What Happens If You’ve Been Told Your Cancer Cannot Be Cured
If you have advanced pancreatic cancer it might be very hard to treat. It may not be possible to cure the cancer.
If this is the case, the aim of your treatment will be to limit the cancer and its symptoms, and help you live longer.
Finding out the cancer cannot be cured can be very hard news to take in.
You will be referred to a special team of doctors and nurses called the palliative care team or symptom control team.
They will work with you to help manage your symptoms and make you feel more comfortable.
The clinical nurse specialist or palliative care team can also help you and your loved ones get any support you need.
Can You Survive Cancer Twice
Some cancers come back only once, while others reappear two or three times. But some recurrent cancers might never go away or be cured. This sounds scary, but many people can live months or years with the right treatment. For them, the cancer becomes more like a chronic illness, such as diabetes or heart disease.
Exploiting How Cells Use Energy
One potential vulnerability is in the metabolism, or the way cells use energy.
The body sends a limited amount of fuel to both the cancer and the immune system. The immune system needs fuel to kill the cancer. But the cancer gobbles up the nutrients, taking more than it needs. Immune cells, starved of nutrients, become exhausted, sluggishly sitting on the edges.
Tumors find a dozen different ways to keep the immune cells away masking themselves, eating the nutrients, says Costas Lyssiotis, Ph.D., assistant professor of molecular and integrative physiology at U-M. If you can block how cancer cells are eating the nutrients, then immune cells can use those nutrients.
His lab has pinpointed several unique metabolic differences specific to the pancreas, and is developing drugs to exploit them. Most of the testing is still in mice, but a phase 3 clinical trial will open soon at the Rogel Cancer Center comparing chemotherapy alone versus chemotherapy plus a metabolomic drug that switches off two pathways of energy.
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Potentially Curable If Caught Very Early
Despite the overall poor prognosis and the fact that the disease is mostly incurable, pancreatic cancer has the potential to be curable if caught very early. Up to 10 percent of patients who receive an early diagnosis become disease-free after treatment. For patients who are diagnosed before the tumor grows much or spreads, the average pancreatic cancer survival time is 3 to 3.5 years.
Physical Status After Treatment
Getting the right nutrition and keeping physically active as much as possible under the circumstances can really impact how a patient tolerates the side effects of treatment and the symptoms of pancreatic cancer.
Younger patients tend to do better because they have fewer other conditions that may limit recovery, but even older patients can positively impact their prognosis by focusing on nutrition and exercise.
Talk to your doctor about what to expect after treatment and what you can do to get the best possible prognosis.
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Surgery To Help Control Symptoms Of Pancreatic Cancer
This can include surgery to:
- unblock the bile duct or stop it getting blocked, which helps with jaundice
- unblock the first part of the small intestine or to stop it getting blocked, which helps with feeling or being sick
Many of these procedures are done using endoscopy. Where the surgeon uses a long, thin, flexible tube to reach the blockage or organ.
The aim of these operations is to help improve your symptoms, not to cure the cancer.
Chemotherapy For Pancreatic Cancer
Chemotherapy drugs kill cancer cells, control their growth or relieve disease-related symptoms. Chemotherapy may involve a single drug or a combination of two or more drugs, depending on the type of cancer and how fast it is growing. Depending on the resectability of the pancreatic cancer, chemotherapy can be given:
- Prior to surgery, to try to reduce the size of the pancreatic tumor that needs to be removed. This is called neoadjuvant therapy.
- After surgery, to destroy any cancer that may not have been completely removed. This can reduce the chance that the cancer returns and is called adjuvant therapy.
- Along with radiation, which is called chemoradiation. This is sometimes used for localized pancreatic cancer.
There are many chemotherapy drugs used to treat pancreatic cancer, including:
- Liposomal Irinotecan
Based on the patients ability to tolerate therapy, two or more chemotherapy drugs are typically given in combination to treat patients.
Two chemotherapy combinations have been approved for the initial treatment of pancreatic cancer, including:
- Gemcitabine + nab-paclitaxel
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Pancreatic Cancer Is Difficult To Diagnose Early
Pancreatic cancer is difficult to detect and diagnose for the following reasons:
- There arent any noticeable signs or symptoms in the earlystages of pancreatic cancer.
- The signs and symptoms of pancreatic cancer, when present, are like the signs and symptoms of many other illnesses.
- The pancreas is hidden behind other organs such as the stomach, small intestine,liver, gallbladder, spleen, and bile ducts.
