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UCLA Center for Pancreatic Diseases

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Pancreatic Cancer

Pancreatic Cancer

Overview

  • Pancreatic cancer is a disease in which normal ductal cells in the pancreas malfunction and begin to grow uncontrollably. These cancerous cells can eventually interfere with proper functioning of the pancreas and metastasize, or spread, to other parts of the body.
  • Pancreatic cancer is considered resectable if it can be surgically removed. Such tumors are localized to the pancreas or may even extend beyond it, but without involvement of the critical arteries or veins in the area. Approximately 15-20% of patients are diagnosed at this stage.
  • Pancreatic cancer is considered unresectable if it is locally advanced, i.e., still confined to the area around the pancreas, but with involvement of the nearby critical arteries or veins or with direct extension of the tumor to surrounding organs. But there is no evidence of spread to any distant areas of the body in locally advanced pancreatic cancer. Approximately 35% to 40% of patients are diagnosed at this stage
  • Pancreatic cancer is considered unresectable if it is metastatic, i.e., when the tumor has spread from the pancreas to involve distant organs, such as the liver or lung. Approximately 45% to 55% of patients are diagnosed at this stage.
  • Pancreatic cancer is considered recurrent if the cancer comes back after it was treated. It may be a locoregional recurrence (recurs within or close to the pancreas) or it may be a distant recurrence (recurs in another part of the body, such as in distant organs, bones or distant lymph nodes).

Symptoms

Pancreatic cancer is sometimes called a silent disease because early pancreatic cancer often does not cause symptoms. But as the cancer grows, symptoms can include:

  • Pain in the upper abdomen or upper back
  • Yellow skin and eyes, and dark urine from jaundice
  • Weakness
  • Loss of appetite
  • Nausea and vomiting
  • Weight loss with no known explanation
  • Burning feeling in stomach or other gastrointestinal discomforts
  • Floating stools with a particularly bad odor, due to malabsorption of fats
  • However, these symptoms may also occur with other less serious conditions.

Treatment

Surgery
Surgery may be used alone or in combination with radiation therapy and chemotherapy. The surgeon may remove all or part of the pancreas. The extent of surgery depends on the location and size of the tumor, the stage of the disease and the patient’s general health.

  • Whipple procedure: The surgeon removes the head of the pancreas and part of the small intestine, bile duct and stomach. The digestive tract and biliary system are then reconnected.
  • Distal pancreatectomy: The surgeon removes the body and tail of the pancreas, and the spleenl.
  • Total pancreatectomy: The surgeon removes the entire pancreas, part of the small intestine, a portion of the stomach, the common bile duct, the gallbladder, the spleen and nearby lymph nodes.

Sometimes before one of the above procedures, the surgeon may choose to start with a staging laparoscopy, With the patient under anesthesia, several small holes are made in the abdomen, through which a camera can be passed. This allows the surgeon to assess whether the cancer has spread to other areas within the abdominal cavity, in which case undertaking the full operation to remove the primary tumor would not be beneficial.

Procedures

Prior to surgery, an endoscopic ultrasound (EUS) may be performed in addition to a CT scan or MRI in order to get a better picture of the tumor in relation to the surrounding structures. The EUS is done by the gastroenterologist on an outpatient basis. Furthermore, if the tumor is unresectable, these procedures may be used to biopsy a piece of the tumor prior to starting chemotherapy. If the bile duct becomes obstructed in patients with tumors that cannot be resected with surgery, then an ERCP is done to place a stent (hollow tube) into the bile duct in order to relieve the obstruction.

  • Chemotherapy
    Chemotherapy is the use of drugs to kill cancer cells. Doctors also give chemotherapy to help reduce pain and other problems caused by pancreatic cancer. It may be given alone, with radiation or with surgery and radiation. Systemic chemotherapy uses drugs to target cancer cells throughout the body. It can be given orally or by injection, and can be done as an outpatient treatment at the hospital, doctor’s office or at home. Chemotherapy is given by a Medical Oncologist.
  • Radiation Therapy
    Radiation therapy uses high-energy rays to kill cancer cells. A large machine directs radiation at the abdomen. Radiation therapy may be given alone, with surgery, with chemotherapy or both. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. Radiation therapy is local therapy because it affects cancer cells only in the treated area. It is given by a Radiation Oncologist.

Downstaging of Pancreatic Cancer - Thoughts About Converting Unresectable Tumors to Resectable Ones

Downstaging of pancreatic cancer (the conversion of unresectable to resectable disease) is occasionally possible. When it appears that the tumor cannot be removed due to local invasion of the blood vessels, patients may be treated with 6-9 months of chemotherapy, occasionally combined with radiation. After this is completed, if it appears that the tumor has gotten smaller and no longer invades the blood vessels, than surgery to remove the tumor may be performed.

The UCLA Experience With Downstaging

From 1992 - 2012, we have accumulated a large experience with patients who initially had unresectable pancreatic cancer, underwent "downstaging" chemotherapy, and then had an operation to resect the cancer.  The cancer was successfully resected in over 80% of cases, and the median survival of these patients was 52 months.  The 5 year survival rate may be as high as 50%. We have now managed about 65 patients in this way, and a number appear to have been cured of their disease.

*Disclaimer
The condition information provided is not for self-diagnosis or self-treatment. Diagnostic testing and physician expertise are required for diagnosing your symptoms. Please check with your physician to determine what may be causing your symptoms and the treatment that is right for you.

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