• Zollinger-Ellison syndrome (in which the stomach makes too much acid) causing stomach ulcers

• Irritations on the tongue and corners of the mouth

• Malnutrition

• Shortness of breath

• Rashes or blisters on the skin

• Excessive thirst

Excessive thirst can be alarming. Frequent thirst or excessive thirst could be a symptom of a serious health condition. Read about 5 common causes of excessive thirst or polydipsia.
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Types Of Pancreatic Cancer

Pancreatic tumors are either exocrine or neuroendocrine (endocrine) tumors based on the type of cell they start in. Every pancreatic cancer patient is different and the treatment is based on the type. Types of pancreatic cancer are:

Exocrine pancreatic cancer

Most of the pancreatic tumors are exocrine tumors. They start in the exocrine cells (that produce enzymes for digestion) of the pancreas and include:

Adenocarcinoma: The most common type of pancreatic cancer is adenocarcinoma. It is an exocrine tumor that starts in the cells lining the pancreatic duct, which make enzymes for digestion.

• Mucinous cystic neoplasm: This is an invasive adenocarcinoma and is a cyst filled with thick fluid. Mucinous cystic neoplasms can be non-cancerous (benign) if they are not invasive.

Other rare exocrine tumors include:

• Squamous cell carcinoma: This extremely and forms in the pancreatic ducts, and is made purely of squamous cells, which are not typically seen in the pancreas.

• Adenosquamous carcinoma: This rarest type of pancreatic cancer. It is a more aggressive tumor with a poorer prognosis.

• Colloid carcinoma: These tumors are very rare and tend to develop from a type of benign cyst called an intraductal papillary mucinous neoplasm (IPMN).

Neuroendocrine pancreatic cancer

Neuroendocrine tumors (pancreatic NETs or PNETs) are rare (about 7 percent). They often grow slower than exocrine tumors. PNETs come from the abnormal growth of endocrine cells in the pancreas called islet cells, responsible for controlling blood sugar levels (hence they are also called islet cell tumors).

PNETs are classified by the hormones they make and common types include:

• Gastrinoma: A gastrin-producing tumor usually located in the pancreas or the duodenal wall. Gastrin is a peptide hormone that stimulates the secretion of gastric acid.

• Glucagonoma: Glucagonoma is a very rare tumor of the islet cells of the pancreas, which leads to an excess of the hormone glucagon in the blood.

• Insulinoma: Pancreatic tumor that leads to extra insulin production causing hypoglycemia (low blood sugar).

• Somatostatinoma: They start in neuroendocrine cells that make the hormone somatostatin.

• VIPoma: A non-beta pancreatic islet cell tumor secreting vasoactive intestinal peptide (VIP), resulting in a syndrome of watery diarrhea, hypokalemia, and achlorhydria (absence of hydrochloric acid in gastric secretions).

• Nonfunctional islet cell tumor: Tumor arising from the pancreatic islet cell that is rare and no hormone is involved.

Note: Benign precancerous lesions are cysts and other benign tumors in the pancreas and can be precursors to pancreatic cancer, including intraductal papillary-mucinous neoplasms (IPMNs).

Causes Of Pancreatic Cancer

The exact cause of pancreatic cancer is unknown.

Pancreatic cancer occurs when abnormal cells begin to grow within the pancreas. These abnormal cells develop because of changes (mutations) in their DNA. This mutated DNA dictates the cells to grow uncontrollably and to continue living after normal cells die. These masses of cells can form a tumor. When left untreated, these cells continue to grow out of control and metastasize (spread to other parts of the body). 

Anyone can get pancreatic cancer. Though it's not always clear what causes it, research has identified some of the risk factors that can lead to it.

Risk Factors For Pancreatic Cancer

Despite other gastrointestinal tumors, evidence of risk factors for the development of pancreatic cancer is poor and can be classified into environmental factors and genetic factors:

Environmental factors

These can be further classified into modifiable and non-modifiable factors that increase the risk of an individual developing pancreatic cancer. They include:

Modifiable factors

1. Smoking: It is the main modifiable risk factor for the development of pancreatic cancer. 

2. Alcohol consumption: Pancreatic cancer is associated with heavy alcohol consumption of > 30 gm per day. This risk is strongest in heavy male drinkers and heavy drinkers of spirits. Excessive alcohol consumption is also the main cause of chronic pancreatitis, which is a known risk factor for pancreatic cancer. 

