Pancreatic cancer secondary prevention

Secondary prevention of pancreatic cancer involves proper diet based on American Cancer Society (ACS) guidelines and palliative therapy for patients. Malabsorption may arise when pancreatic duct obstruction leads to exocrine pancreatic insufficiency. The diet proposed for pancreatic cancer patients is based on ACS guidelines and advocates administration of pancreatic enzyme replacement therapy, avoidance of high-protein/high-fat diets, individualized dietary prescriptions from a registered dietitian and dietary supplementation with omega-3 fatty acids. Palliative therapy is considered as an important part of secondary prevention and includes adequate analgesia, treatment of jaundice and duodenal obstruction, arising as complications of surgery.

Diet supplementation is an important component in the management of patients after pancreatic surgery due to the development of exocrine pancreatic insufficiency:^{[1][2][3][4][5][6][7][8][9][10][11][12][13]}

• Exocrine pancreatic insufficiency due to pancreatic duct obstruction by the tumor may lead to malabsorption.
• Malabsorption in patients presents with anorexia, weight loss, and diarrhea.
• The diet proposed for pancreatic cancer patients is based on American Cancer Society (ACS) guidelines
  • Pancreatic enzyme replacement therapy
  • Avoidance of high-protein/high-fat diet
  • Individualized dietary prescriptions from a registered dietitian
  • Supplementation with omega-3 fatty acids

Palliative therapy in patients with pancreatic cancer mainly involves the management of symptoms arising as a result of complications of surgery or chemoradiation therapy:^{[14][15][16][17][18][19][20]}

• There are various techniques for pain management as palliative therapy in patients with advanced stage of pancreatic cancer:
  • Narcotic analgesics
  • Narcotic analgesics+ tricyclic antidepressants/ antiemetics
  • Radiation therapy

• Surgical techniques used to treat pain in advanced pancreatic cancer cases include:
  • Endoscopic decompression with stent placement in patients with biliary or pancreatic duct obstruction
  • Neurolysis of the celiac ganglia by many approaches:
    • Intraoperative
    • Transgastric
    • Transthoracic
    • Transabdominal

• Obstructive jaundice can present with features of cholangitis:
  • Fever and chills
  • Nausea, vomiting
  • Clay-colored stools
  • Dark urine
  • Yellowish discoloration of skin
  • Pruritus
  • Right upper quadrant pain
  • Anorexia
• Preferred treatment in patients: Endoscopic decompression with stent placement in patients with biliary obstruction.
• Techniques of biliary decompression:
  • Cholecystojejunostomy
  • Choledochojejunostomy

• Types of stents:
  • Metal- costly, longer lifespan
  • Plastic- cheaper, need replacement every three months

• Preferred treatment:
  • Endoscopic stenting of duodenal obstruction
  • Gastrojejunostomy