Almeda, 84, has a history of pancreatic cancer. She has recently undergone a Whipple procedure and is experiencing ongoing nausea and occasional vomiting. After trying several times to advance to a diet by mouth she has been unable to do so. Almeda was offered a transfer to a long-term care facility, but she prefers to live at home.
Unfortunately, Almeda does not have any family members living close by. She does not have any children, and she has outlived her husband by 30 years. She laughs when asked why she did not remarry.
Almeda has two cherished cats that are currently staying with a friend. Almeda credits her cats with the fact that she is still alive. She understands that she probably only has about another year to live, and she wants to spend it at home with her beloved cats.
What is pancreatic cancer?
The pancreas is a gland that produces insulin and glucagon, and digestive enzymes. Most pancreatic cancers arise from exocrine cells, which produce the digestive enzymes your body uses to digest proteins, fats, and carbohydrates. These cancers are referred to as adenocarcinomas. Endocrine cells in the pancreas produce the hormones insulin and glucagon, which control blood sugar.
Despite its rarity, pancreatic cancer is the third leading cause of cancer deaths in the United States. The high mortality rate is primarily due to delayed diagnosis. In 2021, an estimated 60,430 Americans will be diagnosed with pancreatic cancer, with 48,220 dying from their disease. The five-year survival rate is 10.8%.
Unfortunately, the symptoms associated with pancreatic cancer are nonspecific and may include:
- unexpected and unexplained weight loss
- sudden onset of type 2 diabetes
- upper abdominal pain
Jaundice, a yellowish discoloration of the skin and whites of the eyes, affects about one-third of people with pancreatic cancer. This is because bilirubin, a byproduct of red blood cell breakdown, can accumulate when cancer blocks its release from the liver to the small intestine.
What are the risk factors for pancreatic cancer?
Some risk factors for pancreatic cancer are modifiable. The rest you have no control over. Smoking, being overweight, having type 2 diabetes, and having chronic pancreatitis are all modifiable risk factors.
- Smoking: Smokers have twice the risk of developing pancreatic cancer as non-smokers.
- Obesity: Those who are obese have a 20% higher risk of developing pancreatic cancer.
- Diabetes: Having type 2 diabetes increases the risk of developing pancreatic cancer.
- Chronic pancreatitis: Chronic pancreatitis is found much more often in smokers or heavy alcohol users.
Non-modifiable risk factors for pancreatic cancer:
- Age: The incidence of pancreatic cancer increases with age.
- Gender: Men are more likely to develop pancreatic cancer than women.
- Race: The incidence of pancreatic cancer is higher in African Americans than in whites.
- Family history: There is a link between some inherited gene changes and pancreatic cancer.
What is the lifespan of someone with pancreatic cancer?
The peak incidence of newly diagnosed pancreatic cancer is between the ages of 70 and 79 years. With an estimated 70% of pancreatic cancers diagnosed in those over age 65, it is predominantly a disease of older adults. The median age of death for adults with pancreatic cancer in the U.S. is 72 years.
Pancreatic cancer is rare compared to other types of cancer. It accounts for about 3.2% of all cancers.
Survival rates are calculated by looking at how long people with the same type and stage of cancer survived. These figures are only estimates. Each person with cancer has unique circumstances which can affect their predicted lifespan.
Cancer survival data comes from the SEER database, which is maintained by the National Cancer Institute. Based on their findings, the five-year survival rates for someone who has
- Localized pancreatic cancer is 41.6%
- Regionally spread pancreatic cancer is 14.4%
- Distantly spread or metastasized cancer is 3%
The overall five-year survival rate for pancreatic cancer is 10%. The average life expectancy for someone with pancreatic cancer is 3 to 3.5 years.
How fast does pancreatic cancer go from stage 1 to 4?
The stage of cancer describes how far it has spread in the body. This information is used to describe the amount of cancer in the body and make treatment decisions.
