Pancreatic cancer occurs when abnormal cells grow out of control in the pancreas, a small organ behind the stomach that helps the body digest food. Since it is small and tucked away in the abdomen, it can be hard to notice symptoms until the tumor has grown large or spread to other areas of the body.
Because pancreatic cancer can be aggressive, treatment will begin as soon as it’s diagnosed. Gastrointestinal (GI) surgeons specialize in pancreatic cancer procedures and are consulted as part of the treatment planning process for each patient. Today, the GI surgeon is also important in defining the cancer’s stage by determining whether the patient can undergo surgery.
Advances in Pancreatic Cancer Treatment: Staging Based on Whether Surgery is Possible
As with many types of cancer, the oncologist runs tests after a new pancreatic diagnosis to determine the cancer’s stage. The stage of cancer identifies the size and extent of your tumor and guides your cancer care team in choosing the best treatment.
Imaging studies and biopsy results help your GI oncologist understand three critical elements of the cancer:
- Tumor size: indicates the size in centimeters and how far the tumor has grown into blood vessels outside the pancreas.
- Nodes: indicates if the cancer has spread to nearby lymph nodes. If so, how many are affected?
- Metastasis: reveals if the cancer has spread to other parts of the body in addition to the lymph nodes. If yes, where?
Each of those factors is given a value based on test results. Combined, they determine the pancreatic cancer stage (Stages 0, I, II, III, and IV).
Until recently, the staging for pancreatic cancer did not include information about whether the tumor can be resected or surgically removed. Although traditional staging is still an important part of deciding which treatments will be best, the latest pancreatic cancer treatment planning process is guided by whether or not the tumor is resectable (removable).
Pancreatic Cancer Resectability
The ability to quickly identify and remove a pancreatic tumor before it spreads increases the potential for survival. Since surgery, also called resection, is the only option for a complete cure for pancreatic cancer, it is important to prioritize surgery in the treatment plan. That’s why staging pancreatic cancer now includes resectability: the ability to be surgically removed safely.
The staging information will now include one of these three levels of resectability:
- Resectable - A tumor in the pancreas that is relatively small and does not affect any nearby blood vessels or lymph nodes. It has not spread to other areas of the body. In this case, a GI cancer surgeon can remove the tumor without causing damage to nearby body parts. Stage I and II pancreatic cancers are likely to be resectable.
Treatment for resectable pancreatic cancer may also include chemotherapy alone or chemotherapy combined with radiation before surgery to reduce the tumor size. In some cases, only surgery is required. - Borderline Resectable - A pancreatic tumor that has spread to a major blood vessel or other organs. It is considered borderline because there is a chance that surgical resection may not remove all of the cancer cells.
People who are diagnosed with borderline resectable pancreatic cancer are usually at stages II or III (3). In these cases, chemotherapy, targeted therapy, and radiation therapy may be recommended by your GI cancer doctor individually or combined to reduce the tumor before considering surgery.
After the initial treatment, additional studies will be conducted to determine if surgery is the best approach. - Unresectable - A pancreatic tumor that cannot be surgically removed due to its proximity to major vessels or other organs. This can be the situation for people with stage III (3) and IV (4) pancreatic cancer. Metastatic pancreatic cancer often spreads to the liver and the lungs. In these cases, surgery may not be an option.
Surgical Options for Pancreatic Cancer Treatment
Surgeries used to remove pancreatic cancer include:
- Whipple procedure (pancreaticoduodenal resection): removes the head of the pancreas, part of the stomach, part of the small intestine, the gallbladder, and the bile duct are all removed. Some of the pancreas is left to function.
- Distal pancreatectomy: removes the body and the tail of the pancreas, as well as the spleen, if it is affected.
- Total pancreatectomy: removes the entire pancreas, part of the small intestine, part of the stomach, the spleen, the gallbladder, the common bile duct, and some lymph nodes.
Additional Treatments for Pancreatic Cancer
Most cancer treatment plans include several treatments to be sure the cancer cells are destroyed and to lower the likelihood of it returning. The stage of cancer will play a large role in what is needed.
The following are commonly included in pancreatic cancer treatment plans.
- Chemotherapy uses medications to stop the growth of cancer cells. This is a systemic approach, reaching cancer cells throughout the body. Several chemotherapy drugs are available to prevent the growth of pancreatic cancer.
- Targeted therapy uses medications that identify and attack cancer cells based on a specific genetic mutation that is identified through biomarker testing.
For example, the normal KRAS protein helps cells know when they should grow and when not. However, the KRAS G12D mutation, which is present in some pancreatic cancers, causes unregulated cell growth. A targeted therapy drug was developed specifically to block KRAS G12D activity and control the growth of cancer cells.
Additional targeted therapies are available for pancreatic cancer based on the results of the biomarker tests. Additional genetic mutations that can be treated with targeted therapy for pancreatic cancer include:- BRAF
- RET
- EGFR
- PARP
- Radiation therapy targets a specific area of the body with high-energy beams of radiation to kill cancer cells or to keep them from growing.
Two different techniques can be used to limit radiation exposure while treating pancreatic tumors. Intensity-modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) use focused beams directed at the pancreatic tumor and a small amount of the surrounding area to treat pancreatic cancer. These therapies reduce the amount of radiation applied to healthy cells.
Living with Unresectable Pancreatic Cancer
Although GI cancer surgeons are unable to perform surgery to remove pancreatic cancer for all patients, there are still other treatment options to help reduce the symptoms and complications that an advanced tumor may cause.
If pancreatic cancer has spread and is unresectable, surgeons may try the following palliative surgery to relieve symptoms and complications:
Biliary bypass can help when a pancreatic tumor blocks the bile duct, and bile builds up in the gallbladder. In this procedure, the surgeon reroutes the gallbladder or part of the bile duct past the blockage.
Endoscopic stent placement is another approach to fixing a blocked bile duct. A stent (a thin tube) may be placed to drain bile that has built up in that area.
Gastric bypass can help when pancreatic tumors block the flow of food from the stomach. A surgeon can attach the stomach to the small intestine in a new way so the food can digest normally.
Other palliative treatments to relieve pain caused by pancreatic cancer include:
- Pain medications
- Radiation to reduce pain by shrinking pancreatic tumors
- Nerve block injections
Personalized Pancreatic Cancer Treatments is Available in Portland, OR, and Vancouver, WA
At Compass Oncology, we understand that a pancreatic cancer diagnosis requires you to make decisions quickly. Our compassionate pancreatic cancer team of experts includes the GI surgeon, medical oncologist, radiation oncologist, and a team of cancer care professionals who are here to guide you through every step of the way.
We stay at the forefront of pancreatic cancer research and advances in pancreatic cancer treatment to give patients the best support possible. We take pride in knowing our patients personally. We're right there beside them throughout their journey.
Our cancer care team is available for a consultation at our cancer centers in Portland, Oregon, or Vancouver, Washington, where they can answer questions specific to your situation. Request an appointment.
