Is Chemo Worth It For Pancreatic Cancer


What Chemotherapy Drugs You Might Have

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If you are well enough, you might have a combination of chemotherapy drugs called FOLFIRINOX. This is made up of the following drugs:

  • FOL – Folinic acid
  • F – Fluorouracil
  • Irin – Irinotecan

If you can’t have FOLFIRINOX, you may have another combination of drugs:

Another combination of drugs is called GemCap. This is:

If you are not well enough to be able to have a combination of chemotherapy drugs, you might have gemcitabine on its own.

Can You Refuse Chemotherapy For Pancreatic Cancer

A person may decide to stop chemotherapy for pancreatic cancer or refuse it entirely because of the severe side effects that come with it. However, people should accept that this choice will reduce their chances of living longer. Discuss with your oncologist to consider the pros and cons in the case of advanced cancer.

In the advanced stage of pancreatic cancer, people may instead enroll in a hospice or palliative care program, which is available in many hospitals. Palliative care is a special kind of treatment reserved for people with a terminal illness, such as the last stages of pancreatic cancer. It aims to alleviate the symptoms, as well as provide comfort and better quality of life.

Alternative practices, such as yoga and meditation, help people affected with cancer or other serious illnesses. These make them feel relaxed and enable them to take control of their situation. They can register for programs that teach how to do them effectively.

It is normal to feel isolated when a person learns of their diagnosis. To get rid of the feeling, consider joining a cancer support group dedicated to pancreatic cancer. Options are plenty. People may look for one on the websites of organizations, such as the American Cancer Society, or in their locality. Sharing your feelings and journey with people who suffer from the same condition can help you feel at peace.

Pancreatic Cancer Prognosis & Survival

Each year more than 50,000 people in the United States are now diagnosed with pancreatic cancer . The prognosis is such that most of these people will have passed by the end of the first year. In the U.S., pancreatic cancer is 9th or 10th most commonly diagnosed cancer , but the fourth leading cause of cancer death in men and women.

Each year more than 50,000 people in the United States are now diagnosed with pancreatic cancer . The prognosis is such that most of these people will have passed by the end of the first year. In the U.S., pancreatic cancer is 9th or 10th most commonly diagnosed cancer , but the fourth leading cause of cancer death in men and women.

The prognosis of pancreatic cancer is a very tough, though the survival rates have been incrementally improving particularly over the past ten to fifteen years. It is important to realize that each person is individual each cancer is different. Statistics can only indicate what tends to happen in the aggregate, and not in the case of an individual person.

The median survival duration from the time of diagnosis until demise is arguably the worst of any of the cancers certainly of the major cancers. The median survival for untreated advanced pancreatic cancer is about 3 1/2 months with good treatment this increases to about eight months, though many will live much longer. We have encountered nine and eleven and twelve year survivors.

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How Long Does Chemo Work For Pancreatic Cancer

There are a number of factors that influence whether chemotherapy is a successful treatment option for pancreatic cancer and how long remission lasts. For example, the specific kind of chemotherapy drugs prescribed as well as the dosage and length of treatment are all important factors. Your treatment team will make recommendations based on your individual case. If the chemotherapy stops being a viable treatment option, your treatment team will consider other options.

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Three-dimensional conformal radiation therapy : 3D-CRT can precisely target radiation to the areas where cancer cells may be located and therefore minimize side effects from radiation to normal structures such as the liver, stomach, and kidneys. Because many patients with advanced pancreatic cancer may develop areas of cancer cells in the liver, low-dose radiation therapy aimed at the entire liver has been used in an attempt to destroy these cancer cells.

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What Are The Side Effects

Because chemotherapy attacks all rapidly dividing cells, including healthy cells, it can cause side effects. Medications are available to treat many of the common side effects. The specific side effects vary depending on the type of chemotherapy, dosage and length of treatment. Normal, healthy cells that divide rapidly, including bone marrow, blood cells, cells of hair follicles and cells in the reproductive and digestive tracts, are more likely to be damaged during chemotherapy treatment. The doctor and patient must often balance possible side effects with potential benefits of treatment. It is important to keep the doctor informed of any side effects or pain. The doctor can only make changes in treatment or treat side effects if he or she is informed by the patient.

The list below shows some of the common side effects that may occur due to chemotherapy drugs used to treat pancreatic cancer. It also indicates some potential ways to manage these side effects. This list is not comprehensive. Side effects are individual and may not occur in each person who receives treatment.

Treating Cancer Of The Ampulla Of Vater

The ampulla of Vater is the area where the pancreatic duct and the common bile duct empty into the duodenum . Cancer at this site can start in the pancreatic duct, the duodenum, or the common bile duct. In many patients, ampullary cancer cant be distinguished from pancreatic cancer until surgery has been done.

These cancers often cause early symptoms such as jaundice, so they are often found while they are still resectable. Surgery with the Whipple procedure is often successful in treating these early stage cancers. Adjuvant chemoradiotherapy is often recommended after surgery.

More advanced ampullary cancers are treated like pancreatic cancer.

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Stages Of Pancreatic Cancer

The different stages of Pancreatic Cancer include the following.

