How Is The Stage Determined
The staging system used most often for pancreatic cancer is the AJCC TNM system, which is based on 3 key pieces of information:
- The extent of the tumor : How large is the tumor and has it grown outside the pancreas into nearby blood vessels?
- The spread to nearby lymph nodes: Has the cancer spread to nearby lymph nodes? If so, how many of the lymph nodes have cancer?
- The spread to distant sites : Has the cancer spread to distant lymph nodes or distant organs such as the liver, peritoneum , lungs or bones?
The system described below is the most recent AJCC system, effective January 2018. It is used to stage most pancreatic cancers except for well-differentiated pancreatic neuroendocrine tumors , which have their own staging system.
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a persons T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage.
Cancer staging can be complex. If you have any questions about your stage, please ask your doctor to explain it to you in a way you understand.
A Number Of Physical Changes Are Common When The Patient Is Near Death
Certain physical changes may occur in the patient at the end of life:
- The patient may feel tired or weak.
- The patient may pass less urine and it may be dark in color.
- The patients hands and feet may become blotchy, cold, or blue. Caregivers can use blankets to keep the patient warm. Electric blankets or heating pads should not be used.
- The heart rate may go up or down and become irregular.
- Blood pressure usually goes down.
- Breathing may become irregular, with very shallow breathing, short periods of not breathing, or deep, rapid breathing.
However, these signs and changes don’t always occur in everyone. For this reason, it may be hard to know when a patient is near death.
What Are The End
The following are some of the most typical indications of pancreatic cancers end-of-life. As the end of life approaches, all or some of the following indications may be present. We recommend that you contact oasis hospice if your loved one exhibits any of the following symptoms:
- Withdrawal and/or less frequent communication.
Tips for coping with pancreatic cancer symptoms near the end of life.
As a family caregiver, you may actually do a lot to assist your loved one in managing the signs and symptoms of terminal pancreatic cancer. For example, if the patient is in pain, anxious, or restless, you can assist them by delivering medication that will ease some of their symptoms. Additionally, you may assist by being present for your loved ones and being available to them if they have questions or simply like to speak. At times, simply being present is sufficient. What is pancreatic cancer hospice time to live?
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Eating And Drinking Less
It is natural for people to stop eating and drinking in the last days of life. You can help your family member stay comfortable by giving them sips of water or small pieces of ice to suck, to keep their mouth moist. If theyre not awake, the GP or nurse can give you swabs to keep their mouth and lips clean and comfortable. Lip balm or moisturisers can help stop their lips and mouth getting dry.
Discussions About Living And Dying
When APC is diagnosed, most patients and families have an immediate concern about prognosis, whether or not they have the courage to ask the question directly. As oncologists, it is our ethical and legal duty to inform a patient that APC is incurable, although this and any additional news is best delivered in the setting of an empathic, thoughtful dialogue. Any discussion about survival should begin with the provider asking what kind of information the patient and family are able to hear at that visit honoring these requests for the individual patient facilitates trust. A discussion about potential chemotherapy for APC might include relevant published survival data, but should focus on any known palliative benefit-specifically the likelihood of preventing a decline in quality of life due to symptoms of the disease. A learned skill for most physicians, effective communication improves many aspects of a patients care, reflected in part by improved patient satisfaction.
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End Of Life And Professional Care
We talked to people who had lost a loved one to pancreatic cancer, about what happened when they were dying. They told us about where they had died and the care they had from professionals.
You might wonder what to expect as you reach the end of life. The dying process is different for everyone. You may experience a range of different symptoms and increased pain. Palliative care will be available to help keep your symptoms, like pain, under control.
Better Prognosis For Resectable Tumors
Patients whose tumors are found before they have metastasized or become locally advanced tend to have longer survival rates, on average, because their tumors can usually be resected .
About 15 to 20 percent of all pancreatic tumors are resectable. These include stage I and stage II tumors. Rarely, locally advanced stage III tumors, which are typically considered unresectable , are characterized as borderline and may be removed if the patient has access to an experienced, highly trained surgeon.
Tumors can still grow back in many patients. So, on average, patients whose tumors were resected live for 2.5 years after their diagnosis and have a five-year survival rate of 20 to 30 percent.
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Treating Pancreatic Cancer Based On Extent Of The Cancer
This information is about treating exocrine pancreatic cancer, the most common type of pancreatic cancer. See Pancreatic Neuroendocrine Tumor for information about how that type is typically treated.