3. Chronic pancreatitis: Chronic pancreatitis is a progressive inflammatory condition of the pancreas leading to fibrosis and loss of functional cells. It is strongly associated with pancreatic cancer.

4. Obesity: Some studies had demonstrated a relative risk increase of 1.12 for each increase in 5 kg/m2 in the BMI. Obesity since childhood has a higher risk relative to pancreatic cancer development.

5. Diet: There is limited evidence that consumption of red and processed meat is associated with pancreas cancer development. These foods lead to DNA damage and the formation of carcinogens such as N-nitroso compounds. Other dietary items that can increase the risk include foods and beverages containing fructose or foods containing saturated fatty acids.

6. Infection: Increased risk has been observed in patients with Helicobacter pylori (H. pylori) or hepatitis C infections. Further research is necessary to strengthen this relationship.

7. Exposure at workplace: Working with certain chemicals, particularly those used in metalworking and pesticides, has been recognised as a potential risk factor for pancreatic cancer.

Non-modifiable factors

1. Age: Pancreatic cancer generally occurs in patients over 55 years old, mostly between 70-80 years. It is extremely rare for patients to be diagnosed before the age of 30. The age at which the incidence peaks also tends to vary from country to country. For example, In India, there is a peak in incidence in patients in their sixth decade of life whereas in the United States this is in the seventh decade of life.

2. Sex: The incidence is lower in women than in men globally. This difference is even more evident in developed nations.

3. Geographic location: The incidences of development of pancreatic cancer varies in different parts of the world. The incidence rate in Africa is the lowest, and higher cases of development of cancer are seen in China.

4. Blood group: The ABO blood group antigen is present on the entire surface of red blood cells. Studies have shown that people with type A, AB, or B blood groups have a higher risk of developing pancreatic cancer than those with type O.

5. Diabetes mellitus: Diabetes significantly increases the risk of developing pancreatic cancer. However, it must be noted that although diabetes is a risk factor, pancreatic cancer can also present itself as a new onset of diabetes. This has led to interest in HbA1c as a potential biomarker of early detection in pancreatic cancer. 

6. Gut microflora: Lower levels of Neisseria elongata and Streptococcus mitis, and higher levels of Porphyromonas gingivalis and Granulicatella adiacens are associated with an increased risk of pancreatic cancer. However, further research is needed to validate these studies and also to establish if targeted treatment can be a possibility.  

Genetic factors

It is difficult to understand the effect-causing relationship of some risk factors, however, genes and their mutations have a strong role and interconnection with the development of pancreatic cancer. These risk factors include:

1. Hereditary breast cancer and ovarian cancer syndrome (HBOC): The genes BRCA1 and BRCA2 mutations can cause early-onset malignant tumors, most of all breast and ovarian cancer, including pancreatic cancer, especially if in BRCA2 mutation. 

2. Hereditary non-polyposic colorectal cancer or Lynch syndrome (HNPCC): People who have Lynch syndrome (MSH2, MSH6, MLH1, PMS2, and EPCAM gene mutations) are predisposed to early-onset colorectal cancer without polyposic lesions and other-site neoplasia, including pancreatic cancer.

3. Familial atypical multiple mole melanoma syndromes (FAMMM): This syndrome is characterized by malignant melanoma in one or more first-degree or second-degree relatives. In 38% of cases, this pathology is caused by a p16INK4a gene mutation.

4. Hereditary pancreatitis (HP): In 80% of cases of hereditary pancreatitis it is possible to identify a PRSS1 gene mutation. This condition is characterized by recurrent acute pancreatitis starting in childhood, that can be evolved into early pancreatic failure.

5. Familial adenomatous polyposis (FAP): This syndrome, caused by a mutation in the APC gene, is characterized by early-onset polyps in the gastrointestinal tract that can develop into cancer. 

6. Peutz-Jeghers syndrome (PJS): The STK11/LKB1 gene mutation characterizes hamartomatous polyposis syndrome and this condition can determine gastrointestinal neoplasia (cancer) and other tumors like pancreatic cancer.

7. Cystic fibrosis (CF): This pathology, caused by CFTR gene mutation, has the same pathogenetic mechanisms because recurrent acute pancreatitis can be involved in pancreatic cancer onset.