How Fast Can Pancreatic Cancer Spread
Using mathematical models to study the timing of pancreatic cancer progression, the scientists conservatively estimated an average of 11.7 years before the first cancer cell develops within a high-grade pancreatic lesion, then an average of 6.8 years as the cancer grows and at least one cell has the potential to spread …
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How Can I Help Increase Awareness
There are lots of ways you can help increase awareness of the signs, symptoms and risk factors of pancreatic cancer.
For more information, .
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Survival For Pancreatic Endocrine Tumours
Pancreatic endocrine tumours are an uncommon type of pancreatic cancer. More recently doctors have been calling them neuroendocrine neoplasms . This is an umbrella term for this group of disorders. Then they are called either neuroendocrine tumours or neuroendocrine carcinomas . This depends on how slow or fast growing the cells are.
They generally have a better outlook than adenocarcinoma of the pancreas.
1 year survival
The information below is for 1 year overall survival for pancreatic neuroendocrine neoplasms in the UK.
Around 80 in 100 people survive for 1 year or more.
5 year survival
There are no UK-wide 5 year survival statistics available for pancreatic NENs. The statistics below are from a European study. Please be aware that these figures may not be a true picture of survival in the UK. This is due to differences in health care systems, data collection and the population,
Around 40 out of 100 people survive their cancer for 5 years or more after diagnosis.
British Journal of Cancer Volume 121, pages 966972
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Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for pancreatic cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:
- Localized: There is no sign that the cancer has spread outside of the pancreas.
- Regional: The cancer has spread from the pancreas to nearby structures or lymph nodes.
- Distant: The cancer has spread to distant parts of the body such as the lungs, liver or bones.
Whipple Surgery Offers Hope And Potential Cure For Pancreatic Cancer
Karen Bluemke spends as much time as possible these days soaking up the sun in Florida. After completing treatment for pancreatic cancer, she decided, its time to finally have some fun.
Why wait for retirement? said Bluemke, 53, a triage nurse. The west suburban woman is able to work remotely from the oceanfront condo she and her husband recently purchased.
Bluemke learned she had a tumor in her pancreas in March 2016. The first oncologist I saw painted a grim picture, she said. She turned to UChicago Medicine and surgical oncologist Mitchell C. Posner, MD, for a second opinion.
Dr. Posner was fantastic, she said. He had so much experience. I went from devastated to hopeful.
Pancreatic cancer is usually detected late, often after the disease has spread, and has a poor prognosis.
Dr. Posner was fantastic. He had so much experience. I went from devastated to hopeful.
A pancreatic cancer diagnosis is life-defining, said Posner, who has more than 25 years of experience in the surgical management of the disease. Our philosophy is, that at the very least, every patient deserves hope, even when there seems to be little.
Karen came to us a young woman with an advanced, but treatable cancer, he said. We had something to offer.
The malignant tumor was in the head of Bluemkes pancreas. The cancer had spread to one lymph node and involved the portal vein, but no other organs.
What Is the Whipple Procedure?
How Fast Does Pancreatic Cancer Come Back
Using mathematical models to study the timing of pancreatic cancer progression, the scientists conservatively estimated an average of 11.7 years before the first cancer cell develops within a high-grade pancreatic lesion, then an average of 6.8 years as the cancer grows and at least one cell has the potential to spread
Pancreatic Cancer Treatment Is Impacted By Resectability
Surgery is the only treatment that can cure pancreatic cancer, but is an only option for about 20% of cases. This means that its important to define whether a patient may benefit from surgery at the time of pancreatic cancer diagnosis, and reserve surgery only for when it may provide clinical benefit.
Because of this, MD Anderson doctors use a contemporary staging system, called resectability staging, to plan a patients treatment. This type of staging classifies pancreatic cancers into three groups, based on whether or not they can be removed with surgery. A patients potential treatment plan varies depending on the resectability staging of their pancreatic cancer.
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Who Has The Greatest Risk
- People with two or more relatives who have had pancreatic cancer
- Have inherited the BRCA2, p16, STK11 gene mutation or chronic pancreatitis
- Are over the age of 50
- People who are overweight
Third Degree Relatives – First cousins, great-aunts and uncles
An inherited genetic variation in DNA that you are born with
Second Degree Relatives – Aunts, uncles, grandparents, nieces and nephews
First Degree relatives – Blood relatives in your immediate family: parents, children, and siblings
This is an experimental type of treatment. It is a medication made of killed or weakened cells, organisms or manufactured materials, which is used to boost the body’s immune system. Ideally, this will allow the body to fight and kill the cancer cells more effectively. Vaccines include whole killed cancer cells or specific proteins from the cancer.