Most of the time, pancreatic cancer is treated based on its stage how far it has spread in the body. But other factors, such as your overall health, can also affect treatment options. Talk to your doctor if you have any questions about the treatment plan they recommend.
It can be hard to stage pancreatic cancer accurately using imaging tests. Doctors do their best to figure out before treatment if there is a good chance the cancer is resectable that is, if it can be removed completely. But sometimes cancers turn out to have spread farther than was first thought.
Pancreatic Cancer Survival Rates
Pancreatic cancer survival rates are based on groups, but you are an individualand every patients situation is unique. The National Cancer Institutes Surveillance, Epidemiology, and End Results Program tracks five-year survival rates for all types of cancer based on data from previous patients and sometimes older treatments.
Based on people diagnosed with prostate cancer between 2011 and 2017, SEER data shows:
- Localized prostate cancer that is contained within the pancreas has a five-year relative survival rate of 41.6 percent.
- Regional cancer that has spread from the pancreas into nearby parts of the body, such as the lymph nodes, has a five-year relative survival rate of 14.4 percent.
- Distant cancer that has spread to farther parts of the body, such as the liver or lungs, has a five-year relative survival rate of 3 percent.
- The overall five-year relative survival rate for pancreatic cancer is 10.8 percent.
Its important to remember that survival rates are constantly improving, so patients diagnosed now typically have better outcomes than those diagnosed in the past.
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Survival Rates: What To Know
Because doctors rarely find pancreatic cancer in its early stages when its easiest to treat, its one of the most deadly cancers. About 9% of people with pancreatic cancer live at least 5 years after diagnosis. But the 5-year survival rate is much better — 34% — if it hasnt spread past the pancreas. Know that survival rates cant predict what will happen to any single person and may not reflect newer types of treatment.
The Marie Curie Nurses And A Doctor Specialising In Palliative Care Looked After Hughs Mother
Were you actually with her when she died?
Several people wished they had got in touch with palliative care nurses earlier. John and his wife, for example, had assumed things were not bad enough and put off seeking their help. Similarly, Simon regretted not getting the GP and the specialist palliative care nurses involved earlier. But when his wife Karen was dying, he contacted the local palliative care team.
The nurses supported both him and his wife. They called frequently during the day and sometimes at night. Sometimes they stayed in the house for two to three hours. As Karen became more frail she moved from the upstairs bedroom downstairs into the front room. The nurses managed to get a hospital bed with an electronic lifting mechanism to make nursing easier. As death approached Karen was sometimes unconscious, but when she noticed her surroundings she was glad to have members of the family by her bed. Karen died peacefully. After she died Simon and his daughters spent some time with her.
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Complementary Therapies To Help Deal With Symptoms
Some people find that complementary therapies can help with symptoms. These therapies can help you to relax and feel better, although they cant treat the cancer.
Always tell your healthcare team before starting a complementary therapy, as some may affect your treatment. And tell your complementary therapist about any treatments you are having.
- Massage may help you relax, reduce pain and help you feel better generally. Check with your doctor or nurse if it is safe for you to have a massage. You shouldnt have massage on any areas where you have any broken skin, or if the massage is making your pain any worse. If you have problems with bleeding you should avoid deep tissue massage.
- Reiki is a gentler type of massage where the therapists hands gently brush over the body, or a few inches above the body.
- Reflexology or relaxation therapies may help relieve symptoms such as pain.
- Other therapies that you may find helpful include art therapy, music therapy and pet therapy.
Some hospices, hospitals and charities offer complementary therapies. Your doctor or nurse can tell you what is available in your area. The Complementary and Natural Healthcare Council have a list of registered therapists.
What Is Palliative Care
It is likely that you have heard the term palliative care in relation to your treatment. Palliative care is different to end of life care. It is providing the treatment you need to manage your symptoms and give you the best possible quality of life. Palliative care acknowledges that death is a part of life and a natural process. It does not aim to speed up or slow down your death, instead it acts to support you and the people who care about you throughout your disease.
Palliative care can be provided wherever you are and by a number of different professionals. Some doctors and nurses specialise in palliative care, whereas for people like your GP or any carers you may have it is part of their everyday job.
You can have palliative care alongside other treatments and with your current medical team. Palliative care aims to support you with any physical, emotional, social, relationship issues that arise over the course of your illness.
