Nurses’ Guide to Pancreatic Cancer Awareness Month 2023

• November is Pancreatic Cancer Awareness month, a time to reflect on this dangerous diagnosis that affects 45,000 Americans each year.
• In this guide, nurses can review the risk factors for pancreatic cancer, the early symptoms to watch out for, and the diagnostic process. 
• Nurses can also understand the different treatment options for pancreatic cancer, such as chemotherapy, radiotherapy, or surgery. 

November 1 to 31 is pancreatic cancer awareness month. Let’s talk about it.

Pancreatic cancer is currently the fourth-most common cause of cancer-related deaths in the United States. According to the American Cancer Society, pancreatic cancer accounts for about 3% of all cancers in the US and about 7% of all cancer deaths.

Approximately 45,000 people in the United States are diagnosed with it each year. The survival rate of pancreatic cancer is low; about 23% of patients survive 1 year after diagnosis, and fewer than 5% of persons with the disease remain alive 5 years after diagnosis.

Pancreatic cancer includes carcinomas of the head of the pancreas, the ampulla of Vater, the common bile duct, and the duodenum.

The pancreas serves as an endocrine and exocrine gland. The tumor can develop in any of these functional cells.

However, 95% of cases of pancreatic cancer affect the exocrine cells of the pancreas, referred to as adenocarcinoma. The remaining 5% of cases of pancreatic cancer affect the endocrine cells, named after the hormones they produce, such as insulinomas and glucagonomas.

What Causes Pancreatic Cancer?

The exact cause of pancreatic cancer is unknown. However, the incidence is two times more common in smokers than non-smokers. Hence, smoking can play a role in causing pancreatic cancer.

The other associated risk factors for pancreatic cancer can be:

• Consuming a high-fat containing diet
• Too much meat and dehydrated foods
• Fried foods
• Refined sugars
• Soybeans
• Nitrosamines
• Diabetes mellitus
• Chronic pancreatitis
• High coffee consumption

Persons having occupational exposure to gasoline derivatives, naphthylamine, and benzidine are considered to be at higher risk.

What Are the Symptoms of Pancreatic Cancer?

Common symptoms of pancreatic cancer are:

• Weight loss
• Anorexia
• Fatigue
• Epigastric pain

Nurses should inspect the patient for the presence of jaundice, which is the presenting symptom in 80% to 90% of patients with cancer of the pancreatic head.

If the cancer blocks the release of pancreatic juices into the intestines, the patient may have difficulty digesting fatty foods; this will result in pale, bulky, greasy stools that tend to float in the toilet.

The buildup of bilirubin in the blood and skin can cause dark urine and pruritus, assess the patient for that. Note the presence of liver or spleen enlargement. Dullness on percussion may indicate the presence of ascites or gallbladder enlargement due to pancreatic cancer.

How Is Pancreatic Cancer Diagnosed?

The tools that help in the diagnosis of pancreatic cancer are:

• Computed tomography (CT) scan- helps in knowing the size and location of the tumor, providing detailed images with multiple cross-sections of the pancreas.
• Magnetic resonance imaging- helps in knowing the size and location of the tumor and if it is compressing the surrounding blood vessels. It uses radio waves and strong magnets to create detailed images.
• Abdominal sonogram- CT and MRI are more accurate to know about the tumor size and location. But a sonogram can help know about pseudocysts by creating an oscilloscopic picture from echoes of high-frequency sound waves passing over the pancreatic area.
• Tumor marker antigen: CA 19-9- Its normal levels are less than 37 AU/mL. Elevated levels above 1000 AU/ml indicate metastasis that happens in 80% of patients with late-stage pancreatic cancer. This biomarker is also used after treatment to determine effectiveness or reoccurrence.

Other diagnostic tests used in the diagnosis of pancreatic cancer are:

• Upper gastrointestinal (GI) series positron emission tomography
• Biopsy of the pancreatic tissue
• Angiography
• Endoscopic retrograde cholangiopancreatography

What Are the Treatment Options For Pancreatic Cancer?

Surgery, radiotherapy, and chemotherapy all are used to treat pancreatic cancer. The common chemotherapeutic agents used are:

• Gemcitabine
• Fluorouracil (5-FU)
• Cisplatin
• Irinotecan
• Paclitaxel
• Capecitabine
• Oxaliplatin
• Streptozocin
• Pancreatic enzyme supplements, such as pancrelipase and lipase aid in the digestion of proteins, carbohydrates, and fats.

The Bottom Line

Quitting smoking may help lower the incidence of pancreatic cancer because it is more common in smokers, compared to non-smokers.

Till now, there have been no screening tests for early detection of pancreatic cancer. Usually, when it is diagnosed, it has already metastasized to other organs which makes it difficult to treat, leading to poor prognosis.

As a nurse, counsel the patient as they are very anxious when a cancer is diagnosed. Lend them a listening ear, and with the palliative treatment, connect them to a counselor who can help them to cope with the situation mentally.

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