Diagnosis Of Pancreatic Cancer

Pancreatic cancer poses a significant diagnostic challenge and the majority of cases present late, with either locally advanced or metastatic disease. The diagnosis of pancreatic cancer depends on the size and location of the tumor and whether or not the cancer has spread. Depending on this the cancer is divided into 5 stages. There are:

1. Stage 0: Also known as carcinoma in situ and is characterized by abnormal cells in the lining of the pancreas. The cells could become cancerous and spread to nearby tissue.

2. Stage 1: Presence of tumor (cancerous cells) in the pancreas.

3. Stage 2: Presence of tumor in the pancreas and has either spread to nearby tissues, organs, or lymph nodes.

4. Stage 3: Spread of cancer to major blood vessels near the pancreas. It may have also spread to nearby lymph nodes.

5. Stage 4: In this stage, cancer has spread to distant organs in the body like the liver, lungs, or abdominal cavity along with tissues or lymph nodes near the pancreas.

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The diagnosis consists of the following:

Physical examination 

The doctor will examine the patient's skin, tongue, and eyes to see if they are yellow, which is a sign of jaundice. An abnormal buildup of fluid in the abdomen, called ascites, may be another sign of cancer.

Blood tests

The doctor may take samples of blood to check for abnormal levels of bilirubin and other substances. Bilirubin is a chemical that may reach high levels in people with pancreatic cancer due to blockage of the common bile duct by a tumor. 

Imaging tests

These tests help doctors find out where the cancer is located and whether it has spread from the pancreas to other parts of the body.

1. Computed tomography (CT or CAT) scan: Many cancer centers use pancreatic protocol CT scans that involve taking pictures of the pancreas at specific times after the intravenous (IV) injection of contrast medium to find out exactly where the tumor is in relation to nearby organs and blood vessels. 

2. Positron emission tomography (PET) scan or PET-CT scan: A PET scan is usually combined with a CT scan or MRI scan to produce images of the inside of the body. The combination provides a more complete picture of the area being evaluated.

3. Endoscopic retrograde cholangiopancreatography (ERCP): This procedure is performed by a gastroenterologist to o place bile duct stents and not commonly used for diagnosis. The doctor will put a thin, lighted tube called an endoscope through the mouth and stomach into the small intestine. 

4. Ultrasound: An ultrasound uses sound waves to create a picture of the internal organs. There are 2 types of ultrasound devices:

• A transabdominal ultrasound (ultrasound is to see inside the abdomen).

• The endoscopic ultrasound (EUS - ultrasound with the help of an endoscope).

5. Percutaneous transhepatic cholangiography (PTC): This is a x-ray procedure used to detect any blockage in the bile duct due to the tumor. A thin needle is inserted and a dye is injected before taking the x-ray.

6. Magnetic resonance imaging (MRI): An MRI uses magnetic fields to produce detailed images of the body and to measure the tumor’s size. Cholangiopancreatography (MRCP) is a specialized type of MRI using computer software developed specifically to examine pancreatic issues, such as ductal blockages and cysts.

Biopsy

A biopsy is the removal of a small amount of tissue for examination under a microscope. It can make a definite diagnosis for most cancers. There are a couple of different ways to collect a tissue sample:

• Fine needle aspiration cytology (FNAC): It is the removal of the tissue sample by aspiration from the needle.

• Core needle biopsy: The doctor uses a hollow needle to take out pieces of pancreatic tissue from a suspicious area.

Testing for potential biomarkers

Investigation of potential biomarkers including liquid biopsy, to aid in screening, diagnosis, and treatment of pancreatic cancer has been an area of intense research. These include:

• Serum cancer antigen 19-9 (CA 19-9): It is the only marker approved by the United States Food and Drug Administration for use in the routine management of pancreatic cancer.

• Volatile organic compounds (VOC): This is a non-invasive method for early detection biomarker research. This compound is present in exhaled air. 

• DNA mutations:The presence of DNA mutations in pancreatic juice has also been an area of study. Mutant P53 was found in the pancreatic juice of individuals with intermediate and high-grade invasive malignancy.