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Palliative Care And End
Nizar Bhulani1, Arjun Gupta2, Ang Gao1,3, Jenny Li2, Chad Guenther2, Chul Ahn1,3, Elizabeth Paulk2, Stephanie Houck2, Muhammad S. Beg1,2
1Harold Simmons Comprehensive Cancer Center, UT Southwestern Medical Center , USA
Contributions: Conception and design: N Bhulani, MS Beg Administrative support: MS Beg Provision of study materials or patients: N Bhulani, MS Beg Collection and assembly of data: N Bhulani, A Gao, C Ahn, MS Beg Data analysis and interpretation: A Gupta, A Gao, J Li, C Guenther, C Ahn, E Paulk, S Houck Manuscript writing: All authors Final approval of manuscript: All authors.
Correspondence to:
Background: Palliative care has been associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients.
Methods: Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results -Medicare linked database between 2000 and 2009. Trend of palliative care use was studied. Emergency room/intensive care unit utilization and costs in the last 30 days of life were compared between both groups using propensity score-matched analysis.
Keywords: Palliative care end-of-life intensive care unit emergency room cost of care pancreatic cancer
Submitted Jan 24, 2018. Accepted for publication Mar 01, 2018.
doi: 10.21037/jgo.2018.03.08
What Is The Pancreas
The pancreas is a small, hockey stick-shaped gland located behind the stomach. The main jobs of the pancreas are to aid in food digestion and regulate blood sugar levels in the body. The pancreas is involved in maintaining blood sugar levels because it makes insulin and glucagon, two hormones that control blood sugar levels.
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Bladder And Bowel Incontinence
As people near the end of life, their muscles relax. Some medications also have the effect of relaxing your muscles and this can cause incontinence of both urine and faeces. It is natural to feel embarrassed about the idea of this happening to you and lots of people dont want to think too hard about this. However, continence aids can be used to make the situation easier. If you have nurses or carers around you, they will be understanding and can reassure you that it is natural. If you are being looked after by family and friends, it may be important to consider if they are able to manage this and if you would want them to.
Some people also have issues passing urine and holding their urine . Then it may be appropriate to fit a catheter to make sure that you are passing urine and to prevent any pain or discomfort.
Potentially Curable If Caught Very Early
Despite the overall poor prognosis and the fact that the disease is mostly incurable, pancreatic cancer has the potential to be curable if caught very early. Up to 10 percent of patients who receive an early diagnosis become disease-free after treatment. For patients who are diagnosed before the tumor grows much or spreads, the average pancreatic cancer survival time is 3 to 3.5 years.
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Borderline Resectable Pancreatic Cancer
Depending on the location of stage 2A, stage 2B and stage 3 pancreatic cancers, treatment often involves resection in combination with neoadjuvant treatment to shrink the tumor before surgery takes place. Borderline resectable pancreatic cancer has grown into nearby tissues, organs or a major blood vessel. Although it may be possible to remove the tumor, surgeons may not be able to extract all of the cancer via surgery. Adjuvant treatment via chemotherapy or radiation may be performed after surgery to help destroy remaining cancer cells.
Confusion Restlessness Or Agitation
Sometimes a person may become confused, restless or agitated. Your loved one may not know where they are or who is with them. Or they may fidget, or want to move about even if theyre not able to. You may want to reassure them by reminding them of who you are and what is going on around them.
They may describe speaking to someone who has died or they may see things that arent there. If theyre not upset, its fine to talk to them about what they can see or hear. Some people may be frightened staying near them, gently touching them and reassuring them may help. A calm room with quiet music and familiar items like photos nearby can also help.
It can be upsetting for you if your family member is confused or agitated. There could be different reasons for why it is happening, so speak to the doctor or nurse. They will look for anything that is causing it, like pain, problems with their bladder or bowels, or issues with their medicines. They may recommend giving medicine to relax and calm them. Or they may suggest putting in a catheter . This will stop the bladder getting full and causing discomfort. If you are worried that your family member may be in pain, the doctor or nurse can help with this.
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What Happens If You’ve Been Told Your Cancer Cannot Be Cured
If you have advanced pancreatic cancer it might be very hard to treat. It may not be possible to cure the cancer.
If this is the case, the aim of your treatment will be to limit the cancer and its symptoms, and help you live longer.
Finding out the cancer cannot be cured can be very hard news to take in.
You will be referred to a special team of doctors and nurses called the palliative care team or symptom control team.
They will work with you to help manage your symptoms and make you feel more comfortable.
The clinical nurse specialist or palliative care team can also help you and your loved ones get any support you need.
Feeling Too Hot Or Cold
As the body struggles to regulate its own temperature you may feel very warm or cold. This can be relieved through interventions the family can do such as opening windows or closing them, taking blankets on and off or using a fan in the room. Some medications such as paracetamol can also help to lower your temperature.
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