Page 15 - MedicaWell No3

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medica well 15

• Chemotherapy and targeted treatment
• Radiotherapy

A combination of these treatments may be required for
some patients.

The first-line treatment is surgery, although not all
patients are operable. This is related with the tumor load
of the liver. If tumor load is very high in liver or if there is
more than one lesion and the remaining hepatic tissue is
not sufficient for the patient, surgical treatment is
contraindicated. Volume of liver is measured on a CT
scan. First, the portal vein is embolized at the side of the
liver to be resected and thus, the hepatic lobe that will puted tomography, positron emission tomography,
not be resected in enlarged in 4 to 6 weeks. Next, ultrasound and endoscopic ultrasound (EUS), ERCP,
surgery is carried out and postoperative hepatic failure laparoscopy and biopsy methods are used for the diag-
is prevented. Chemotherapy and specific drugs are ther- nosis.
apeutic options for the group of inoperable patients.
Radio-embolization is reserved for metastatic lesions. In How is it treated?
radioembolization method, microspheres (20 to 50 For pancreatic cancer, treatment modalities include
microns in size) labeled with radioactive substance are surgery, chemotherapy and radiotherapy and they
directly instilled into the feeding artery of liver and thus, require multidisciplinary approach. If the tumor is opera-
treatment is applied. ble, surgery is the most efficacious modality. Whipple
surgery is performed for tumors that involve the head of
What to expect after treatment? the pancreas (pancreatic head, duodenum, gallbladder
After the treatment is completed, patients should and bile duct as well as peripheral lymph nodes are
necessarily be followed up at certain intervals. Liver and excised), while distal pancreatectomy is the surgical
intra-abdominal organs are imaged using ultrasound, method preferred for tumors that are located in corpus
computed tomography or magnetic resonance imaging and tail of the pancreas (middle segment and the tail of
to check the post-operative course in the follow-up. the pancreas, spleen and peripheral lymph nodes are
Cancers usually relapse within two to three years. For excised). If venous involvement (portal vein, splenic vein)
In Hepatopancreatobiliary (Liver, Pancreas and Gall • Pain originating from right upper abdominal quadrant recurrences, a new treatment method is decided consid- is identified in locally advanced tumors, the involved
vein is also resected. The patient can be started on
Bladder Surgery) Clinic of Liv Hospital, all diseases of and refers to the back ering the stage of the relapsed cancer. chemotherapy to prevent postoperative recurrence of
liver, gall bladder and pancreas are treated by specialist • Fever the cancer. For locally advanced pancreatic cancers,
physicians with multidisciplinary approach. Diseases of PANCREATIC CANCER treatment options are chemotherapy and radiotherapy
gall bladder and bile ducts, liver and pancreas tumors as How is it diagnosed? combined with chemotherapy. Sometimes, these treat-
well as hepatic metastases are managed with ERCP, The first step of diagnosis is a physical examination by What are the symptoms? ments are used to shrink the tumor into an operable
laparoscopic method, open surgery and robotic surgery physician. This examination focuses on intra-abdominal Pancreatic cancers become symptomatic at very late size. One of the standard treatments for advanced stage
by ensuring patient’s comfort. organomegalies, such as hepatomegaly and splenomeg- stages. However, some alarming signs emerge before pancreatic cancers is chemotherapy.
aly, fluid collection in abdominal cavity – also referred to the cancer is diagnosed.
In Hepatopancreatobiliary (Liver, Pancreas and Gall as ascites, and yellowing of skin and eyes. Blood tests Jaundice: Sudden-onset jaundice is a sign of bile duct What to expect after treatment?
Bladder Surgery) Clinic of Liv Hospital, where experi- may reveal out hepatic dysfunctions. Imaging modalities obstruction. When this symptom develops, bile ducts Patients face less postoperative problems, if the disease
enced specialists are employed, the patients can engage such as ultrasound, computed tomography and MRI may should necessarily be evaluated with imaging methods is diagnosed and treated in the early stage. Chemother-
daily life activities within the shortest time possible be necessary. Moreover, tissue specimens may be (Ultrasound, computed tomography or MRI). apy or radiotherapy is planned depending on the stage
thanks to robotic surgery, which represent the future of collected from the liver for testing. A tissue specimen is Weight loss: Unintended weight loss in a short period is of the disease. In this period, the body tries to adapt to
the surgery, and the risks of infection and bleeding are collected from the liver during the biopsy and this speci- a finding that should be investigated.Diabetes mellitus: the surgery. Occasionally, complaints of abdominal pain,
minimized comparing to the conventional surgeries. men is examined under microscope. If cancer is diag- Diagnosis of diabetes mellitus may be an early sign, if constipation and dyspepsia can be experienced. The
nosed, the condition is staged to understand the extent family history is unremarkable for diabetes.
LIVER CANSER of the spread and to decide the treatment method. Stag- Steatorrhea (Fatty Stool): Many patients may experience doctor may prescribe additional medicines to manage
those complaints. Nutritional disorder is one of the
ing is not only based on computed tomography and changes in bowel habits secondary to the insufficiency important problems. If nutrition is insufficient, food
What are the symptoms? magnetic resonance imaging, but it is also determined of pancreatic enzymes. Patients generally neglect this supplements or nutrition solutions may be required. If
• Abdominal distension, with laparoscopic exploration under general anesthesia. finding, but workup is necessary if diarrhea persists for a the patient cannot tolerate oral nutrition, the patient
• Yellow discoloration of skin. long time. can be given intravenous fluid support. Nutrition
• Itching How is it treated? requires extra attention for patients who need addition-
• Sudden weight loss There are various treatment methods for liver cancers. How is it diagnosed? al treatment (chemotherapy).
• Loss of appetite persisting for weeks Treatment plan should consider the stage of the cancer Since symptoms of pancreas cancer are very similar to
• Postprandial fullness and flatulence even if patient and whether the rest of the liver is intact. Primary treat- symptoms of many other diseases, they are not taken as
eats a little ment options for the liver cancer are as follows: seriously as they should be. Diagnosis is generally made
• Nocturnal sweating • Surgical intervention (partial hepatectomy or liver with various tests and detailed examination and imaging
• Sudden-onset worsening of overall health transplant) of the pancreas and the peripancreatic region. Blood
• Dark discoloration of urine and light or clay-colored • Regional therapies like ablation or embolization test, tissue analysis, magnetic resonance imaging, com-
stool