CTV News- Alex Trebek Ann...
Mar 28, 2019 - https://atlantic.ctvnews.ca/video?clipId=1630470
Important Points to Remember
Many times pancreatic cancer is thought of as a one disease which has one outcome and follows one pathway. This is not true at all!
It is important to understand that not all pancreatic cancers are the same and should not be treated all the same. Different types of tumours behave differently.
Some names of pancreatic cancer are;
Adenocarcinoma - Make up about 90% of all pancreatic cancers. This is the name for a cancer that makes up glands in tissues.
Mucinous Adenocarcinoma- this is a type of pancreatic cancer that grows very slowly but can present as a very large mass in the pancreas. They can be perfectly fine and remain fine for years, even without treatment.
Neuroendrocrine - The rarest of all pancreatic cancers and are totally different, the treatment is different and the pathway is different.
Lymphoma- Cancer of the lymph glands around the pancreas.
The only way to find out what type of pancreatic cancer a patient has is to look at the tissue. Remember that “Tissue is the Issue.” This requires a biopsy.
Strongly advocate for a biopsy. There are those rare cases where a biopsy may not be performed and these rare occasions could include very old age, a patient who is in very poor health or a patient who is on blood thinners.However these are cases where, with or without a biopsy, the treatment would be the same. This will be a small minority.
Surgical oncologists may not take a biopsy beforehand, because they feel the tumour is surgical and will be removing it. However a biopsy will be taken of the tumour upon removal.
Brush biopsies are not as accurate as needle biopsies as they often come back negative.
The role of surgery is to remove all of the disease IF;
There is no disease spread to other organs, distant lymph nodes or abdominal linings.
It is technically feasible- there are times when the tumour is wrapped around the blood vessels, making surgery impossible.
The patient is able to tolerate surgery with expectations for full recovery. This is major surgery.
Second opinions are recommended for a number of reasons;
To clarify a poorly understood or poorly communicated diagnosis or to ask questions not answered before.
To speak to a specialist trained/experienced in treating pancreatic cancer.
To explore other treatment options.
To participate in a possible clinical trial.
To visit a higher volume hospital, where more surgeries are performed or where specialists are trained in the treatment and care of patients with pancreatic cancer.
For psychological reasons, putting any uncertainties to rest.
To seek a second opinion from a different specialty. For example if you have seen a surgical oncologist, you may want to see a medical oncologist or radiation oncologist.
Wait times- When a patient is diagnosed with pancreatic cancer, the wait time to see a surgical oncologist should be 2-3 weeks. Ask your family physician to advocate for this. If it is determined that surgery is not a treatment option, you should be referred to an oncologist and seen right away. These wait times will vary to some degree, but this diagnosis requires prompt medical treatment and care.
Nutrition- Patients should keep their physician and specialists advised of any weight loss, as this is a very important element of your treatment and care. Oncologists, surgical oncologists, nutritionists and family physicians can all assist with this. See chapters on Chemotherapy and Nutrition.
Pain Medication- Patients should not have to live in pain. Pain can be controlled. See sections on Pain Management and Chemotherapy.
Remember that family physicians still can offer a lot to their patients in terms of advocacy, referrals, nutrition, and minor symptom control such as acid reflux etc.
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