Prevention Of Pancreatic Cancer

Cancer prevention is an action taken to lower the chance of getting cancer. Many things in our genes, our lifestyle, and the environment around us may increase or decrease our risk of getting cancer. Some of the ways to prevent pancreatic cancer include:

• Avoiding or controlling things known to cause cancer

• Changing diet and adopting a healthy lifestyle

• Finding precancerous conditions at an early stage

• Taking medicines to treat a precancerous condition or to keep cancer from starting (chemoprevention)

• Planning risk-reducing surgery

• Avoiding tobacco smoking

• Reducing alcohol consumption

• Minimizing risk factors associated with chronic pancreatitis

• Individuals with a high-risk genetic background may require:

  • Counseling

  • Genetic testing if appropriate (BRCA2 mutation or p16INK4A inactivity) 

  • Secondary screening for pancreatic cancer

Specialist To Visit

Cancer is not a single disease but a group of related diseases. Hence, it requires comprehensive care. Doctors that take care of patients with pancreatic cancer and help in diagnosing and formulating a treatment plan are:

• Gastroenterologist

• Oncologist

A gastroenterologist is a doctor who treats diseases of the esophagus, stomach, small intestine, colon and rectum, pancreas, and gallbladder. An oncologist is a doctor who treats cancer and provides medical care for a person diagnosed with cancer.

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Treatment Of Pancreatic Cancer

Pancreatic cancer requires multidisciplinary treatment and requires surgery, chemotherapy, and radiation, alone or in combination.

Surgical management

Surgical treatment is considered the best way to cure pancreatic cancer as it can significantly prolong survival. The surgical procedures include:

1. Pancreatectomy

It consists of the Whipple procedure (pancreaticoduodenectomy), which is an operation to remove the head of the pancreas. Along with this, the distal or total pancreatectomy (removal of the pancreas) is the best surgical option for the resection of pancreatic cancer depending on the anatomical location of the tumor or tumors. It requires:

• Preoperative biliary drainage: A significant proportion of patients with pancreatic cancer present with jaundice and pre-operative drainage relieves the obstruction and may reverse the pathophysiological dysfunction caused by obstructive jaundice.

• Anastomotic technique: A major source of death following Whipple’s procedure is a leak from pancreatic anastomosis and the formation of a pancreatic fistula. It consists of anastomosing (suturing) the pancreatic duct to the jejunum (middle part of the small intestine) or stomach.

2. Laparoscopic surgery

Laparoscopy is a type of surgical procedure that allows a surgeon to access the inside of the abdomen (tummy) and pelvis without having to make large incisions in the skin. This minimally invasive surgery requires laparoscopic distal pancreatectomy for the resection. There was no difference in the rate of positive resection margins and outcomes.

3. Vascular resection

The relationship between any pancreatic tumor and the surrounding vasculature is an important determinant of how much resection needs to be done. Pancreatic cancer resection includes total pancreatectomy, distal pancreatectomy plus splenectomy (removal of the spleen). 

Medical management

1. Chemotherapy

Chemotherapy is an important part of the comprehensive treatment of pancreatic cancer. The overall survival rate after radical resection and adjuvant chemotherapy improves in most cases. Generally, used chemotherapy regimens after radical resection are:

• Modified leucovorin, 5-fluorouracil, irinotecan, and oxaliplatin (MFOLFIRINOX) for 6 months 

• Gemcitabine and capecitabine combined for 6 months 

• Folfirinox regimen, gemcitabine, and Pac-Nab in combination with chemotherapy in patients with metastasis (spread of cancer to other organs)

• Gemcitabine is the first choice if the patient is not suitable for combination chemotherapy

• Gemcitabine (with or without erlotinib) combined with 54 Gy (radiation dose) is used for patients with locally advanced pancreatic cancer

Radiotherapy

Radiation therapy uses X-rays to destroy or damage cancer cells, making them unable to proliferate. Radiotherapy is mainly used in patients with locally advanced pancreatic cancer. It uses:

• External beam radiation therapy: This uses external radiation therapy sources that emit X-rays, gamma rays, electrons or heavy particles. 

• Brachytherapy: It is a type of internal radiation therapy in which seeds, ribbons, or capsules that contain a radiation source are placed inside the body, or near the tumors. It is mainly used for internal radiotherapy by surgery or laparoscopy in the pancreas or adjacent to the pancreas.

