About Pancreatic Cancer
Multiple factors, including a complex and poorly understood pathophysiology and difficulty in early detection and diagnosis make successful treatment of pancreatic cancer extremely challenging.
Pancreatic cancer is typically not detected until it has already reached a locally advanced or metastatic stage due to the relative lack of symptoms in early disease. Current standard of care comprises surgery if the tumor is contained within the pancreas, followed by adjuvant chemotherapy and possibly radiation.
However, if the cancer has spread, conventional treatment is limited, and long-term survival rates remain very low. The rapidly accelerating use of specialized immunotherapies represent the next generation of novel medical treatment for pancreatic cancer.
- Jaundice (yellowing of the skin and whites of the eyes) due to blockage of the bile duct or liver malfunction.
- A gnawing pain from the stomach to the back.
- Unexplained weight loss.
- Fatigue, weakness, dark urine, light stools, and anorexia.
Poor survival in pancreatic cancer is due not to early spread but to late diagnosis. Early diagnosis of this cancer is rare because symptoms develop gradually and cancer is often present for many months or even years before diagnosis.
Physicians use a range of imaging techniques to confirm the diagnosis. Techniques used to diagnose pancreatic cancer include ultrasound, computerized tomography (CT) scans, magnetic resonance imaging (MRI) and, sometimes, positron emission tomography (PET) scan.
Treatment options for patients with metastatic pancreatic cancer depend heavily on a patient’s overall health and preferences. First-line options include:
- Surgery: Laparoscopy. During this surgery, the surgeon can find out if the cancer has spread to other parts of the abdomen. If it has, surgery to remove the primary tumor is generally not recommended.
- Surgery to remove the tumor: Different types of surgery are used depending on where the tumor is located in the pancreas. If the cancer is located only in the head of the pancreas, the surgeon may do a Whipple procedure. If the cancer is located in the tail of the pancreas, the common operation is a distal pancreatectomy. If the cancer has spread throughout the pancreas or is located in many areas in the pancreas, a total pancreatectomy may be needed. Side effects of surgery include weakness, tiredness, and pain for the first few days after the procedure. Other side effects caused by the removal of the pancreas include difficulty digesting food and diabetes from the loss of insulin produced by the pancreas.
- Radiation therapy: External-beam radiation therapy is the type of radiation therapy used most often for pancreatic cancer. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. There are different ways that radiation therapy can be given: Traditional radiation therapy is made up of daily treatments of lower doses of radiation per fraction or day. It is given over 5 to 6 weeks in total. Shorter treatments of higher doses of radiation therapy given over as few as five days is called stereotactic body radiation (SBRT) or Cyberknife. Proton beam therapy is a type of external-beam radiation therapy that uses protons rather than x-rays.
- Chemotherapy: Often, chemotherapy will be given at the same time as radiation therapy because it can enhance the effects of the radiation therapy, which is called radiosensitization. Combining chemotherapy and radiation therapy may occasionally help shrink the tumor enough so it can be removed by surgery.