Best Treatments for Pancreatic Cancer

Pancreatic cancer is an insidious disease, it is rarely detected in the early stages. Fortunately, modern medicine provides many ways to treat this formidable disease.

Pancreatic cancer (PCa) is a malignant tumor that develops from the epithelium of the pancreas.

In the vast majority of cases, adenocarcinoma occurs, which most often affects the head of the pancreas.¹. Malignant tumors in the body and tail of the pancreas are much less common and differ in their symptoms.

Cancer of the head of the pancreas, as a rule, is manifested by the development of jaundice caused by obstruction of the bile ducts. With cancer of the body and tail, the patient complains of rapid weight loss, abdominal pain and high blood sugar^2.

Symptoms of pancreatic cancer are:

aching back pain;
vomiting, nausea, belching;
enlarged liver;
enlargement and soreness of the gallbladder;
development of ascites (dropsy);
multiple thromboses;
functional disorders of the pancreas – primarily diarrhea³.

Long latent course, late onset of symptoms and their similarity to the symptoms of chronic pancreatitis makes it difficult to diagnose pancreatic cancer in the early stages¹. As a result, in 40% of cases, by the time of detection, the tumor grows into neighboring organs, and distant metastases appear, which greatly worsens the survival prognosis.

The task of doctors is not only to detect a tumor at an early stage, but also to determine an effective treatment strategy. Modern medicine offers a variety of methods for the treatment of pancreatic cancer. Let’s talk about them in more detail.

Pancreatic Cancer Facts

Mortality	5th place in mortality among oncological diseases
Risk group	smokers, diabetics, over 60s, overweight people
Gender	Men are affected 1,5 times more often than women
Forecast	with adenocarcinoma for more than 5 years, 20-40% live
Relapse	in 50–60% of cases within a year after surgery (with adenocarcinoma)

Causes of pancreatic cancer

genetic predisposition. If the family has had cases of cancer of the pancreas, stomach, breast and ovaries, small and large intestine, it is recommended to visit a medical geneticist.
Age is more than 60 years.
Chronic pancreatitis.
Diabetes.
Smoking. Smokers are twice as likely to get pancreatic cancer.
Obesity.
Diet with excessive amounts of red meat, fried and smoked.

Symptoms of pancreatic cancer

Pancreatic cancer in its early stages does not give itself away. Symptoms of the disease appear as the tumor process develops. The first symptoms of pancreatic cancer may include:

lack of appetite;
causeless weight loss;
discomfort and pain in the upper abdomen, in the right or left hypochondrium;
frequent loose stools;
bloating;
weakness and fatigue;
yellowness of the skin;
itching;
nausea;
vomiting.

Stages of pancreatic cancer

1 stage	The tumor is localized in the gland and has a size of up to 2 cm
2 stage	Tumor 2–4 cm without metastases or smaller tumor with metastases in 1–3 regional lymph nodes
3 stage	Tumor larger than 4 cm, cancer cells have penetrated into regional lymph nodes and large vessels of the abdominal cavity
4 stage	There are metastases in other organs, the size of the tumor can be any

1. Drug therapy for pancreatic cancer

Drug or chemotherapy is used:

for the treatment of metastatic cancer to relieve symptoms and keep the disease under control;
to reduce the size of the tumor before surgery;
after surgery to reduce the risk of recurrence of the disease.

The following drugs are used as chemotherapy drugs: oxaliplatin, irinotecan, leucovorin, 5-fluorouracil (all within the same regimen), as well as gemcitabine, and nab-paclitaxel⁴.

How do different chemotherapy drugs work? Capecitabine and 5-fluorouracil reduce the division of tumor cells. Gemcitabine destroys cancer cells, and oxaliplatin inhibits tumor DNA synthesis⁶. The overall goal of using these drugs is to stop the growth of the tumor and reduce it in size.

2. Radiotherapy for pancreatic cancer

Radiation therapy is used for various types of pancreatic cancer. The effect is achieved due to the destructive effect on tumor cells in the irradiation zone.

If a pancreatic tumor has grown into neighboring organs, external beam radiation therapy is performed to reduce its size. At the same time, external beam radiation therapy is considered more toxic compared to the same chemotherapy.¹.

Stereotactic radiotherapy is considered the optimal solution.². It is distinguished from classical radiation therapy by the high precision of X-ray radiation, due to which healthy cells are not “touched”. This type of radiation therapy is also used in case of recurrence after surgical treatment.⁷.

Radiation therapy alone is rarely used. Much more often, irradiation of a malignant tumor is prescribed in complex treatment together with chemotherapy. Together, these treatments are more effective in the postoperative period and significantly increase the average life expectancy of the patient.⁸.

3. Chemotherapy for pancreatic cancer

Chemotherapy refers to the use of special drugs called anticancer chemotherapeutic agents. The names of the substances are listed in the chapter “Drug Therapy”. Here we will tell you how doctors combine these drugs.

Even 30 years ago, pancreatic cancer was treated mainly with 5-fluorouracil (alone or in combination with other substances). Later, gemcitabine became popular as a standalone drug. However, today physicians use various combinations of substances – depending on the patient’s condition and the goals pursued.

Chemotherapy is given before surgery to reduce the size of the tumor and after surgery to reduce the risk of the disease returning. Chemotherapy can also be used in combination with other treatments for pancreatic cancer.⁶.

For the treatment of metastatic and locally advanced (when the tumor grows into adjacent tumors) pancreatic cancer, the FOLFIRINOX regimen (irinotecan, oxaliplatin, leucovorin, 5-fluorouracil) and the combination of nab-paclitaxel with gemcitabine are usually used.⁵. It helps to prolong the life of cancer patients.

