Pancreatic Cancer

• What is the pancreas?
• The pancreas is the secretory organ located at the back of the stomach and in front of the spine bones, which mainly produces the enzymes necessary for digestion and hormones that are effective in regulating blood sugar. It empties the enzymes, and it produces for digestion into the duodenum, the first part of the small intestine, through the pancreatic duct.
• Tumor and mass are formed as a result of the development and uncontrolled proliferation of abnormal cells in the pancreas. Some tumors can be benign. Malignant tumors are called cancer. Poor benign tumors can spread to other tissues and organs to grow out of control. Pancreatic cancer usually spreads to the liver, abdominal wall, lungs, bone and / or lymph nodes.

• What are the risk factors?
• Changes in our DNA and genetic code cause cancer. This situation can be hereditary or can be acquired over time as a result of exposure to harmful substances. Sometimes it can develop spontaneously. The exact cause of pancreatic cancer isn’t yet fully understood. Approximately 5-10 percent of patients are thought to be family-related. Most pancreatic cancers develop spontaneously or due to factors such as smoking, obesity and advanced age.
• If two or more numbers in your first-degree relatives develop pancreatic cancer,
• If a first-degree relative has developed pancreatic cancer before the age of 50,
• If you have a genetic syndrome associated with pancreatic cancer, you are at risk for pancreatic cancer.
• If you have any of these risk factors, you should seek genetic counseling and have your health monitored. Pancreatic cancer is seen more often in men and African-American or people with Ashkenazi ethnic backgrounds. Apart from these, the factors causing pancreatic cancer can be respectively related to long-term diabetes, patients with chronic and family medical history of pancreatitis, smoking, being over 60 years of age, obesity, red meet over consummation habits. It should not be inferred that anyone with these risks may develop pancreatic cancer. However, one or more of these risk factors are encountered in patients who develop pancreatic cancer.

• What are the specific symptoms?
• Pancreatic cancer can cause unclear and unexplained symptoms. Further examination for pancreatic cancer is recommended if you have one or more of the following symptoms:
• Abdomen or back pain.
• Weight loss
• Jaundice (yellowing of the skin and / or eyes and sometimes itching)
• Anorexia
• Nausea
• Change in stool
• Pancreatitis (Pancreatic inflammation)
• Sudden diabetes
• Sometimes weakness and depression

• How is it diagnosed?
• Pancreatic cancer is difficult to diagnose. The pancreas, which is located in a deep part of the abdomen, cannot be felt in physical examination. In addition, the symptoms are not very obvious and develop over time. Although many medical examinations are used in its diagnosis, there is no standard test. This situation makes the diagnosis more difficult. Pancreatic tumors can only be visualized by imaging methods such as computed tomography (CT), magnetic resonance (MR) or endoscopic ultrasonography.

• How is it treated?
• Pancreatic cancer treatment is determined according to the general condition of the patient and the stage of the disease. Although the most important treatment method is surgery, chemotherapy and radiation therapy are also used. Surgery is the best treatment option for the control of pancreatic cancer in the long term. However, usually the diagnosis can be made in the advanced stage of the disease. This makes it difficult to treat the disease. For this reason, it is of great importance to diagnose pancreatic cancer at an early stage.
• Success in the surgical treatment of pancreatic cancer requires advanced surgical technique and experience, and can be achieved through the coordinated work of a specialist and professional team. Treatment of hepatopancreatobiliary tumors is planned with a multidisciplinary approach. Physicians from hepatobiliary surgeons, medical oncologists, interventional radiologists, radiation oncologists, and diagnostic radiology are all a part of this multidisciplinary structure.

• The difference in pancreatic cancer treatment at Egepol Healthcare Group
• In Egepol Healthcare Group, the treatment plan in pancreatic cancer cases is created by our expert and experienced physician staff with a multidisciplinary approach. Surgical treatment of pancreatic cancer is performed in our hospital with laparoscopic (closed), hybrid (using closed and open surgery together) or open surgical techniques. The ability to apply different surgical methods is of great importance in determining the most appropriate treatment method for each patient.

• Volume factor
• Pancreatic cancer surgery; It is a major practice that requires advanced technique, experience and often the use of vascular (vascular) surgery. Many reports show that the number of operations performed annually in pancreatic cancer surgery is a very influential factor on patient survival. The generally accepted number of operations per year is 15 or more. Owing to the competence and high experience of our team, more than 75 pancreatic cancer surgeries are performed annually at Egepol Healthcare Group.

• ERAS Protocol
• In our hospital, ERAS (Enhanced Recovery After Surgery) protocol is applied in the surgical treatment of pancreatic cancer.  The ERAS Protocol, founded by Danish physician Prof. Dr. Henrik Kehlet at the end of the 1990s, is a term used to describe the concept of multi-modal, perioperative interventions applied to ensure faster healing of the patient after surgery. ERAS recommends changes to a patient's entire journey, which begins before surgery and ends at home. As a result of the data obtained since its inception, there is sufficient evidence that the protocol accelerates postoperative recovery and shortens the duration of hospital admission. In the meta - analyzes published in recent years, it was revealed that the hospital admission was shortened by 2-3 days and complications decreased by 30-50% owing to the ERAS Protocol application in major surgeries.

• Special approach for elderly patients
• The elderly population is increasing all over the world not only in Turkey. The prolongation of life expectancy brings along the necessity of surgical treatments at an advanced age. A special approach is required for elderly patients who need surgical treatment, especially in serious surgeries such as pancreatic cancer. Elderly patients treated in our hospital are well prepared for surgery. Surgical technique and postoperative care are taken into consideration, according to the sensitivity required. In our hospital, especially with the protocols specially prepared for the elderly patient group, aging is prevented from the obstacle of surgical treatment and successful results can be obtained.

• Close follow-up with telemedicine
• Following major surgical procedures such as pancreatic cancer, follow-up after discharge is also very important. Our patients who are discharged after pancreatic surgery in our hospital are contacted by telephone and video conference methods and mutually evaluated. Patients who are found to be at risk in their clinical condition are urgently invited to our hospital for further evaluation without waiting for the appointment date.

Assoc. Prof. Dr. İsmail SERT

General Surgery