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Wednesday, May 14, 2008

Treating pancreatic cancer with surgery

Removal of the cancer (resection)

Occasionally, it is possible to remove all of the cancer with surgery. This is a major operation, only suitable for people with early-stage pancreatic cancer. This type of surgery should be done by specialist surgeons who are trained and experienced in pancreatic surgery, so you may need to be referred to a specialist centre to have this type of treatment. It is important to discuss the benefits and the risks with your surgeon before making the decision to go ahead with any surgery.

Depending on where the cancer is, and how much of the pancreas is involved, all, or part of the pancreas may need to be removed during surgery.

  • Removal of the whole pancreas is called pancreatectomy
  • Removal of the lower end of the pancreas is called distal pancreatectomy
  • A part of the stomach, small bowel (duodenum), the common bile duct, gall bladder and the surrounding lymph nodes may also have to be removed to reduce the risk of the cancer coming back. This type of operation is called a pancreatoduodenectomy or a Whipple’s operation. A Whipple’s operation in which the lower end of the stomach is not removed is called a pylorus-preserving pancreatectomy.

Your specialist may suggest that you have a laparoscopy to see which type of surgery is possible in your case.

Occasionally, even if the cancer cannot be completely removed, a partial resection (removal of some of the cancer) can be done to reduce symptoms and control the cancer for a while.

After your operation

After your operation, you may stay in an intensive care ward for the first couple of days. You will then be moved to a general ward. As soon as possible you will be encouraged to start moving around. This is an essential part of your recovery, and even if you have to stay in bed it is important to do regular leg movements and deep breathing exercises. A physiotherapist or nurse will explain these to you.

Drips and drains

A drip into a vein in your arm (intravenous infusion) will be used to give you fluids until you are able to eat and drink again.

You may have a fine tube that passes down your nose, into your stomach or small intestine. This is called a nasogastric tube and it allows any fluids in the stomach to be removed so that you don’t feel sick. You may need this for up to five days.

Often a small tube (catheter) is put into the bladder, and urine is drained into a collecting bag. This will save you having to get up to pass urine and is usually taken out after a couple of days. You may also have one or more drainage tubes in your wound, to collect any extra fluid or blood, or to drain bile or pancreatic fluid.

Pain

After your operation, you will probably have some pain and discomfort for a few days. Pain can usually be well controlled with painkillers. It is important to let your doctor or the nurses on the ward know if you are in pain, or if your drugs are not completely relieving your pain, so that the dose can be increased or the painkillers changed as soon as possible.

Insulin and enzyme replacement

People who have had the whole pancreas removed will need to either take tablets to regulate their blood sugar, or have daily insulin injections to replace the insulin normally produced by the pancreas. They will need this for the rest of their life. They may also need to take capsules containing the special proteins (enzymes) that are normally produced by the pancreas, to help with digestion.

If you have had a part of your pancreas removed, immediately after the operation the remaining pancreas may not be able to produce enough enzymes to help with digestion, or enough insulin to control your blood sugar. You may need to have insulin given through a fine tube (cannula) inserted into a vein (intravenously). This is usually only until the remaining pancreas recovers and starts to produce insulin again. You may also need to take capsules containing digestive enzymes normally made by the pancreas.

Bypass surgery

Sometimes, surgery is carried out to treat a blockage in the first part of the small bowel (duodenum), if the blockage is causing vomiting. During the operation, a piece of the small bowel (the jejunum) is connected to the stomach, to bypass the duodenum. This is called a gastrojejunostomy. It is often done at the same time as a bile duct bypass.

Via: http://www.cancerbackup.org.uk

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