Pancreatic Cancer

  • Medical Author:
    Francis W. Nugent, MD

    Dr. F.W. Nugent is a medical oncologist specializing in gastrointestinal cancers with a special interest in pancreatic cancer. Dr. Nugent graduated from Middlebury College with a bachelors degree in religion before graduating from Albany Medical College. He presently serves as vice-chairman of medical oncology at the Lahey Clinic in Burlington, Massachusetts.

  • Medical Author: Keith E. Stuart, MD
    Keith E. Stuart, MD

    Dr. Keith E. Stuart is a medical oncologist specializing in the study and treatment of cancers involving the gastrointestinal tract, with a special interest in tumors involving the liver. He was educated at Harvard University (graduating magna cum laude) and Albert Einstein College of Medicine and did his medical training at the New England Deaconess Hospital.

  • Medical Author: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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Quick GuidePancreatic Cancer Pictures Slideshow

Pancreatic Cancer Pictures Slideshow

How is pancreatic cancer staged?

Once pancreatic cancer is diagnosed, it is "staged." Pancreatic cancer is broken into four stages with stage 1 being the earliest stage (stage 0 is not counted) and stage IV being the most advanced (metastatic disease). The following are the stages of pancreatic cancer according to the National Cancer Institute:

Stage 0: Cancer is found only in the lining of the pancreatic ducts. Stage 0 also is called carcinoma in situ.

Stage I: Cancer has formed and is in the pancreas only.

  • Stage IA: The tumor is 2 centimeters or smaller.
  • Stage IB: The tumor is larger than 2 centimeters.

Stage II: Cancer may have spread or advanced to nearby tissue and organs and lymph nodes near the pancreas.

  • Stage IIA: Cancer has spread to nearby tissue and organs but has not spread to nearby lymph nodes.
  • Stage IIB: Cancer has spread to nearby lymph nodes and may have spread to other nearby tissue and organs.

Stage III: Cancer has spread or progressed to the major blood vessels near the pancreas and may have spread to nearby lymph nodes.

Stage IV: Cancer may be of any size and has spread to distant organs, such as the liver, lung, and peritoneal cavity. It also may have spread to organs and tissues near the pancreas or to lymph nodes. This stage has also been termed end stage pancreatic cancer.

Unlike many cancers, however, patients with pancreatic cancer are typically grouped into three categories, those with local disease, those with locally advanced, unresectable disease, and those with metastatic disease. Initial therapy often differs for patients in these three groups.

Patients with stage I and stage II cancers are thought to have local or "resectable" cancer (cancer that can be completely removed with an operation). Patients with stage III cancers have "locally advanced, unresectable" disease. In this situation, the opportunity for cure has been lost but local treatments such as radiation remain options. In patients with stage IV pancreatic cancer, chemotherapy is most commonly recommended as a means of controlling the symptoms related to the cancer and extending life. Below, we will review common treatments for the three groups of pancreatic cancers (resectable, locally advanced unresectable, and metastatic pancreatic cancer).

What is the treatment for resectable pancreatic cancer?

If a pancreatic cancer is found at an early stage (stage I and stage II) and is contained locally within or around the pancreas, surgery may be recommended (resectable pancreatic cancer). Surgery is the only potentially curative treatment for pancreatic cancer. The surgical procedure most commonly performed to remove a pancreatic cancer is a Whipple procedure (pancreatoduodenectomy). It often comprises removal of a portion of the stomach, the duodenum (the first part of the small intestine), pancreas, bile ducts, lymph nodes, and gallbladder. It is important to be evaluated at a hospital with lots of experience performing pancreatic cancer surgery because the operation is a big one and evidence shows that experienced surgeons better select people who can get through the surgery safely and also better judge who will most likely benefit from the operation. In experienced hands, mortality from the surgery itself is less than 4%.

After the Whipple surgery, patients typically spend about one week in the hospital recovering from the operation. Complications from the surgery can include blood loss (anemia), leakage from the reconnected intestines or ducts, or slow return of bowel function. Recovery to presurgical health often can take several months.

After patients recover from a Whipple procedure for pancreatic cancer, treatment to reduce the risk of the cancer returning is a standard recommendation. This treatment, referred to as "adjuvant therapy (chemotherapy)," has proven to lower the risk of recurrent cancer. Typically 6 months of adjuvant chemotherapy is recommended, sometimes with radiation incorporated into the treatment plan.

Unfortunately, only about 20 people out of 100 diagnosed with pancreatic cancer are found to have a tumor amenable to surgical resection. The rest have tumors that are too locally advanced to completely remove or have metastatic spread at the time of diagnosis. Even among patients whose cancers are amenable to surgery, statistical data suggest that only 20% live 5 years. Most pancreatic cancer patients do not qualify for a pancreas transplant because of their advanced disease; most pancreas transplants are done in patients with diabetes that results from the removal of the endocrine portion of the pancreas.

Medically Reviewed by a Doctor on 2/29/2016

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