Pancreatic Cancer Treatment

What is pancreatic cancer?

Pancreatic cancer is a malignant tumor of the pancreas. Each year approximately 37,000 new cases of pancreatic cancer are diagnosed in the United States and about 60,000 in Europe. Survival is directly proportional to the stage when diagnosed. The most common type of cancer of the pancreas is an adenocarcinoma of the pancreas (>90%). Although it is the 4th leading cause of cancer deaths in men and women in the United States, survival is getting better everyday. Almost 30-40% of the patients have disease confined to the pancreas. The key is to find an experienced surgeon who can completely resect (remove) the cancer. This is the key to success. There is growing evidence to suggest that post-op chemotherapy improves long term survival and is slowly becoming the norm.

Gold Standards for the treatment of pancreatic cancer

• If it is removable, then remove it (resect it)
  
• If it is not removable, then give chemotherapy and then reassess. If it becomes removable and there is no progression, then remove it
  
• If there is disseminated disease, then give chemotherapy. There are several protocols for chemotherapy and finding the right one for you requires working with your medical oncologist closely. If conventional chemotherapy fails and your general condition allows, then considering a trial chemotherapeutic drug may prove very useful. Once again contact your medical oncologist for the open trials at your center or contact our team for further options.
  

Whipple Resection: The whipple operation involves “removing the head of the pancreas”. As you will note from the illustration the common bile duct, the ampulla, the duodenum are all integrally related to the head of the pancreas and all share their blood supply. Therefore the Whipple operation is a fairly complex operation removing portions of all these structures and then re-hooking these back up to a new loop of intestine.

Distal Pancreatectomy: is the removal of tumors located in the tail or the body of the pancreas.

What is the role of Chemotherapy post-operatively?

A lot of pancreatic cancer patients are now offered post-op chemotherapy to ostensibly eliminate microscopic or non-visualizable disease. This decision is based on the size, aggressiveness of the tumor, lymph nodal status and several other minor criteria. This decision is best deferred to your team of surgeons and medical oncologists.

What is the role for Radiation post-operatively?

Post operative radiation continues to remain fairly controversial. This decision is often made on a case-by-case basis and is based on the size and aggressiveness of the tumor. The patient often also receives chemotherapy. As with chemotherapy this decision is best deferred to your team of treating physicians.
 

 

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