Pancreatic Cancer (cont.)
Francis W. Nugent, MD
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.
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.
In this Article
How is pancreatic cancer staged?
Once pancreatic cancer is diagnosed, it is "staged." Pancreatic cancer is broken into four stages with stage I being the earliest stage and stage IV being the most advanced (metastatic disease). 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 resectable, locally advanced unresectable, and metastatic pancreatic cancer.
What is the treatment for resectable pancreatic cancer?
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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. Surgery is the only 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 can often 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," has proven to lower the risk of recurrent cancer. Typically six months of chemotherapy is recommended, sometimes with radiation incorporated into the 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 who are amenable to surgery, only 20% live five years.
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