Targeted therapy

This is very successful in many types of cancer, though, to date, all other targeted drugs have failed in pancreatic cancer patients, including affrecept, cetuximab, sorafenib, bevacizumab, and axitinib. Recently the Food and Drug Administration (FDA) has approved pembrolizumab as a targeted treatment for pancreatic cancer.

Latest treatment protocols

A lot of research and studies on the latest treatment options are going on. Some of them are:

• Gene therapy: Gene therapy is the delivery of specific genes to cancer cells, which are often carried by specially designed viruses. 

• Cancer stem cells: Research is currently focused on identifying treatments that may specifically target the pancreatic cancer stem cells.

• Genetic/molecular studies: Many new research developments are based on identifying damaged genes and proteins and repairing them or changing how they work.

• Circulating tumor (ct)DNA: The ctDNA is being studied as a tool for monitoring response to treatment, for observing early signs of disease recurrence, and as a way to determine the disease's resistance to the ongoing treatment.

Other treatment modalities

Patients with pancreatic cancer need palliative care at some point, it is as important as other treatments themselves. Some of the procedures done for the management of patients with gastric outlet obstruction include:

• Percutaneous bile duct drainage: A procedure to drain bile to relieve pressure in the bile ducts caused by a blockage.

• Surgical gastrojejunostomy: A surgical procedure in which an anastomosis is created between the stomach and the proximal loop of the jejunum.

• Endoscopic duodenal stents: A stent is a small metal mesh tube that is placed in the narrowed or blocked area of your duodenum (first part of the small intestine).

Home-care For Pancreatic Cancer

A pancreatic cancer diagnosis can be shocking and life-changing. It not only takes a toll on the body but the mind as well. Certain things that the patient can do that will help them cope with the diagnosis and treatment include:

• Joining a support group for people with pancreatic cancer

• Spending time with others who are going through the same things

• Empowering and strengthening their mental and emotional health

• Talking to a counselor, therapist or social worker about the feeling

• Meditating and keeping the mind calm

• Finding hobbies that make them happy 

Knowledge is power, and there are several helpful resources available for the patient and their family. Here are a few tips that the caregivers can follow to help the patient in the difficult times:

• Provide as much as emotional support and encouragement

• Talk with the health-care team and understand the course of treatment

• Help the patient manage their symptoms and side effects

• Assist the patient in maintaining personal care and hygiene

• Coordinate their medical appointments

• Stay with them throughout the appointments

• Assist their meals and grocery shopping

• Help them with household chores

• Handle insurance and billing issues for them

• Give them medications on time

• Always talk with empathy and a positive attitude

Complications Of Pancreatic Cancer

Pancreatic cancer progresses unchecked for a long time before symptoms are recognized. Complications of pancreatic cancer include:

Common complications

Upon progression of the tumor, the complications that arise include:

• Jaundice: Pancreatic cancer that blocks the liver's bile duct can cause jaundice. Signs include yellow skin and eyes, dark-colored urine, and pale-colored stools. Jaundice usually occurs without abdominal pain. 

• Weight loss: Many people with pancreatic cancer lose their appetite and lose weight. People in the last few weeks of life will gradually feel less like eating.

• Muscle wasting: Cancer cachexia is a highly debilitating condition characterized by weight loss and muscle wasting that contributes significantly to the morbidity and mortality of pancreatic cancer.

• Abdominal pain: A common symptom of pancreatic cancer is a dull pain in the upper abdomen (belly) and/or middle or upper back that comes and goes probably caused by the tumor

• Diabetes: Diabetes or impaired glucose tolerance is present in the majority of patients with pancreatic cancer due to pancreatic insufficiencies.

General complications after resection of the pancreas

Medical complications that require another surgery as a consequence of surgery include:

• Cardiac problems like angina (chest pain), infarction (heart attack) and arrhythmias

• Cardiovascular accidents like stroke

• Cardiorespiratory distress (increase in the number of breaths) 

• Kidney dysfunction

• Pneumonia

• Thrombosis (blood clots)

• Pulmonary embolism (blood clot gets lodged in an artery in the lung)

• Psychological disturbances 

• Hepatic (liver) and metabolic dysfunction.