However, there are contraindications. For example, these regimens are not recommended for severely debilitated patients and patients with serious comorbidities because they are quite toxic. In such cases, other options are selected – for example, gemcitabine monotherapy.

4. Targeted therapy for pancreatic cancer

The main difference between targeted therapy and chemotherapy is that drugs do not act on cells (both “cancer” and healthy), but on molecules involved in the process of cancer formation.⁹. This also includes radioimmunotherapy.

5. Ultrasound therapy for pancreatic cancer

High Intensity Focused Ultrasound (HIFU) can also be used to treat inoperable patients with pancreatic cancer. During treatment, the tumor is “bombarded” with focused ultrasound waves of a certain frequency.

The advantages of the method are that it does not require surgical intervention and anesthesia, and is easily tolerated by patients. As a result, the tumor decreases in size, the pain becomes less intense. In combination with chemotherapy, HIFU allows you to prolong the life of the patient, while maintaining its quality.

6. Surgery for pancreatic cancer

The “gold standard” for pancreatic head cancer treatment is surgical treatment. The founder of this method is the American Allen Whipple, who developed the method of resection of the pancreas.

Since cancer is often detected in the later stages, it is not always possible to operate – only in 20% of patients¹¹. In other cases, you need to look for other ways, or to carry out preoperative therapy (chemotherapy, radiation therapy, or in combination).

Various types of surgery are currently being performed. More about them below.

Operation Whipple

Otherwise called pancreatoduodenal resection (or pancreatoduodenectomy). As a rule, it is used in the surgical treatment of adenocarcinoma of the pancreatic head.

During the operation, the head of the pancreas, the distal part of the common bile duct, the gallbladder, the duodenum and the distal parts of the stomach are removed. The remaining pancreas, stomach and intestines are connected to ensure the process of digestion.

The Whipple operation has very serious disadvantages: frequent complications (bleeding, abscesses), in 15% of cases the patient dies after the operation. Also, after the operation, a long rehabilitation is required.

Distal resection

During distal resection, not the head is removed, but part of the body and tail of the pancreas. The spleen is also often removed. This method of surgical treatment is used for benign tumors and low-grade cancer.

The most popular is laparoscopic distal resection, when the operation is performed through a small incision. Pros: less blood is lost, fewer deaths and serious complications. Possible complications include fistula formation, fluid accumulation¹².

Total pancreatectomy

In a total pancreectomy, the entire pancreas is removed. In addition, part of the stomach, duodenum, end of the common bile duct, gallbladder, and spleen will need to be removed.

Such an operation can be used for multifocal tumors (several separate foci, outwardly similar to a single tumor), avoiding purulent-septic complications.

After the operation, you will have to “replace” the functions of the pancreas with medication. You will need to take medications – substitutes for enzymes that break down fats, control blood sugar levels and take insulin to maintain it at a safe level.¹³. After removal of the pancreas, diabetes mellitus often occurs (moreover, in severe form).

Palliative surgery

For inoperable tumors of the pancreas, patients may be recommended a palliative operation – stenting (installation of a special stent to expand) the bile duct and duodenum. Such operations will help relieve the symptoms of jaundice, prevent small bowel obstruction, and improve the general condition of the patient. Palliative surgery is performed using laparoscopy (a small incision), so recovery takes less time. Radiation therapy can also be used as palliative care.

Popular questions and answers

Pancreatic cancer, like any other oncology, almost always catches by surprise. The most popular questions related to tumor treatment are answered by oncologist of the highest category, surgeon, professor Rim Kalanov.

How fast does pancreatic cancer develop?

– From the moment of accidental detection of a tumor in the early stages and until the appearance of characteristic symptoms, about 6-8 months pass. Therefore, we can say that the disease develops very quickly. Unfortunately, pancreatic cancer is usually detected late because the tumor rarely shows up in the early stages.

How long can a person live with pancreatic cancer?

– Life expectancy depends on the stage of the disease. In the early stages, the disease is diagnosed in only 3,8% of patients, and the remaining 96,2% of patients, unfortunately, receive medical care very late. Therefore, the survival after surgery is about 10-18 months, and the five-year average survival after a course of treatment is about 8-45%. If it is not possible to remove the tumor completely, a relapse occurs. Therefore, the statistics are disappointing.

Can pancreatic cancer be beaten?

– In oncology, it is not customary to talk about a complete cure for cancer. We can talk about stable remission. The whole world is working to beat cancer. And to do that, we need early diagnosis. In 2012, a young US scientist, Jack Andraki, claimed to have invented a tester that could detect pancreatic cancer by analyzing a patient’s blood or urine. According to the author, the method is more than 100 times faster and more accurate than traditional diagnostic methods. However, in official medicine, the Jack Andraki test is not used.

Who is at risk?

– Precancerous diseases of the pancreas include benign tumors, chronic pancreatitis, and risk factors for tumor development – liver cirrhosis, diabetes mellitus, fatty and spicy foods, smoking, drinking alcohol.

In recent years, much attention has been paid to the hereditary theory of the occurrence of tumors. Recently, a gene has been discovered that affects the shape of normal pancreatic cells. It may be involved in the development of pancreatic cancer.

How to maintain quality of life after pancreas removal?

– After complete removal of the pancreas and resection of its tail, patients develop enzymatic deficiency and insulin dependence. They are forced to take lifelong replacement therapy. Cancer patients are subject to mandatory dispensary observation by an oncologist at least once a year. The list of examinations is included in the standard program for the management of cancer patients, and is also supplemented individually.

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