The cancer is confined to the top layer of cells and has not invaded the deeper tissue.
Cancer has not spread to lymph nodes or distant sites.
- 1A: Cancer is confined to the pancreas and is no bigger than 2 cm across.
- 1B: Cancer is confined to the pancreas and is larger than 2 cm in size but no more than 4 cm in size.
Cancer has increased in size or spread to lymph nodes
- IIA: Cancer is confined to the pancreas and is bigger than 4 cm in size but has not spread to any lymph nodes.
- IIB: Cancer is confined to the pancreas and is no bigger than 2 cm, between 2 cm and 4 cm, or bigger than 4 cm, and it has spread to no more than 3 lymph nodes.
Cancer has spread more locally or has spread outside of the pancreas.
- The cancer is confined to the pancreas and is no bigger than 2 cm, between 2 cm and 4 cm, or bigger than 4cm, and it has spread to 4 or more nearby lymph nodes.
- The cancer has spread outside of the pancreas and into nearby blood vessels. It may have spread to nearby blood vessels but has not spread to distant sites.
Cancer has spread to distant sites such as the liver, the abdominal cavity lining, the lungs, or the bones.
Once pancreatic cancer has been diagnosed, it spreads rapidly. Researchers have estimated that the time it takes for pancreatic cancer to progress from stage 1 to stage 4 is just over a year.
What are the symptoms of end-stage pancreatic cancer?
The symptoms of end-stage pancreatic cancer may include:
- Pain in the right upper quadrant of the abdomen that extends to the back
- Weight loss
- Loss of appetite
- Abdominal bloating
- Breathing pattern changes
- Jaundice or paleness
- Speaking less
When these symptoms develop or any others, let your doctor know. Comfort care, pain control, and hospice care can all help your loved one feel more at ease.
Almeda plans to schedule weekly home nursing visits to assess her condition and provide medical assistance as needed. In addition, home nursing can contact hospice for care when Almeda feels it is appropriate.
What is a Whipple Procedure?
A Whipple procedure is a series of different procedures that are all done in the same surgery. The surgery takes about four to six hours and requires a hospital stay of seven to ten days. The Whipple procedure involves removing the:
- Head of the pancreas
- Bile duct (section)
- Small intestine (section)
- Stomach (a small part)
After these organs are removed, the remainder of the stomach, tail of the pancreas, and bile duct are attached to the small intestine.
Almeda had pancreatic cancer in the head of the pancreas and therefore was a suitable candidate for this procedure. Complications of the procedure include:
- Delayed stomach emptying
- Leakage from the pancreatic or bile duct
Almeda has had delayed stomach emptying resulting in constant nausea and occasional vomiting. She was discharged from the hospital with instructions for home total parenteral nutrition. She will receive her nutrition through an intravenous line in her neck to allow her stomach to heal.
Almeda is also receiving physical therapy in her home. Her goal is to regain her strength so she can continue to live independently.
Is pancreatic cancer painful in the end?
Pancreatic cancer can be painful. Cancer cells can spread outside the pancreas and press on the nerves surrounding it causing pain in the upper abdomen or back. Pain medications are available to treat pain, however, they work best if they are used at the start of pain and regularly thereafter.
How can home healthcare help you manage post-operative complications from pancreatic cancer surgery?
Almeda remained on TPN to meet her nutritional needs for nine days. After she was finished with TPN and able to eat normally, Almeda requested that the nurse come by weekly to perform a wellness check. Following this appointment, Almeda’s Sunland nurse spoke with her healthcare providers, facilitating any needed changes or referrals.
Almeda also requested in-home services three times weekly for help with personal care, meal preparation, and housekeeping.
Sunland Home Care and Medical can:
- Administer medications
- Assess nutritional status
- Answer questions about pancreatic cancer and nutrition
- Reduce the need for rehospitalization
- Develop an action plan
- Do light housekeeping
- Provide transportation to medical appointments
- Prepare meals
- Assist with personal care