Pancreatic cancer is commonly considered to be an extremely deadly neoplasm and there is little that can be done about it. On the other hand, the facts are that even among patients whose prognosis was very poor, there are some who live for many years with this diagnosis.
The diagnosis of “pancreatic cancer” is treated by patients with this cancer as a death sentence with a close deadline. Is pancreatic cancer really a ruthless and hopeless killer?
I absolutely disagree with this statement! I would never say that a diagnosis of pancreatic cancer is a death sentence for a sick person. Patients whose cancer is diagnosed early, before it has metastasized, may be candidates for surgery. Modern postoperative chemotherapy along with good diagnostics leads to more and more frequent cures. It is difficult to say how often these cures are stated. It depends on the stage of the cancer. We already have the first results of studies which suggest that in a selected group, after surgical removal of the tumor and modern chemotherapy, potentially permanent cures may be as high as 40%. And 40 percent. it’s a lot.
We should remember that pancreatic cancers also include those with a lower malignancy than adenocarcinoma, e.g. neuroendocrine neoplasms. It is a rarer type of pancreatic cancer, it occurs in only 2 percent. patients with this cancer and usually has a better prognosis. In their case, we observe many years of experiences not so rarely.
The diagnosis of a pancreatic tumor is later verified to determine if it is a seriously diagnosed cancer. However, we cannot say with certainty that such a diagnosis means a death sentence with a short execution period.
Is primary prophylaxis possible to avoid pancreatic cancer?
We divide prophylaxis into primary, secondary and tertiary. Primary is how to avoid getting sick. They are defined and very simple. In the case of pancreatic cancer prevention, it is mainly not smoking and limiting alcohol consumption. The World Health Organization has compiled a list of 12 steps that will help you protect yourself against cancer. In addition to those already mentioned, these steps also include physical activity, a balanced diet, and avoiding obesity.
Unfortunately, there is no early detection prophylaxis for pancreatic cancer. It is impossible to design a screening program to detect this cancer at an early stage. However, we must remember that if a patient has typical symptoms, he should undergo diagnostics. These typical symptoms are upper abdominal pain, which often radiates to the back, symptoms of endocrine failure, i.e. decreased secretion of pancreatic enzymes, e.g. fatty stools, diarrhea. It is also unexplained weight loss, increased bilirubin and associated jaundice. Research suggests that a sudden onset of type 2 diabetes in people 50 years of age or older may be an early symptom of pancreatic cancer, especially in those who have a low body mass index (BMI), experience continuous weight loss, or have no family history of diabetes. Therefore, newly diagnosed diabetes is an indication for simple control examinations of the pancreas, i.e. ultrasound of the abdominal cavity. When the suspicion of a pancreatic tumor is significant, computed tomography is the basic diagnostic method. Contrast tomography with the early arterial phase is the most perfect test.
What is the treatment of pancreatic cancer?
Pancreatic cancer is a disease in which chemotherapy plays a key role. It would seem that this is an older generation method, but there are new things in this regard as well. Contemporary chemotherapy regimens are multi-drug chemotherapy. So we give the patient not one drug, but several at the same time, because the action of one drug potentiates the action of the others. In the postoperative treatment of pancreatic cancer, we use three drugs: oxaliplatin, irinotecan, and 5-fluorouracil. Such a procedure is associated with a better prognosis after surgery. In a situation where surgery cannot be performed or we are dealing with metastatic disease, therapies consisting of several drugs are also used, because they give a better effect than single-component chemotherapy.
In the first line of non-radical / palliative treatment, we use the same chemotherapy as after surgery, i.e. the FOLFIRINOX regimen, or a combination of gentitabine with nab-paltitaxel. Both of these treatment regimens are reimbursed. Unfortunately, after some time, such treatment ceases to control the disease and it is necessary to change the therapy. In the so-called In the second line of treatment, after the FOLFIRINOX regimen, we use gemcitabine, and after an alternative method of treatment, we can use chemotherapy with oxaliplatin or irinotecan.
Poland lacks access to the liposomal nanoparticle form of irinotecan, which, according to scientific research, is an added value for patients whose cancer has stopped responding to previous treatment. The drug was designed to more effectively reach cancer cells, then destroying them. It is included in the European and American guidelines in the event of failure of prior gemcitabine-based chemotherapy. It is worth noting that this drug used in the second-line treatment in a well-chosen group of patients with advanced pancreatic cancer extends overall survival by approx. 75%. This means that it gives patients hope for a longer life.
And this is basically the only limitation of availability for Polish patients compared to other countries.
What is the prognosis of pancreatic cancer today?
The oncologist is an optimist by definition. With a cancer patient in front of me, I don’t see a statistic element. I see a sick person with his problem. Even among patients whose prognosis was very poor, I have those who live with this diagnosis for many years. They come back to me for new therapies, participate in research projects with new drugs, and these people do not look at the statistics. The patient is looking for hope for life. He is not interested in statistics, he wants to know his real chance.
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