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Pancreatic-Cancer-Sophie-Heriot versatile.pdf
1. NHSGGC Community Palliative Resource Nurse Network
NHSGGC Community Palliative Resource Nurse Network
Sophie Heriot
Clinical Nurse Specialist
West of Scotland Pancreatic Unit
Glasgow Royal infirmary
2. Objectives
What is pancreatic cancer?
What causes it?
How do we diagnose it?
How do we diagnose it?
What are the treatments?
What does the future look like?
3. Pancreatic Cancer
5th most common cause of Cancer death in Scotland
90% of patients are diagnosed too late for curative surgery
90% of patients are diagnosed too late for curative surgery
Average life expectancy following diagnosis is 4-6 months
4% 5 year survival rate following potentially curative
surgery (No significant change in the last 40 years)
4. Types of Pancreatic Tumours
Exocrine (95%)- PDAC is most common (80%)
Endocrine (5%)- eg. pNETs
IPMNs (pre-malignant)
IPMNs (pre-malignant)
Tumours arising from tissues close to the pancreas,
such as bile duct (Cholangiocarcinoma), Ampulla of
Vater (Ampullary Adenocarcinoma) may cause similar
symptoms to pancreatic cancer but have different
treatments and a different prognosis.
5. Aetiology
Exact cause is unknown
Tobacco smoking (approx 29% of cases)
Genetics
Genetics
Age
CP
Diabetes
Obesity
6. Alarming/Presenting symptoms
New onset diabetes
Nausea and vomiting
Abdominal pain/back pain
Indigestion/heartburn/bloating
Indigestion/heartburn/bloating
Steatorrhoea, diarrhoea
Unexplained weight loss
Jaundice
Symptoms can be vague and some patients may have none at all.
On average patients attend their GP 3-5 times prior to
referral.
7. Longer term symptoms
Exocrine insufficiency
Poorly controlled diabetes
Weight loss
Weight loss
Pain
Nausea/vomitting
Medication
Creon, nutritional supplements, analgesia, anti-
emetics
9. Diagnosis
Attend GP or local AE
CT
Referral to a specialist team
Referral to a specialist team
EUS and FNA
ERCP, stent and brushings
Combined EUS and ERCP
10. Pathway/Staging
Complex and lengthy pathway
Recovery from jaundice impacts staging
Cancer waiting times: 31 day target
62 day target
Additional investigations: MRI liver, CPET, occasionally PETCT
and possibly further fitness evaluation
Clasifications: A B C D E
15. CNS Role
Clinical nurse specialists improve efficiency, reduce
emergency admissions and improve the quality of
cancer care (CNO Bulletin 2010)
Support patients, families and carers throughout cancer
journey
Manage treatment side effects and/or symptom control
Provide nurse-led services that free up consultant resource
Manage individual patients cancer pathways
Facilitate rapid re-entry into acute services if appropriate
16. Research/Trials
BOC- Clinical trials
Understanding mechanisms that lead to tumour growth in
Understanding mechanisms that lead to tumour growth in
pancreatic cancer – University of Oxford
Identifying sub-types of pancreatic cancer and tailoring
effective treatments- Institute of Cancer Research
Finding the right treatment for the right patient in
pancreatic cancer – University of Glasgow
