How To Treat Pancreatic Cancer

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Stage Information For Pancreatic Cancer

New breakthroughs in pancreatic cancer treatment
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T0 = No evidence of primary tumor.
Tis = Carcinoma in situ. This includes high-grade pancreatic intraepithelial neoplasia , intraductal papillary mucinous neoplasm with high-grade dysplasia, intraductal tubulopapillary neoplasm with high-grade dysplasia, and mucinous cystic neoplasm with high-grade dysplasia.
T1 = Tumor 2 cm in greatest dimension.
T1a = Tumor 0.5 cm in greatest dimension.
T1b = Tumor > 0.5 cm and < 1 cm in greatest dimension.
T1c = Tumor 12 cm in greatest dimension.
T2 = Tumor > 2 cm and 4 cm in greatest dimension.
T3 = Tumor > 4 cm in greatest dimension.
T4 = Tumor involves celiac axis, superior mesenteric artery, and/or common hepatic artery, regardless of size.
NX = Regional lymph nodes cannot be assessed.
N0 = No regional lymph node metastases.
N1 = Metastasis in one to three regional lymph nodes.
N2 = Metastasis in four or more regional lymph nodes.
M1 = Distant metastasis.
References
  • Kakar S, Pawlik TM, Allen PJ: Exocrine Pancreas. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. Springer 2017, pp. 33747.
  • What Are The Risk Factors For Pancreatic Cancer

    The average lifetime risk of developing pancreatic cancer is about 1 in 64. A risk factor is something that raises the chance that you will get a disease. There are risk factors that are a result of behavior and that can be changed. For pancreatic cancer, these types of risk factors include:

    • Smoking cigarettes, cigars and using other forms of tobacco.
    • Obesity is also a risk factor. Carrying weight around the waist is a risk factor even if you do not have obesity.
    • Having diabetes, especially type 2 diabetes, which is linked to obesity. The new development of diabetes at an older age and in someone with a normal weight or body mass index could be a sign of pancreatic cancer.
    • Being exposed to chemicals used by dry cleaners and metal workers.
    • Having chronic pancreatitis, a permanent inflammation of the pancreas usually associated with smoking and drinking a lot of alcohol.

    There are also risk factors that you cant change. These include:

    • Hereditary chronic pancreatitis due to gene changes passed from parent to child.
    • Hereditary syndromes with gene changes in genes such as BRCA genes passed from parent to child.
    • Being older than 45.
    • Being of Ashkenazi Jewish descent.

    Your healthcare provider might suspect pancreatic cancer if you have certain symptoms or if youve recently developed diabetes or pancreatitis.

    What Are The Types Of Pancreatic Cancer

    There are two types of tumors that grow in the pancreas: exocrine or neuroendocrine tumors. About 93% of all pancreatic tumors are exocrine tumors, and the most common kind of pancreatic cancer is called adenocarcinoma. Pancreatic adenocarcinoma is what people usually mean when they say they have pancreatic cancer. The most common type begins in the ducts of the pancreas and is called ductal adenocarcinoma.

    The rest of the pancreatic tumors about 7% of the total are neuroendocrine tumors , also called pancreatic NETs , an islet cell tumor or islet cell carcinoma. Some NETs produce excessive hormones. They may be called names based on the type of hormone the cell makes for instance, insulinoma would be a tumor in a cell that makes insulin.

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    What Will Happen After Treatment

    Youll be glad when treatment is over. For years after treatment ends, you will see your cancer doctor. Be sure to go to all of these follow-up visits. You will have exams, blood tests, and maybe other tests to see if the cancer has come back. At first, your visits may be every 3 to 6 months. Then, the longer youre cancer-free, the less often the visits are needed.

    Some treatments may not cure your cancer. You many need to keep getting treatment and care. From time to time tests will be done to see how your treatment is working.

    Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. Call us at 1-800-227-2345 or talk to your cancer care team to find out what you can do to feel better. You cant change the fact that you have cancer. What you can change is how you live the rest of your life.

    Side Effects Of Interventional Radiology

    Understanding Pancreatic Cancer Causes and Treatments

    Although interventional radiology procedures are less likely to cause severe side effects than more invasive treatments, you may still experience them. For example, SIR-Spheres Y-90 can cause pain and tightness in the abdomen, nausea and/or loss of appetite after the procedure. After chemoembolization, its normal to experience pain, fever, and nausea or vomiting for up to 48 hours. Your progress will be monitored after an interventional radiology procedure, and supportive therapies may be introduced to manage your side effects.

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    A Willingness To Tackle The Challenge

    Already into his first round of chemotherapy upon arriving at Mayo, John says the first question Dr. Truty asked him was if he was ready for more. “I said, ‘Yes I am,'” John says. “My care team described as weed killer and said there’d be no surgery until I went through more chemo and radiation to try and shrink the tumor as much as possible.”

    After eight rounds of chemotherapy, 25 rounds of radiation and another 25 rounds of oral chemo, Dr. Truty reassessed John’s condition. “He made it clear my ability to have surgery was predicated on what they saw on my presurgery PET scan â whether my treatments had done what they were designed to do,” John says. “After my scan, he looked at the results and said, ‘Are you ready to go into surgery?'”

