Pancreatic Cancer Stage 4 Treatment

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Help Getting Through Cancer Treatment

Understanding stage IV pancreatic cancer

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.

How Long Will I Live With Stage 4 Pancreatic Cancer

Stage 4 pancreatic cancer does not have many treatment options. Even with treatment, most people do not live for more than a year or two.

Based on SEERs data, the five-year survival rate for people diagnosed with distant pancreatic cancer is 3%. That means 3% of people with metastatic pancreatic cancer are alive five years after they are diagnosed.

The number changes based on age. People who are diagnosed when they are younger are more likely to live longer. For example, someone who is 50 years old when they are diagnosed with distant pancreatic adenocarcinoma has a 10.5% chance of surviving at least five more years.

Here’s a table that shows the survival rates for PACs.

Survival Rates for Distant Pancreatic Cancer, by Age
Age

PNET has an overall five-year survival rate of 51.3%.

  • The five-year survival rate for people with PNET that has not spread to other parts of the body is 93%.
  • If the tumor has spread to nearby tissue or the regional lymph nodes, the five-year survival rate is 77%.
  • If the tumor has spread to distant areas of the body, the survival rate is 25%.

Survival rates depend on different factors. For example, if the tumor can be taken out with surgery, a person might be more likely to live longer.

Treating Locally Advanced Pancreatic Cancer

In locally advanced pancreatic cancer, surgery can’t remove the entire tumor. Since surgery to remove only part of the pancreatic cancer has been shown not to help, nonsurgical therapies are best.

Treatment consists of chemotherapy with or without radiation therapy. Either 5-FU or gemcitabine can extend life in people with locally advanced pancreatic cancer.

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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.

How Is The Stage Determined

Pancreatic Cancer Stage 4 Pictures / Pancreatic Cancer Insidious And ...

The staging system used most often for pancreatic cancer is the AJCC TNM system, which is based on 3 key pieces of information:

  • The extent of the tumor : How large is the tumor and has it grown outside the pancreas into nearby blood vessels?
  • The spread to nearby lymph nodes: Has the cancer spread to nearby lymph nodes? If so, how many of the lymph nodes have cancer?
  • The spread to distant sites : Has the cancer spread to distant lymph nodes or distant organs such as the liver, peritoneum , lungs or bones?

The system described below is the most recent AJCC system, effective January 2018. It is used to stage most pancreatic cancers except for well-differentiated pancreatic neuroendocrine tumors , which have their own staging system.

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a persons T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage.

Cancer staging can be complex. If you have any questions about your stage, please ask your doctor to explain it to you in a way you understand.

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Treatment And Survival Rates Of Stage Iv Pancreatic Cancer At Va Hospitals: A Nation

Ibrahim Azar1, Gurjiwan Virk1, Saghi Esfandiarifard1, Ali Wazir1, Syed Mehdi2

1Department of Internal Medicine, 2Division of Hematology-Oncology, Department of Internal Medicine, Stratton Veterans Affairs Medical Center , , USA

Contributions: Conception and design: I Azar, S Mehdi, A Wazir Administrative support: S Mehdi Provision of study material or patients: None Collection and assembly of data: I Azar, G Virk, S Esfandiarifard Data analysis and interpretation: I Azar Manuscript writing: All authors Final approval of manuscript: All authors.

Correspondence to:

Background: Metastatic pancreatic cancer is associated with an extremely high mortality. Current NCCN guidelines recommend systemic therapy, as it is superior to best supportive care. Undertreatment of MPC continues to be an issue. Recent treatment and survival data of MPC in Veterans Affairs hospitals have not been published. The relationship between MPC treatment and survival and the American College of Surgeons Committee on Cancer accreditation in VA hospitals has not been studied.

Methods: Nationwide data from the National Veterans Affairs Cancer Cube Registry was analyzed. In total, 6,775 patients were diagnosed with MPC between 2000 and 2014. CoC accreditation of each VA hospital was obtained using the ACS website.

Treatment and survival of MPC have risen significantly in the past decade at VA hospitals. CoC accreditation is not associated with a change in treatment or survival rates.

