Pancreatic cancer: Nursing

Pancreatic cancer is a malignant tumor arising in the pancreas. Unfortunately, it’s one of the most aggressive types of cancer, so most clients have a poor prognosis.

Now, let’s quickly review some anatomy and physiology. The pancreas is located in the abdomen, right behind the stomach, and it consists of four main parts, the head, neck, body, and tail. Now, the pancreas is a mixed exocrine and endocrine organ. Its exocrine glands produce digestive enzymes like amylase and lipase, which are released through the pancreatic duct into the duodenum; while its endocrine glands produce hormones like insulin and glucagon, which are released into the blood to help regulate our metabolism and blood glucose.

Okay, so pancreatic cancer can rarely arise from endocrine glands, called neuroendocrine tumors; and more commonly from exocrine glands, which is called pancreatic adenocarcinoma. So, pancreatic adenocarcinoma occurs when a cell from the exocrine pancreas acquires mutations, which can arise due to a variety of risk factors. Modifiable risk factors include smoking, excessive alcohol consumption, chronic pancreatitis, diabetes mellitus, obesity, and diet high in processed meat; while non-modifiable risk factors include older age, being assigned male at birth, family history, and genetic predisposition due to inherited gene mutations like BRCA or PALB2.

Once a pancreatic cell becomes mutated and cancerous, it starts dividing uncontrollably, forming a tumor mass. Most often, tumors originate in the head of the pancreas, and less frequently, in the body or tail of the pancreas. Now, as the tumor keeps growing, new blood vessels also develop via angiogenesis to supply it. Eventually, cancerous cells start invading neighboring tissues, such as the bile duct, duodenum, or stomach; and may even spread to nearby lymph nodes or metastasize to more distant organs, such as the liver.

Initially, clients with pancreatic cancer may experience symptoms like fatigue and weight loss, as well as nausea, vomiting, and epigastric pain that radiates to the back. In addition, the tumor can interfere with the exocrine function of pancreatic enzyme secretion, leading to malabsorption and diarrhea. The tumor may also interfere with the endocrine function of the pancreas, so clients may develop new-onset diabetes mellitus.