  • Stage 0: There are abnormal cells in the lining of the pancreas, which could be malignant.

  • Stage 1: The cancer is present in the pancreas only.

  • Stage 2: Cancer has spread to the nearby lymph nodes, tissues, or organs.

  • Stage 3: The cancerous cells have spread to the major blood vessels.

  • Stage 4: Cancer has metastasized to distant organs such as the abdominal cavity, liver, or lungs.

Signs That Pancreatic Cancer Has Spread

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If your pancreatic cancer has spread, you may notice new symptoms. Most often, pancreatic cancer spreads to the liver, but it can also move into the lymph nodes, abdomen, lungs and, sometimes, the bones.

Advanced pancreatic cancer symptoms may include:

  • General feeling of being unwell
  • Swollen stomach caused by fluid buildup
  • Lack of appetite

If you experience any of these symptoms, check with your doctor to determine a cause. Also, keep in mind that these symptoms may be due to other conditions.

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Newsimproved Detection And Treatment Of Pancreatic Cancer Provides Hope

Historically, doctors have given pancreatic cancer patients chemotherapy or radiation hoping it would cause the tumor to shrink or pull away from the artery or vein its ensnared. Truty believes thats the wrong approach. Youre going to be sorely disappointed if thats what youre expecting, Truty told NBC News.

The Mayo Clinic approach works like this: Patients are given extended, personalized chemotherapy until levels of a tumor marker in the blood called CA 19-9 fall to a normal range. Then if a PET scan shows the tumor is destroyed, doctors move forward with radiation and surgery.

Among 194 pancreatic cancer treated this way at the Mayo Clinic, 89 percent lived longer than the expected 12 to 18 months. The approach has pushed average survival to five years after diagnosis, according to a study by the Mayo Clinic.

And for about a third of patients in the study, Truty said his team couldnt even calculate their average survival because theyre alive and doing very well.

Outside pancreatic cancer experts say the Mayo approach is exciting. Its really remarkable to be able to accomplish this, said Allison Rosenzweig, senior manager of Scientific and Clinical Communications at the Pancreatic Cancer Action Network.

But Rosenzweig cautions the approach wont work for all patients diagnosed with stage 3 pancreatic cancer. Some wont respond to the chemotherapy necessary to kill tumor cells. Others are too sick to tolerate the therapy.

A Medical Oncologist Explains The Benefits And Risks Of Chemotherapy

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If you’re like many cancer patients, you immediately envision an unpleasant experience at the thought of chemotherapy: weeks of intense nausea and vomiting, diarrhea, fatigue and transient hair loss.

These preconceived ideas about chemotherapy arent entirely accurate. Many cancer patients do experience some side effects of chemotherapyboth short-term and long-termbut others experience very few. Cancer treatment is improving and changing rapidly. We have many more chemotherapy drug options to choose from than ever before. These drugs may be used in combination with one another or with other innovative treatments, so they may be just one piece of your cancer care.

Chemotherapy drugs dont all come with the risk of the same side effects. More medications and supportive therapies are available to help patients prevent and manage potential side effects. Many patients are surprised to find that not everyone experiences hair loss, and some patients actually feel better after starting chemotherapy when it causes the disease to regress.

Can you refuse chemotherapy? Yes. Your doctor presents what he or she feels are the most appropriate treatment options for your specific cancer type and stage while also considering your overall health, but you have the right to make final decisions regarding your care.

To help you make an informed decision about the benefits and risks of chemotherapy, this article addresses:

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Global Experts Around The Corner

She honed in on a very scary diagnosis.

I was convinced I had pancreatic cancer and I dont know how to get anyone to believe me, she said.

Finally, on Mothers Day in 2013, Marybeth went to an ER near her home. She knew a CT scan would show a tumor if she had one. Doctors there tried to reassure her that she was fine, but when the scans came back, they revealed a mass in Marybeths pancreas.

And with that, my life changed in a second.

The next day, not sure what to do, she went in to see her regular doctors. They were crestfallen that they had missed her cancer.

You dont think about yourself. You think about your family, she said.

While not offering false hope, Schulick explained that the team was going to start Marybeth immediately on intensive chemotherapy to see if the medication would attack her cancer.

Were going to see you back here in six months, he said.

In early June, Marybeth learned she was dealing with multiple areas of cancer, including spots on her liver and her lymph nodes. That meant her cancer was even worse stage IVB and the possibility that Schulick ever could cut out her original tumor grew even more remote.

Still, the fight was on.

And so began Marybeths 132 rounds of chemo.

Advantages To Giving Chemotherapy Before Surgery

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Although adjuvant chemotherapy has been shown to extend survival of patients with early-stage pancreatic cancer, Dr. Rudloff noted that waiting until after surgery to give chemotherapy has potential problems and might lead to inferior outcomes. When patients have surgery first, a proportion have complications and then arent healthy enough to receive chemotherapy, or there is a significant delay in starting chemotherapy, he said.

Almost all patients with early-stage disease likely have tiny, undetectable deposits of pancreatic cancer cells, called micrometastases, in other organs at the time of diagnosis, added Dr. Rudloff. So, if patients arent healthy enough to receive chemotherapy after surgery, they are at higher risk of their disease recurring earlier and having worse outcomes, he explained.

