Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Cancer, Pancreas


Related Terms

  • Cancer of the Pancreas
  • Carcinoma of the Pancreas
  • Pancreatic Cancer

Differential Diagnosis

  • Cancer of another organ that has metastasized to the pancreas
  • Cancer of the bile duct
  • Harmless (benign) growth of the pancreas
  • Inflammation of the pancreas (pancreatitis)

Specialists

  • Endocrinologist
  • Gastroenterologist
  • General Surgeon
  • Oncologist
  • Radiology Oncologist

Comorbid Conditions

  • Digestive disorders (e.g., Crohn's disease or colitis)
  • Prolonged malnutrition
  • Systemic diseases such as diabetes

Factors Influencing Duration

Factors that may influence the length of disability include the site and stage of the tumor at initial diagnosis. For individuals with pancreaticoduodenectomy or Whipple procedure, duration depends on extent of resection. Disability may be permanent.

Medical Codes

ICD-9-CM:
157.0 - Neoplasm, Head of Pancreas, Malignant
157.1 - Neoplasm, Body of Pancreas, Malignant
157.2 - Neoplasm, Tail of Pancreas, Malignant
157.3 - Malignant Neoplasm of Pancreas; Pancreatic Duct; Duct Of: Santorini, Wirsung
157.4 - Malignant Neoplasm of Pancreas; Islets of Langerhans; Islets of Langerhans, Any Part of Pancreas
157.8 - Malignant Neoplasm of Pancreas; Other Specified Sites of Pancreas; Ectopic Pancreatic Tissue; Malignant Neoplasm of Contiguous or Overlapping Sites of Pancreas Whose Point of Origin Cannot be Determined
157.9 - Cancer, Pancreas, Part Unspecified

Overview

Cancer of the pancreas refers to uncontrolled growth of new cells within the pancreas, an elongated gland attached to the first portion of the small intestine (duodenum). The pancreas is subdivided into three anatomic regions (the head, body, and tail) and serves two major functions (digestion and the regulation of blood sugars). It produces secretions (enzymes) that empty into the small intestine, which aid in the digestion of food as it passes through the intestines. It also releases hormones (insulin, glucagon) directly into the circulatory system that help regulate the concentration of sugar in the bloodstream.

The pancreas is located behind the stomach and extends across and toward the back of the abdominal cavity. Because the pancreas lies behind many of the other abdominal organs, it cannot be felt during physical examination, and there are no blood tests to allow early detection in the asymptomatic individual. By the time an individual experiences symptoms, the cancer is often large and may have spread to other organs.

Incidence and Prevalence: The estimated mortality from pancreatic cancer in the US is 31,270 individuals per year. It is the fourth most common cause of cancer death ("What Are the Key Statistics").

Source: Medical Disability Advisor



Causation and Known Risk Factors

The cause of pancreatic cancer is unknown but there may be a relationship between inflammation of the pancreas (chronic pancreatitis), diabetes, and pancreatic cancer. Other risk factors may include age (most frequently diagnosed between 45 to 85 years), cigarette smoking, high fat or high caloric intake, eating meat, and exposure to industrial chemical carcinogens such as gasoline, beta naphthylamine, benzidine, dry-cleaning solvents, and substances used in the chemical coke and metal industries. Alcohol consumption and coffee drinking have not been conclusively associated with pancreatic cancer. There may be a genetic cause in up to 10% of pancreatic cancers, but this factor is not yet fully understood ("Can Pancreatic Cancer").

There is a slight male predominance, and blacks are affected more frequently than whites.

Source: Medical Disability Advisor



Diagnosis

History: The individual usually reports a vague pain in the upper region of the abdominal cavity that classically spreads through the back. Other symptoms can include rapid and marked weight loss; a yellow discoloration (jaundice) of the skin, whites of the eyes (sclera), and mucous membranes; persistent back pain that worsens while eating or lying down; weakness and loss of energy (asthenia); signs of low blood sugar (hypoglycemia) such as fatigue, shakiness, chills, headaches, and anxious feelings; loss of appetite (anorexia); difficulty digesting fatty foods; nausea and/or vomiting; constipation; light-colored stool; and dark-colored urine.

Physical exam: Examination of the abdomen may reveal abdominal extension due to an enlarged liver, upper abdominal mass, or enlarged gallbladder. Examination of the skin and whites of the eyes (sclera) may reveal jaundice. Lymph nodes may be enlarged.