Stages Of Pancreatic Cancer

Stage is a term used in cancer treatment to describe the extent of the cancer‘s spread. The stages of pancreatic cancer are used to guide treatment and to classify patients for clinical trials. The stages of pancreatic cancer are:

  • Stage 0: No spread. Pancreatic cancer is limited to the top layers of cells in the ducts of the pancreas. The pancreatic cancer is not visible on imaging tests or even to the naked eye.
  • Stage I: Local growth. Pancreatic cancer is limited to the pancreas, but has grown to less than 2 centimeters across or greater than 2 but no more than 4 centimeters .
  • Stage II: Local spread. Pancreatic cancer is over 4 centimeters and is either limited to the pancreas or there is local spread where the cancer has grown outside of the pancreas, or has spread to nearby lymph nodes. It has not spread to distant sites.
  • Stage III: Wider spread. The tumor may have expanded into nearby major blood vessels or nerves, but has not metastasized to distant sites.
  • Stage IV: Confirmed spread. Pancreatic cancer has spread to distant organs.

Determining pancreatic cancer’s stage is often tricky. Imaging tests like CT scans and ultrasound 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 . Pancreatic cancer is then described as follows:

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Systemic Therapy: Precision Cancer Medicine Chemotherapy And Immunotherapy

Systemic therapy is any treatment directed at destroying cancer cells throughout the body. Patients with locally advanced and metastatic pancreatic cancer require systemic treatment to decrease the chance of cancer recurrence and prolong survival. All patients should consider participation in a clinical trial evaluating new. systemic therapies which include precision cancer medicines and chemotherapy.

What Are The Symptoms Of Pancreatic Cancer

Pancreatic Cancer Stage 4

Most people dont experience early signs of pancreatic cancer. As the disease progresses, however, people may notice:

  • Upper abdominal pain that may spread to the back.
  • Yellowing of the skin and the whites of the eyes .
  • New or worsening diabetes.
  • Nausea and vomiting

Your healthcare provider might suspect pancreatic cancer if you have some symptoms and youve recently developed diabetes or pancreatitis a painful condition due to the inflammation of pancreas.

Symptoms of pancreatic neuroendocrine cancer may be different than the traditional pancreatic cancer symptoms, such as jaundice or weight loss. This is because some PNETs overproduce hormones.

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Smoking And Health History Can Affect The Risk Of Pancreatic Cancer

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer not having risk factors doesnt mean that you will not get cancer. Talk with your doctor if you think you may be at risk.

Risk factors for pancreatic cancer include the following:

Looking For The Right Custom Solution

In my laboratory we have studied hundreds of pancreatic cancer patients. What we find is that patients are quite unique.

While one patient is resistant to every drug, the next patient is sensitive to many. One patient may be a slam dunk for the DNA buzz saw while the next needs the rubber band effect of Abraxane, and never the twain shall meet.

More importantly, FOLFIRINOX and Abraxane plus Gemcitabine are not the only choices.

One combination known as GTX remains an active regimen with less severe side effects. Another combination, Cisplatin plus Gemcitabine, has re-emerged as a treatment for patients with certain DNA damage repair deficiencies like BRCA-2. All of these and others can be examined in the laboratory before patients start therapy as we previously reported

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Remission And The Chance Of Recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. It is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer returns after the original treatment, it is called recurrent cancer. Pancreatic cancer may come back in or near the pancreas , or elsewhere in the body .

When this occurs, a new cycle of diagnostic testing will begin again to learn as much as possible about the extent and location of the recurrence. After this testing is done, you and your doctor will talk about the treatment options. The treatment of recurrent pancreatic cancer is similar to the treatments described above and usually involves chemotherapy. Radiation therapy or surgery may also be used to help relieve symptoms. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

Choosing To Stop Treatment Or Choosing No Treatment At All

Stage 4 Bile Duct Cancer Symptoms

For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. Whether or not you continue treatment, there are still things you can do to help maintain or improve your quality of life.