Also known as a pancreatoduodenectomy, the Whipple procedure is the surgery typically performed to remove cancers of the head of the pancreas . It typically involves the surgical removal of the head of the pancreas, a portion of the duodenum and a portion of the bile ducts.
The part of the pancreas that bends backwards, hooking around two very important blood vessels, the superior mesenteric artery and vein. The word “uncinate” comes from the word uncus which means “hook.”
Unable to be surgically removed. This usually means that the cancer has spread beyond the areas that can be removed surgically.
A benign tumor made up of cells that form glands .
Early Detection A Challenge
The pancreas is an organ about the size of a hand that makes insulin and enzymes for digestion. It sits across the upper abdomen, behind the lower part of the stomach more or less in the middle of your body.
And that makes it really hard to detect cancer.
Pancreatic cancer causes few symptoms and when they emerge, its often when the cancer is no longer curable through surgery.
Early detection is important for pancreatic cancer. Patients come in with potentially precancerous lesions and within a year, it can progress from precancerous to metastatic, says Vaibhav Sahai, MBBS, M.S., assistant professor of hematology and oncology at U-M.
Patients dont have symptoms early on and almost always present with advanced disease.
The most common symptoms unexplained back pain, unexplained weight loss, yellowing of the eyes or skin are general enough to blame on other problems. Many people are sent to a chiropractor when they first report unusual back pain.
We need to do a better job of educating people and providers to be more alert when symptoms arise. Too many people are not having their symptoms recognized, says Timothy Frankel, M.D., assistant professor of surgery at U-M.
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Survival For Pancreatic Cancer
Pancreatic cancer is often diagnosed at an advanced stage. Your outlook is better if your cancer hasn’t spread and you can have surgery to remove it.
Survival depends on many factors. No one can tell you exactly how long you will live.
Below are general statistics based on large groups of people. Remember, they cant tell you what will happen in your individual case.
If Treatment Does Not Work
Recovery from pancreatic cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team and family and friends to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people want and need support to help them cope with the loss. Learn more about grief and loss.
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Radiation For Pancreatic Cancer
Radiation therapy uses high-energy photon beams to slow or shrink pancreatic tumors. Due to the level of precision of some types of radiation therapy, higher than normal doses of radiation can be considered and used without damaging normal tissues. MD Anderson uses several different types of radiation therapy to treat pancreatic cancers.
At MD Anderson, our radiation oncologists use a special machine called a CT on rails to deliver higher than normal doses of radiation with extreme precision. This technique is typically used during IMRT and SBRT.
Limited Success With Chemotherapy
Surgery and radiation are often coupled with chemotherapy to kill any cancer remaining in the body. Recent improvements in chemotherapy, notably the drug combination FOLFIRINOX, have improved outcomes.
But another unusual hallmark of pancreatic cancer limits success.
If you look at pancreatic cancer under a microscope, it doesnt look like cancer. It looks like scar tissue with little spots of cancer, Cho says.
This scar tissue, or fibrosis, increases pressure inside the tumor and causes blood vessels to collapse. When that happens, the chemotherapy drugs pumped through the veins dont actually get into the tumor.
If the tumor doesnt see the chemotherapy, it doesnt really do anything, Crawford says. All it does is make the patient sick.
Research at the Rogel Cancer Center is looking at how to decrease fibrosis and diminish pressure on the blood vessels. Current clinical trials open at U-M are investigating approved drugs both novel and existing in new combinations to address this.
Whats tricky, though, is that this isnt normal scar tissue. When researchers look at pancreatic cancer tissue samples, they see the tumor, the stroma and the rest of the tumor microenvironment composed of different types of cells.
Typically, scar tissue is quiescent, but these are active and secreting a lot of signals. Its similar to scar tissue but different, Pasca di Magliano says. People are starting to unravel what these cells do.
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Bile Duct Bypass Surgery
is an option if the tumor is blocking the common bile duct.
The liver normally releases a substance called bile, which helps with digestion. Bile is stored in the gallbladder. It then travels through the common bile duct to the intestines. From there, its removed from the body in the stool.
When a tumor blocks the small intestine, bile can build up in the body and cause jaundice, which is the yellowing of the skin and eyes.