    Johnwas, and early the next morning, he did. While Dr. Truty understands why othersurgeons had advised against surgery due to the location of John’s tumor, hesays it was something he and his surgical team were prepared for.

    “We just have a different perspective on things here at Mayo Clinic, and we’re willing to take on the more challenging cases that don’t necessarily fit into nice, normal boxes.”

    Mark Truty, M.D.

    There Are Several Forms Of Pancreatic Cancer Surgery:

    • The Whipple Resection: Named for the Columbia University surgeon who developed the procedure, the Whipple operation involves removing the head of the pancreas, where many tumors form. In this procedure the surgeon also removes the duodenum , part of the bile duct , the surrounding lymph nodes, the gallbladder, and sometimes part of the stomach. City of Hope surgeons have extensive experience in this highly complex operation, performing more than 100 Whipple procedures each year.
    • Distal Pancreatectomy: In this procedure the bottom half, or tail of the pancreas is removed, usually along with the spleen.
    • Total Pancreatectomy: Removing the entire pancreas along with bile duct, gallbladder, nearby lymph nodes and parts of the stomach and small intestine.When appropriate, these operations can be done with minimally-invasive techniques, which can be as effective as open surgery, but with less pain, reduced loss of blood, faster recovery, shorter hospital stays and a lower risk of complications.

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    Help Getting Through Cancer Treatment

    People with cancer need support and information, no matter what stage of illness they may be in. Knowing all of your options and finding the resources you need will help you make informed decisions about your care.

    Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms. Communicating with your cancer care team is important so you understand your diagnosis, what treatment is recommended, and ways to maintain or improve your quality of life.

    Different types of programs and support services may be helpful, and can be an important part of your care. These might include nursing or social work services, financial aid, nutritional advice, rehab, or spiritual help.

    The American Cancer Society also has programs and services including rides to treatment, lodging, and more to help you get through treatment. Call our National Cancer Information Center at 1-800-227-2345 and speak with one of our trained specialists.

    Pancreatic Cancer Is Rarely Caught At An Early Stage

    Pancreatic cancer treatment options

    MSK pancreatic cancer expert Steven Leach, director of the David M. Rubenstein Center for Pancreatic Cancer Research, explains that the disease usually does not cause symptoms in its early stages. Those that do occur such as pain or weight loss are often mistaken for signs of other illnesses. In addition, the pancreas is located in the back of the abdomen behind many other organs, making it hard for doctors to feel during routine examinations and even to conduct imaging tests to detect tumors.

    Its not a frequently occurring cancer, so it becomes hard to generate cost-effective screening strategies for early detection, such as the use of mammography or MRI forbreast cancer, or colonoscopy for colorectal cancer, Dr. Leach says. We have a long way to go when it comes to early diagnosis.

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    Why Is Pancreatic Cancer So Deadly

    In short, pancreatic cancer is aggressive and its difficult to treat.

    Symptoms dont typically occur until the disease is already more advanced and it tends to be more resistant to treatment than other cancers, says Dr. Geister.

    Unlike mammograms for breast cancer, colonoscopies for colon and rectal cancers or pap tests for cervical cancer, there isnt a standardized screening for pancreatic cancer. Generally, you only become aware when symptoms appear and you have a reason to get blood work or imaging. By then, the cancer growth can be considerable and has possibly spread to another area, further complicating treatment.

    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 U.S., based on how far the cancer has spread. The SEER database 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.

    Stage 0 Pancreatic Cancer

    Within stage 0 pancreatic cancer, when the tumors are usually small, treatment options typically include:

    Surgical options

    Resection: When tumors are small enough, they can usually be entirely removed by surgery. Complete removal of the tumors vastly improves survival rate for this type of cancer. Types of surgical procedures include:

    • Distal pancreatectomy

    Within stage 2 pancreatic cancer, treatment options include:

    Surgical options

    Resection : Stage 2A tumors may still be small enough to be surgically removed, vastly improving survival rate.

    Borderline resectable : In some cases, in stage 2A, as well as in 2B, the cancer may have spread to nearby tissues, organs or a major blood vessel. In this case, the patient would have a neoadjuvant treatment to shrink the tumor before having surgery.

    Nonsurgical options

    If the tumor is locally advanced and has spread into surrounding organs or tissues, its possible the surgeon may not be able to remove the entire tumor. To help shrink the tumor in order to remove it, the doctor may use one of nonsurgical options listed below prior to surgery. If the cancer can be surgically removed, the doctor may still recommend one of these nonsurgical options in addition to surgery:

    Within stage 3 pancreatic cancer, treatment options include:

    Surgical options

    Borderline resectable : As with locally advanced stage 2 tumors, the patient would have neoadjuvant treatment to shrink the tumor before having surgery.

    Nonsurgical options

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    Pancreatic Cancer Stage 2

    Stage 2 pancreatic cancer is cancer that remains in the pancreas but may have spread to a few nearby lymph nodes or blood vessels.

