The early diagnosis of pancreatic cancer is difficult. Symptoms are often not specific until the disease is advanced. When a tumor of the pancreas is suspected, the evaluation should be systematic with the goals of clarifying the diagnosis, staging the disease accurately and directing therapy.
The early symptoms of pancreatic cancer are difficult to tell apart from common aches and pains that most of us experience. Symptoms include upper abdominal or back pain, bloating, poor appetite, nausea and weight loss. If the tumor blocks the bile duct then dark urine, light colored stools and jaundice (yellow skin and eyes) will occur. If you or your physician are concerned about these symptoms a medical history and examination as well a laboratory tests will be performed. These results will determine the remaining evaluation which may include ultrasound, CT or MRI scanning, endoscopic ultrasound and/or ERCP.
If you have already been diagnosed with pancreatic cancer the VCPI Pancreatic Cancer Team members will review all the existing medical information (x-rays, pathology and laboratory work). Occasionally, we will need to repeat one or more tests if important information is missing.
Our team meets regularly to review all new patients and to follow up on the progress of existing patients. The Tumor Conference attendees include representatives from - pancreatic surgery, medical oncology, gastroenterology, radiation oncology, pathology, radiology, genetic counseling, palliative care, cancer rehabilitation, research nursing and of course the nurse coordinators. All aspects of your needs and medical evaluation are considered, the treatment options reviewed and a treatment recommendations formulated. Because we often have 10 to 15 physicians and surgeons present, the discussions can be spirited. The end result is what we sometimes call “10 free second opinions” because the only consideration of the team members is developing the best recommendation for you.
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The diagnosis and staging of pancreatic cancer includes an assessment of the tumor, lymph nodes and the presence of distant spread. This is called the TNM staging system. Stage is important because it helps direct the treatment options and plan.
- T - tumor - the size and relationship to surrounding structures
- T1 means the size of the tumour in the pancreas is 2cm or less in any direction
- T2 means the tumour is more than 2cm across in any direction
- T3 means the cancer has started to grow into surrounding tissues around the pancreas, in the duodenum or the bile duct
- T4 means the cancer has grown further into the stomach, spleen, large bowel or nearby large blood vessels
- N - lymph nodes
- N0 - no lymph nodes containing cancer
- N1 means there are lymph nodes which contain cancer cells (cancer in the lymph nodes is a marker for a higher risk of distant spread)
- pN1a - cancer in a single nearby lymph node
- pN1b - cancer in more than one lymph node
- M - metastatic spread
- M0 - the cancer has not spread into distant organs such as the liver or lungs
- M1 - the cancer has spread to other organs
Stage I: The cancer is found in the pancreas only.
Stage IA:The tumor is 2 centimeters or smaller (T1, N0, M0).
Stage IB:The tumor is larger than 2 centimeters (T2, N0, M0).
Stage II
Stage IIA:Cancer has spread to nearby tissue and organs but has not spread to nearby lymph nodes (T3, N0, M0).
Stage IIB:Cancer has spread to nearby lymph nodes and may have spread to nearby tissue and organs (T1-3, N0, M0).
Stage III
In stage III, cancer has spread to the major blood vessels near the pancreas and may have spread to nearby lymph nodes (T4, any N, M0).
Stage IV
In stage IV, the cancer has spread to distant sites (peritoneum, liver, lung, lymph nodes outside the region of the tumor and others) (any T, any N, M1).
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