Pancreatic cancer

Disease Description (Causes and Symptoms)

• Definition and pathophysiology
  • The pancreas is a digestive and endocrine organ located in the upper abdomen. Most (>90%) pancreatic cancers are adenocarcinomas originating from exocrine cells. Tumors mainly arise in the head, body, or tail of the pancreas, and clinical manifestations vary depending on the location. Tumors in the head are prone to compressing the bile duct and causing obstructive jaundice, while tumors in the body and tail are often asymptomatic in the early stages and therefore tend to be detected late. Metastases mainly occur in the liver, peritoneum, and lymph nodes.
• Major causes (risk factors)
  • Age (generally 50 years or older), smoking (approximately increased risk), high-calorie and high-fat diets, chronic pancreatitis, genetic predisposition (family history and gene mutations, such as BRCA), obesity, diabetes, etc.
• Major symptoms
  • Abdominal pain (most common), weight loss, loss of appetite, jaundice (especially with tumors in the head), gray stools/steatorrhea, nausea and vomiting, fever, and newly developed or worsening diabetes.

Treatment Methods

• Treatment principles (classification according to resectability)
  • Resectable: Curative surgery (pancreaticoduodenectomy (Whipple) — for tumors in the head; distal pancreatectomy — for tumors in the body/tail, etc.) followed by adjuvant chemotherapy. For eligible patients, postoperative mFOLFIRINOX (when physical condition permits) is often recommended in standard guidelines; gemcitabine-based regimens may also be used depending on the patient's condition.
  • Borderline resectable: Generally, neoadjuvant chemotherapy (e.g., FOLFIRINOX or gemcitabine + nab-paclitaxel) is followed by reassessment, after which surgery may be considered.
  • Locally advanced/metastatic (unresectable/metastatic): Systemic chemotherapy is the first-line treatment (FOLFIRINOX for patients in good physical condition or gemcitabine + nab-paclitaxel). Radiation therapy is used selectively to control lesions.
• Biopsy
  • When imaging findings indicate a high likelihood of surgery, a preoperative biopsy is often not performed (considering the risk of misdiagnosis and peritoneal dissemination). When resection is impossible or preoperative pathological confirmation is required, diagnosis is made using EUS-FNA (endoscopic ultrasound-guided fine-needle aspiration) or similar methods.
• Treatment of local symptoms and complications
  • Biliary obstruction: Relieve jaundice through endoscopic stent placement by endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous biliary drainage.
  • Pain control: Medication (acetaminophen → NSAIDs → opioids) and nerve block procedures (celiac plexus nerve block) may be considered.
  • Pancreatic exocrine insufficiency: Pancreatic enzyme replacement therapy (PERT) and supplementation with fat-soluble vitamins.
  • Glucose metabolism disorders: Blood glucose management (insulin may be necessary).
• Supportive care and clinical trials
  • Nutritional management (high-protein and high-calorie support and dietary counseling), maintaining physical strength, pain and psychological support, and consideration of clinical trials are recommended.
• Precautions
  • Patients should be informed in advance about and receive management for the side effects of anticancer drugs and radiation (bone marrow suppression, neuropathy, gastrointestinal symptoms, etc.) and postoperative complications (bleeding, infection, fistula, etc.).

Checklist Before an Outpatient Visit (Including Preparation Items and Sample Questions)

• Items to prepare (recommended to bring)
  • A list of currently used medications (including prescriptions, OTC medications, and herbal medicines) and a history of allergies
  • Previous test results (CT/MRI image CDs or radiology reports, ultrasound results, endoscopy and contrast study reports) and pathology reports, if available
  • Records of recent weight changes (weight and amount of food intake) and the timing and changes in symptoms (pain pattern and intensity, changes in jaundice or stool color, etc.)
  • Whether you have diabetes and your blood glucose measurement results; recent test results (blood test values), if possible
  • Insurance card and identification
• Practical considerations before an outpatient visit
  • If an endoscopy or procedure is planned, confirm the fasting instructions (explanation regarding sleeping pills/sedatives may be necessary).
  • If possible, send imaging reports and outside medical records to the hospital in advance or bring them with you to improve the accuracy of the consultation.
• Examples of questions to record and bring to the outpatient visit
  • Make a note of how long recent symptoms (pain, weight loss, jaundice, etc.) have lasted and how severe they are.
  • Check whether you are taking any supplements or anticoagulants (e.g., aspirin, warfarin, etc.).

Examples of General Questions to Ask the Doctor

• "Is my lesion resectable? Is there a possibility of a cure with surgery?"
• "What standard chemotherapy do you recommend, and what side effects can be expected and how should they be managed?"
• "What is the risk of recurrence or metastasis after surgery or chemotherapy (prognosis)?"
• "How should I manage my lifestyle and nutrition? Do I need pancreatic enzyme supplementation or diabetes management?"
• "How can symptoms such as pain and jaundice be controlled? How should I contact you if my symptoms worsen urgently?"

Examples of Disease-Specific Questions

• "To what extent does the CT/MRI show involvement of major blood vessels (the superior mesenteric artery, superior mesenteric vein, common hepatic mesenteric artery, etc.)? How do you determine resectability (or borderline resectability) based on these findings?"
• "Is genetic testing of the tumor tissue (e.g., BRCA, MMR/MSI) necessary? Does the possibility of targeted therapy or immunotherapy differ depending on the test results?"

(Note: The above is general information, and the treatment plan may vary depending on individual test results and overall health status. Please discuss specific testing and treatment plans with your healthcare provider during your visit.)