    This stage is divided into two subcategories, depending on where the cancer is and the size of the tumor:

    • Stage 2A. The tumor is larger than 4 centimeters but hasnt spread to any lymph nodes or nearby tissue.
    • Stage 2B. The tumor has spread to nearby lymph nodes, but not to more than three of them.

    Symptoms of stage 2 pancreatic cancer tend to be very subtle and may include:

    • targeted drug therapies

    Your doctor may use a combination of these approaches to help shrink the tumor and prevent possible metastases.

    Tests That Examine The Pancreas Are Used To Diagnose And Stage Pancreatic Cancer

    Why Pancreatic Cancer Is So Deadly

    Pancreatic cancer is usually diagnosed with tests and procedures that make pictures of the pancreas and the area around it. The process used to find out if cancercells have spread within and around the pancreas is called staging. Tests and procedures to detect, diagnose, and stage pancreatic cancer are usually done at the same time. In order to plan treatment, it is important to know the stage of the disease and whether or not the pancreatic cancer can be removed bysurgery.

    The following tests and procedures may be used:

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    Better Research Models Yield Major Strides

    Progress really began to open up in 2003 when researchers finally created a good mouse model of pancreatic cancer. Previous models struggled to express the correct cancer-driving genes or express them at the right level, so cancer in a mouse didnt behave the same as cancer in a human.

    Now, the pancreatic cancer mouse model is considered one of the closest to replicating human disease.

    We went from having no good model to having one of the best. The models have really led to the field exploding, Pasca di Magliano says.

    Researchers also began to improve upon traditional cell lines, which reflected only the tumor cells but not all of the other complicated systems at play in the stroma and microenvironment. Now, they can create three-dimensional organoids that better mimic whats happening in the pancreas.

    Another approach is to take tumors directly from patients and implant them into mice. These models can also capture key aspects of human pancreatic cancer for testing in the laboratory.

    But because so few patients can have surgery, tissue samples are limited. The ultimate goal is to use tissue obtained from the biopsy that all patients undergo. Initial work in Pasca di Maglianos lab suggests that the small amount of tissue obtained in a biopsy provides enough cells to grow into organoids.

    Coronavirus And Pancreatic Cancer Treatment

    There may be some changes to your treatment because of coronavirus. For example, you may need to have a coronavirus test before having treatment, and your treatment may be delayed if you have coronavirus or have symptoms of it.

    Speak to your doctor or nurse about what coronavirus might mean for your treatment.

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    Screenings Risk Factors Remain Elusive

    Currently, there are no proven effective screening tests for pancreatic cancer. Research is focused on using ultrasound or finding factors in the blood or urine that might serve as early markers.

    Rogel Cancer Center researchers are working to detect circulating tumor cells or RNA markers of pancreatic cancer in the blood. Others are developing a scaffold device that could be inserted in the body to attract cancer cells, potentially triggering an early warning of a developing tumor.

    But the question is: Who should get these screenings? A small proportion of pancreatic cancers involve an inherited defect in genes such as BRCA1, BRCA2 or PALB2. This is likely around 5 percent of patients.

    There are a few other indications that might suggest high risk, including other rare inherited gene defects, a first-degree relative with pancreatic cancer, and a new diagnosis of diabetes in middle-aged people without obesity. The only controllable risk factor is cigarette smoking.

    Beyond these, little is known about why someone has a high risk of developing pancreatic cancer.

    And then, if a screening test did exist, what would happen with someone at high risk or with a positive screening test?

    We need both better screening and better treatments. Its not either/or, says , associate professor of surgery and of cell and developmental biology at U-M. Even if we have great screening tools, we will also need effective therapies.

    Pain Control For Pancreatic Cancer

    Little-known approach to pancreatic cancer treatment offers hope to patients

    Pain can be a major problem for people with pancreatic cancer. These cancers can invade and press on nerves near the pancreas, which can cause pain in the abdomen or back.

    Treatment is available to help relieve this pain. If you are having any pain, please be sure to tell your doctor or nurse. Pain is easier to control if the treatment is started when you first have it. You and your doctor or nurse can talk about the best ways to treat your pain. A pain specialist can also help develop a treatment plan.

    Some proven ways to relieve pain from pancreatic cancer include:

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    What Is Acoustic Cavitation

    A key point that excites researchers about these findings, is the evidence that sound waves can create significant weakness in an ordinarily dense tumour.

    This is called acoustic cavitation.

    Acoustic cavitation is the term used to describe the rapid vibration of tiny microbubbles of gas by the sound waves, and it is this which is thought to be enhancing the uptake of immune cells into the tumours by breaking them up the shaking breaks up the tumour cells, causing them to spill their contents.

    The spill then also alerts the immune system, attracting immune cells to the site to fight the cancer.

    Study lead Professor Gail ter Haar, Professor of Therapeutic Ultrasound at The Institute of Cancer Research, London, said: This is the first ever study to show the anti-cancer benefit of these two treatments, HIFU in combination with immunotherapy, in pancreatic cancer. This study paves the way for clinical trials of treating pancreatic cancer patients with HIFU, and we will be developing HIFU-delivery platforms to achieve that.

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