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Pancreatic cancer treatments by stage

The treatment recommended for pancreatic cancer will depend on how advanced it is, how far it has spread and the person's overall health.

Stages of pancreatic cancer

Stage is a term used in cancer treatment to describe the extent of spread. The stages of pancreatic cancer exist partly to guide treatment, but also to classify patients for clinical trials.

Determining pancreatic cancer's stage is often tricky. Imaging tests like CT scans and MRIs provide some information, but knowing exactly how far pancreatic cancer has spread usually requires surgery.

Since surgery has risks, doctors first determine whether pancreatic cancer appears to be removable by surgery (resectable). Pancreatic cancer is then described as follows:

  • Resectable: On imaging tests, pancreatic cancer hasn't spread (or at least not far), and a surgeon feels it might all be removable. About 10% of pancreatic cancers are considered resectable when diagnosed.
  • Locally advanced (unresectable): Pancreatic cancer has grown into major blood vessels on imaging tests, so the tumour can't safely be removed by surgery.
  • Metastatic: Pancreatic cancer has clearly spread to other organs, so surgery can't remove it.

If pancreatic cancer is resectable, surgery could extend life and offer a small chance of a cure.

Treating resectable pancreatic cancer

People whose pancreatic cancer is considered resectable may undergo one of three operations:

Whipple procedure (pancreaticoduodenectomy): A surgeon removes the head of the pancreas, parts of the stomach and small intestine, some lymph nodes, the gall bladder, and part of the bile duct. The remaining organs are reconnected in a new way to allow digestion.

About half the time, once a surgeon can see inside the abdomen, pancreatic cancer that was thought to be resectable turns out to have spread, and thus is unresectable. The Whipple procedure is not completed in these cases.

Pylorus preserving pancreaticoduodenectomy (PPPD): A surgeon removes the head of the pancreas, part of the small intestine, some lymph nodes, the gall bladder, and part of the bile duct. The remaining organs are reconnected in a new way to allow digestion.

Distal pancreatectomy: The tail and/or body of the pancreas are removed, but not the head. This surgery is uncommon for pancreatic cancer because most tumours arising outside the head are unresectable.

Total pancreatectomy: The entire pancreas is surgically removed. Although once considered useful, this operation is uncommon today.

Chemotherapy and/or radiotherapy can also be used in conjunction with surgery for resectable pancreatic cancer in order to:

  • Shrink pancreatic cancer before surgery, improving the chances of resection (neoadjuvant therapy)
  • Prevent or delay pancreatic cancer from returning after surgery (adjuvant therapy)

Chemotherapy includes cancer drugs that travel through the whole body. Chemotherapy kills pancreatic cancer cells in the main tumour, as well as those that have spread widely.

In radiotherapy, a machine beams high-energy X-rays over the skin of the abdomen. The X-rays penetrate and kill pancreatic cancer cells. Radiotherapy is done during a series of daily visits to hospital, usually over a period of weeks.

Both radiotherapy and chemotherapy damage some normal cells, along with cancer cells. Side effects can include nausea, vomiting, appetite loss, weight loss, and fatigue. Chemotherapy can cause severe anaemia and immune system suppression. Symptoms usually ease a few weeks after radiotherapy is complete.

 

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