In addition, said Geertjan van Tienhoven, M.D., Ph.D., of the Academic Medical Center in Amsterdam, who presented results from the neoadjuvant chemotherapy study at ASCO, in some patients the tumor is too close to blood vessels to be safely removed completely . Giving chemotherapy before surgery may shrink such tumors enough to make complete removal safe.

Many oncologists who treat pancreatic cancer have already been giving neoadjuvant treatment, hoping to allow more patients to undergo surgery, explained Dr. Ocean. And now there’s data showing that we should, she said.

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How Pancreatic Cancer Is Treated

In cancer care, different types of doctors and other health care professionals often work together to create a patients overall care and treatment plan that combines different types of treatments and supportive care. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, patient navigators, social workers, pharmacists, counselors, dietitians, and others.

The common types of treatments used for pancreatic cancer are described below, followed by a general outline of treatments by stage. The current treatment options for pancreatic cancer are surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. Your care plan also includes treatment for symptoms and side effects, an important part of cancer care.

When detected at an early stage, pancreatic cancer has a much higher chance of being successfully treated. However, there are also treatments that can help control the disease for patients with later stage pancreatic cancer to help them live longer and more comfortably.

When Might Chemotherapy Be Used

Chemo is often part of the treatment for pancreatic cancer and may be used at any stage:

  • Before surgery : Chemo can be given beforesurgery to try to shrink the tumor so it can be removed with less extensive surgery. Neoadjuvant chemo is often used to treat cancers that are too big to be removed by surgery at the time of diagnosis .
  • After surgery : Chemo can be used after surgery to try to kill any cancer cells that have been left behind or have spread but cant be seen, even on imaging tests. If these cells were allowed to grow, they could form new tumors in other places in the body. This type of treatment might lower the chance that the cancer will come back later.
  • For advanced pancreatic cancer: Chemo can be used when the cancer is advanced and cant be removed completely with surgery, or if surgery isnt an option, or if the cancer has spread to other organs.

When chemo is given along with radiation, it is known as chemoradiation. It helps the radiation work better, but can also have more side effects.

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What Are The Different Types Of Chemotherapy

There are currently four chemotherapy drugs approved by the United States Food and Drug Administration for the treatment of pancreatic cancer: ABRAXANE® , Gemzar® , 5-FU and ONIVYDE® .

Gemzar® was approved in 1996 for the treatment of unresectable pancreatic cancer. Studies have also shown that there is a benefit to using Gemzar® after surgery. This is called adjuvant therapy. Prior to Gemzar®, 5-FU was used as the standard treatment for unresectable pancreatic cancer. Both of these drugs are still used today.

In September 2013, ABRAXANE® was approved to be used in combination with Gemzar® as first-line treatment for metastatic pancreatic adenocarcinoma, the most common type of pancreatic cancer.

ONIVYDE® , in combination with 5-FU and leucovorin, was approved in October 2015 as treatment for metastatic pancreatic adenocarcinoma that has progressed following treatment with gemcitabine based therapy.

Other chemotherapies for pancreatic cancer are still under investigation in clinical trials.

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Pancreatic cancer is especially challenging and deadly because theres no screening test for it.

For breast cancer, weve got mammograms. For colon cancer, weve got colonoscopies. For melanoma, we can do skin checks, Schulick said.

But theres no way to find pancreatic cancer until you find it. And by then, its often too late. Pancreatic is the No. 3 cancer killer in the U.S. behind lung cancer and colorectal cancer.

There are risk factors for pancreatic cancer like smoking and obesity. Age is a risk factor, as well, along with having a family member with pancreatic cancer, Schulick said.

Her athleticism, on the other hand, was a big help.

Whenever someone goes into treatment healthy, we can treat them with a tougher and more effective regimen, Schulick said. Its always better to go in in good shape. If youre frail, you cant get much chemo.

Schulick, who describes himself as conservative when it comes to using surgery with metastatic pancreatic cancer, made the rare decision to do a second surgery.

In the proper situation, Im willing to be very aggressive. I typically will vet my decision with the 30 pancreas experts who work with me in our multidisciplinary group. Its not something I do very often. You treat everyone and you follow them and see who responds. There are super-responders. Thats what I would call Marybeth, he said.

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Treating Borderline Resectable Cancer

A small number of pancreatic cancers have reached nearby blood vessels but have not grown deeply into them or surrounded them. These cancers might still be removable by surgery, but the odds of removing all of the cancer are lower, so they are considered borderline resectable.

These cancers are often treated first with neoadjuvant chemotherapy to try to shrink the cancer and make it easier to remove. Imaging tests are then done to make sure the cancer hasnt grown too much to be removed. As long as it hasnt, surgery is then done to remove it. This might be followed by more chemotherapy.

Another option might be to have surgery first, followed by adjuvant chemotherapy . If, during the surgery, it becomes clear that not all of the cancer can be removed, continuing the operation might do more harm than good. The surgery might be stopped, or the surgeon might continue with a smaller operation with a goal of relieving or preventing problems such as bile duct blockage.

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