Some people, especially if the cancer is advanced, might not want to be treated at all. There are many reasons you might decide not to get cancer treatment, but its important to talk to your doctors and you make that decision. Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms.

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Treatment Of Locally Advanced Pancreatic Cancer

For information about the treatments listed below, see the Treatment Option Overview section.

Palliative therapy can be started at any stage of disease. See the Palliative Therapy section for information about treatments that may improve quality of life or relieve symptoms in patients with pancreatic cancer.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Treatment Options By Stage Of Pancreatic Cancer

Different treatments may be recommended for each stage of pancreatic cancer. Your doctor will recommend a specific treatment plan for you based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier in this page. Clinical trials may also be a treatment option for each stage.

Below are some of the possible treatments based on the stage of the cancer. The information below is based on ASCO guidelines for the treatment of pancreatic cancer. Your care plan may also include treatment for symptoms and side effects, an important part of pancreatic cancer care. Also, patients with any stage of pancreatic cancer are encouraged to consider clinical trials as a treatment option. Talk with your doctor about all of your treatment options. Your doctor will have the best information about which treatment plan is recommended for you.

Potentially curable pancreatic cancer

Locally advanced pancreatic cancer

Metastatic pancreatic cancer

Your treatment plan may include a combination of the treatments discussed above. Treatment options for people with metastatic pancreatic cancer depend heavily on a patients overall health, preferences, and support system.

Information below is based on the ASCO guideline, Metastatic Pancreatic Cancer. Please note that this link takes you to another ASCO website.

Depending on factors such as your preferences, characteristics, and your comorbidity profile, first-line options include:

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Embolization Of Metastases In Germany

The embolization technique aims to block the blood vessels supplying the pancreatic tumor and its metastases. For this purpose, doctors use emboli in their medical practice. Emboli are various chemicals.

Recently, German doctors have increasingly used one specific variation of the procedure selective transarterial chemoembolization. This method involves the introduction of microspheres imbued with chemotherapy drugs as emboli.

Chemoembolization in cancer treatment contributes to the cessation of blood flow in the tumor, which leads to oxygen starvation of the cancer cells and therefore, their death. In addition, an embolus gradually releases a large number of chemotherapy drugs, which destroy the tumor and prevent its repeated growth.

This method has the following advantages:

  • It reduces the tumor size, so that it is possible to perform surgery
  • It increases the life expectancy of patients with inoperable tumors
  • The procedure is absolutely safe side effects develop in only 2-5% of cases and they can be easily eliminated with the help of symptomatic treatment
  • It allows the use of an increased concentration of chemotherapy drugs, which cannot be applied in a case of systemic chemotherapy due to their high toxicity
  • Antineoplastic drugs affect only the pathological focus, whilst leaving healthy cells intact
  • It does not require a long rehabilitation period.

Treatment Of Metastatic Or Recurrent Pancreatic Cancer

Veteran shares story of beating Stage 4 pancreatic cancer

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of pancreatic cancer that has metastasized or recurred may include the following:

Palliative therapy can be started at any stage of disease. See the Palliative Therapy section for information about treatments that may improve quality of life or relieve symptoms in patients with pancreatic cancer.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

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Locally Advanced Pancreatic Cancer

This type of pancreatic cancer has grown into nearby tissues, organs or a major blood vessel. Although it may be possible to remove the tumor, surgeons may not be able to extract all of the cancer via surgery. Chemotherapy or radiation therapy may be used to shrink the tumor, so it may be surgically removed.

What Resources Are Available For People With Pancreatic Cancer

You might find the following organizations to be helpful:

  • Visit our Butts & Guts Podcasts page to learn more about digestive conditions and treatment options from Cleveland Clinic experts.

A note from Cleveland Clinic

A pancreatic cancer diagnosis can be shocking and life-changing. You might consider joining a support group for people with pancreatic cancer. Spending time with others who are going through the same things can be empowering and beneficial for your mental and emotional health. You can also talk with a counselor, therapist or social worker about how youre feeling. Knowledge is power, and there are several helpful resources available for you and your family.

Last reviewed by a Cleveland Clinic medical professional on 09/07/2021.

References

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