Pancreatic cancer is an abnormal growth of the cells of the pancreatic duct, the tube that drains the juices made by the pancreas to aid digestion in the small intestine. The pancreas also makes hormones, such as insulin and glucagon. The hormones go directly into the bloodstream to help the body use and store the energy it gets from food. The pancreas is located behind the stomach.
According to the American Cancer Society , in 2012 in the United States:
Approximately 43,920 people (22,090 men and 21,830 women) will be diagnosed with pancreatic cancer.
Approximately 37,390 people (18,850 men and 18,540 women) will die of pancreatic cancer
Multidisciplinary Cancer Clinic
We always follow a team approach to care. Patients have their diagnosis discussed by oncologists, surgeons, gastroenterologists, radiation oncologists and pathologists. By having everyone involved, a personalized treatment plan is developed.
Pancreatic cancer can be classified (or staged) into three main groups:
Operable cancer, which means a tumor is able to be surgically removed primarily, or following chemotherapy with or without radiation therapy (resectable or borderline resectable). Borderline resectable tumors are those tumors which are touching important structures that may be able to be removed and reconstructed if necessary. These tumors are often treated with chemotherapy with or without radiation prior to surgery to try to shrink the tumor away from these important structures.
Locally advanced cancer, which means the tumor is found only in the pancreas with no evidence of spread to other organs, but is involving structures which cannot be safely removed (tumors at this stage are unresectable).
Metastatic disease, which means that the cancer has spread to other parts of the body, for example, the liver (tumors at this stage are also unresectable).
These classification groups help to determine the most effective way to treat the cancer. If it’s determined that the cancer can be successfully removed, then surgery is considered.
For patients with localized, but not operable, cancer, two treatment strategies are used:
A combination of chemotherapy and radiation
Clinical trials which include promising therapies for pancreatic cancer, which are compared to existing treatments for pancreatic cancer
Surgery for Pancreatic Cancer
When patients are diagnosed with pancreatic cancer, approximately 20% of the tumors are found to be operable or resectable. The location of the pancreas adds to the technical difficulties of a surgical operation.
Diagnostic tests give information about the size, location and involvement of other surrounding tissues and vessels. These tests help the surgeon determine whether a cancer is operable or resectable. In addition, a surgeon will evaluate the patient’s overall health to determine if the patient can tolerate the surgical procedure. Each case is individual. In some cases, chemotherapy and radiation therapy, or other new agents, given as part of a clinical trial, will be recommended to potentially reduce the size of the tumor and improve the outcome of surgery. If the tumor is found to be in the head of the pancreas and is operable, the surgical procedure performed is a pancreaticoduodenectomy, also called a Whipple procedure. This surgery involves removing the head of the pancreas, the gallbladder, part of the bile duct, and part of the stomach. Surgery includes re-connecting the remainder of the bile duct, pancreas and stomach to the bowel so these structures can drain properly.
Radiation Therapy For Pancreatic Cancer
Radiation therapy is used in three ways:
To decrease the risk of local recurrence after surgery
To reduce the size of the tumor before surgery (preoperative or neoadjuvant therapy) and
As part of a treatment regimen for patients who have a tumor that is found to be unresectable.
When radiation is used, it is often in combination with chemotherapy, or with other new treatments as part of a clinical trial, which enhances the effectiveness of the radiation. Radiation and chemotherapy together have been found to benefit patients with locally advanced pancreatic cancer.