Surgical complications following pancreatic resection

Many postoperative complications respond to medical treatment, radiological intervention, and endoscopic intervention without the need for surgical intervention. They are:

• Intra-abdominal abscess (collection of pus in the inner lining of the stomach)

• Hemorrhage (bleeding)

• Fistulae of the pancreatointestinal anastomosis (abnormal connection between pancreas and intestinal sutures)

Alternative Therapies For Pancreatic Cancer

The limitations of current treatment for pancreatic cancer have led to the need for new therapeutic approaches that have promising results. These include:

Microbial therapy

There is now a piece of strong evidence that the human microbiota plays a key role in regulating cancer development and response to cancer treatment. To date, the results of intestinal microflora forming systemic immunity and tumor-specific immunity in pancreatic cancer have been confirmed, but the mechanism remains to be studied. 

Immunotherapy

Immune checkpoint blockade (ICB) therapy is now approved for various types of cancer such as melanoma, lung cancer, renal cell carcinoma, and head and neck squamous cell carcinoma. However, pancreatic cancer is considered to be less immunogenic and the microenvironment of pancreatic tumors is thought to create an environment that suppresses immunity. Therefore, there is currently no immunotherapy approved for patients with pancreatic cancer.

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Living With Pancreatic Cancer

Pancreatic cancer has only a five-year survival rate for pancreatic cancer when compared with many other cancers. This is because most people are diagnosed with stage IV when the disease has metastasized.

Living with pancreatic cancer means different things to different people. Whether you are a patient who has been diagnosed with pancreatic cancer or care for someone who has the disease, it will have a large impact on their lives. Things that the caregiver and the patient should take into consideration include:

Managing the emotions

It may be difficult to cope with a diagnosis of cancer both practically and emotionally. These may include dealing with a variety of emotions such as sadness, anxiety, or anger, or managing the stress level. The following information may provide some help:

• Getting all the information needed to go about with the treatment

• Talking to the loved ones

• Joining support groups

• Understanding the physical limitations

• Starting palliative care to get relief from other symptoms

• Coping with practical issues like financial expenses, childcare, and work issues

Surviving the physical side effects

Changes to the physical health depend on several factors including cancer’s stage, the length and dose of treatment, and the patient’s general health. Things to keep in mind are:

• Talk to the doctors and healthcare team regularly about the feelings

• Know about any new side effects or changes in existing side effects

• Inform the healthcare team about the side effects so that they can potentially keep any side effects from worsening

• Keep track of the side effects so it is easier to explain any changes to the healthcare team

• Get treatment for long-term side effects and late effects as it is important to survive post the completion of treatment 

Supervising the costs of cancer care

Cancer treatment can be expensive. It may be a source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. This can stop many patients from continuing the treatment. This can be managed by:

• Understanding the cost of the treatment

• Encouraging the patients and their families to talk about financial concerns with a member of their healthcare team

• Knowing about federal healthcare law and how it can be used 

• Getting support from organizations that help with treatment, housing, travel, and other cancer-related costs

Focusing on diet

Having cancer of the pancreas will affect your eating and drinking habits, whatever your stage of cancer or treatment. Here are things that need to be considered from a dietary aspect.

• Sticking to smaller and lighter meals throughout the day

• Avoiding very high fiber foods such as cereal and dried fruit in case of diarrhea

• Sipping a nutritional supplement between meals to boost the calorie intake

• Maintaining blood sugar levels

• Taking enzyme supplements

Preparing for the treatment

The diagnosis can leave the patient worried and overwhelmed, but there are things that can be done to help the patients feel more in control of their physical and mental health during this time. This includes:

• Understanding prehabilitation (getting ready for cancer treatment in whatever time you have before it starts)

• Preparing mentally and physically for the treatment

• Eating a wide range of foods in the right proportion

Getting follow-up care

Post the completion of the treatment, the doctors will still want to watch the patient closely. It’s very important to go to all of the follow-up appointments. These visits consist of exams and lab or imaging tests to look for signs of cancer or treatment side effects.

Some side effects might last a long time or may not even show up until years after you have finished treatment. It’s important for all pancreatic cancer survivors to let their health care team know about any new symptoms or problems because they could be caused by cancer coming back or by a new disease or second cancer.

Cancer can drain a person physically and mentally. Gaining knowledge and awareness about cancer and the myths that surround it is necessary to enable timely diagnosis and treatment. 
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