Tests: There is no single specific test for detection of pancreatic cancer and diagnosis is most often determined by multiple tests. Computer-aided x-ray analysis (computed tomography or CT scan) is usually the first step and may be complemented by other tests using low-energy radio waves and strong magnets (MRI) or high-frequency sound waves (endoluminal ultrasonography or ultrasound) to visualize the tumor.

The pancreatic and bile ducts may also be visualized to determine if they are narrowed or obstructed by the tumor. This is done with a fiberoptic device (endoscope) passed through the mouth in ever-narrowing tubing (cannula) into the stomach, through the duodenum, and into the small intestine (endoscopic retrograde cholangiopancreatography or ERCP). This procedure serves two purposes: (1) the pancreatic cells floating in digestive juices can be removed for microscopic inspection and examined for their ability to secrete digestive juices (pancreatic function test), and (2) an opaque dye can be injected through the cannula into the pancreatic duct or bile duct (transhepatic cholangiography) allowing x-rays to show whether or not ducts have narrowed or are blocked. The pancreatic duct may also be visualized by injecting a contrast dye directly into a vein (intravenous cholangiography) and viewed radiographically.

A pancreatic tissue biopsy (percutaneous needle biopsy) may be taken with the aid of an x-ray device to examine deep structures (fluoroscope) and microscopically look for signs of cancer cells. Low levels of the digestive enzyme trypsin in pancreatic juice may indicate cancer of the pancreas. Blood tests for pancreatic cancer include those for carcinoembryonic antigen (CEA), pancreatic oncofetal antigen (POA), and carbohydrate antigen 19-9 (CA 19-9).

Source: Medical Disability Advisor



Treatment

Staging is carried out to determine how widespread the cancer is, and whether it has spread to other parts of the body. Based on the stage of pancreatic cancer, treatment usually requires an integrated approach involving surgery, radiation therapy, and chemotherapy. In general, surgery to cure the cancer is only possible in individuals whose tumor is localized to the head of the pancreas. This occurs in only 10% of cases. Removal of the tumor and head of the pancreas, duodenum, part of the stomach, common bile duct, and surrounding lymph nodes (pancreaticoduodenectomy or Whipple's procedure) may be done if the cancer has not spread into other organs (metastasis).

Pancreatic cancer in the tail or body of the organ usually presents as more advanced disease than cancer of the head of the pancreas. Surgery on these tumors is designed to reduce the discomfort of the disease (palliative treatment) but not to produce a cure. Partial or complete removal of the pancreas (pancreatectomy) along with various surgical bypass procedures that allow continued secretion of digestive juices into the intestine (cholecystoenterostomy or pancreaticojejunostomy) could be performed. These individuals will need insulin and/or a pancreatic enzyme supplementation depending on how much of the pancreas remains following surgery.

Radiation therapy may be used in addition to surgery or as the primary treatment for tumors that cannot be surgically treated. When radiation therapy is the primary treatment, it is most often used to relieve painful symptoms and make individuals more comfortable. In these cases, surgery may become necessary to alleviate jaundice or bowel obstructions caused by liver complications. Most clinical studies indicate that chemotherapy has little impact on survival or quality of life in individuals with pancreatic cancer. The compound gemcitabine (2',2'-difluorodeoxycytidine), however, improves pain control, weight gain, and survival times. This compound is now the drug of choice for treatment of advanced pancreatic cancer because it is tolerated well by most individuals. Pain control is a major concern for individuals with pancreatic cancer.

Source: Medical Disability Advisor



Prognosis

The predicted outcome for individuals with pancreatic cancer is very poor, with a 5-year cure rate of only 1% following diagnosis and after surgical treatment using the Whipple procedure. Individuals without surgery can only hope for a very short survival. Partial or total pancreatectomy causes digestive disorders such as poor absorption of fats (steatorrhea) and deficiency of various dietary nutrients (dietary deficiency syndrome). These conditions are usually compensated for with administration of pancreatic extracts. Weight loss is common. Pancreatectomy may also lead to diabetes that requires ongoing treatment with insulin and serious alteration of the individual's quality of life.

Chemotherapy or radiation treatment used in addition to surgery also diminishes the quality of survival. Numerous follow-up medical examinations are required for individuals surviving pancreatic cancer for any length of time.

Source: Medical Disability Advisor



Rehabilitation

Long-term rehabilitation is not a consideration for most individuals with pancreatic cancer as the condition is usually fatal. For those individuals who have had Whipple's procedure, intermittent positive pressure breathing exercises may be useful in preventing postoperative pulmonary complications. Certain exercises may also be performed to reduce postoperative pain and speed recovery including progressive relaxation and deep breathing techniques. This is especially valuable during the first 48 hours after surgery and may continue until recovery from surgery is complete and pain is no longer noticeable while walking or breathing.

If the individual receives chemotherapy, the therapist performs various techniques of range of motion exercises to address joint stiffness resulting from general inactivity and fatigue. This helps return joint mobility and also reduces pain resulting from a stiff joint (contractures). Stretching exercises consist of the therapist moving the affected limb with no effort initiated by the individual.

Supportive rehabilitation allows individuals to gain some control over the ordinary activities of life and helps them cope emotionally. Palliative rehabilitation allows individuals in advanced stages of the disease to achieve some level of physical comfort and provides emotional support and assistance in day-to-day functioning.

The frequency and duration of the rehabilitation program varies among individuals with pancreatic cancer. Intensity and progression of the exercise depend on the prognosis, if surgery was performed, if the individual is receiving any current cancer treatment, the extent of the disease, and the individual's overall health.

Source: Medical Disability Advisor



Complications

The pancreas is located close to a number of vital organs in the abdominal cavity including the liver, stomach, duodenum, small intestine, spleen, kidney, large intestine (colon), and lymph nodes. A pancreatic tumor often metastasizes into these organs directly or indirectly via the lymphatic or vascular systems, particularly if it continues to develop undetected and untreated. This usually leads to widespread cancer throughout the abdominal cavity and accumulation of fluid within the abdomen (ascites). If the cancer spreads via the vascular system, the most commonly affected organ is the liver followed by the lung and (less frequently) bone and brain.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

With few exceptions, individuals with pancreatic cancer will not return to work in any capacity. The rare individual who is cured of pancreatic cancer may require more sedentary work for a period of time because of weakness and fatigue following surgery, radiation therapy, or chemotherapy.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • How old is individual? Sex?
  • Does individual have risk factors such as cigarette smoking, high fat or high caloric intake, and meat eating? Chronic pancreatitis or diabetes?
  • Does individual have a history of exposure to industrial chemical carcinogens such as gasoline, beta naphthylamine, benzidine, dry-cleaning solvents, or substances used in the chemical coke and metal industries?
  • Does individual report vague pain in the upper abdomen that sometimes spreads around or through the back?
  • Has individual had recent, rapid and marked weight loss?
  • Does individual have jaundice of the skin, sclera, and mucous membranes? Persistent back pain that worsens while eating or lying down? Does individual have weakness and loss of energy? Anorexia, nausea and/or vomiting, constipation, light-colored stool, and dark-colored urine?
  • Are signs of hypoglycemia present such as fatigue, shakiness, chills, headaches, and anxious feelings?
  • On exam, does individual have abdominal distention? Liver or any masses palpable?
  • Was CT, MRI, ultrasound, or endoscopy done? Transhepatic cholangiography or intravenous cholangiography? Pancreatic tissue biopsy?
  • Does individual have low levels of the digestive enzyme trypsin in the pancreatic juice? Was individual's blood tested for carcinoembryonic antigen (CEA), pancreatic oncofetal antigen (POA), and carbohydrate antigen 19-9 (CA 19-9)?
  • Were conditions with similar symptoms ruled out?

Regarding treatment:

  • Has individual had surgery, radiation therapy, and chemotherapy?
  • Has the cancer metastasized? Was palliative surgery done?
  • Is it necessary to treat individual with insulin and/or pancreatic enzymes?

Regarding prognosis:

  • If individual returns to work, can employer accommodate any necessary restrictions?
  • Does individual have any conditions that may affect ability to recover?
  • Have any complications developed such as ascites or metastasis?

Source: Medical Disability Advisor



References

Cited

"Can Pancreatic Cancer Be Found Early?" American Cancer Society. Apr. 2004. 21 Dec. 2004 <http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_Can_pancreatic_cancer_be_found_early_34.asp?sitearea=>.

"What Are the Key Statistics About Pancreatic Cancer?" American Cancer Society. Apr. 2004. 21 Dec. 2004 <http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_pancreatic_cancer_34.asp?sitearea=>.

Source: Medical Disability Advisor






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