Questions To Ask Your Doctor When Diagnosed With Stage Iv Pancreatic Cancer
- What treatment do you recommend? Why?
- Are there any clinical trials available to me at this hospital? At other local hospitals?
- Do you offer molecular profiling or refer patients to the Pancreatic Cancer Action Networks Know Your Tumor® precision medicine service to help find other treatment options?
- What medicine will you prescribe to help control my side effects? Do these medicines cause other side effects?
- Do I need to change my diet?
- Is there a dietitian you recommend?
- Will I need to take pancreatic enzymes or vitamins? If so, how often?
- Should I make any lifestyle changes?
- What support programs are there for me and my family?
- Whom can I speak with about my financial or insurance concerns?
- Who can help me navigate the medical system? Is there an oncology social worker or patient navigator at this hospital?
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.
Symptoms Of Metastatic Pancreatic Cancer
The symptoms of metastatic pancreatic cancer can be challenging to detect and are often confused with those of other conditions. However, there are some early warning signs to look out for, and you should see your physician if you experience any of the following:
- Pain in the back or abdomen which may be worse when lying down or after food
- Loss of appetite
- Dark yellow or orange urine
- Pale or loose stools
- Blood clots or deep vein thrombosis
Many of these symptoms can be associated with other, less serious conditions. However, they should never be ignored. Early diagnosis is key to improving your prognosis, and so the above symptoms should always be investigated urgently.
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Endpoints Variables And Assessments
The primary endpoint was the evolution of HRQoL in patients with mPAC treated with first-line chemotherapy in a routine clinical practice setting. HRQoL was assessed using two self-administered questionnaires: the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire , and the European Quality of Life-5 Dimensions . The QLQ-C30 is a 30-item, cancer-specific multidimensional questionnaire designed for prospective clinical studies that includes five functional scales , three symptom scales , a global health and quality-of-life scale, additional specific symptoms commonly reported by cancer patients , and the perceived financial impact of the disease and treatment . The EQ-5D is a 5-item generic measure of health status, including five dimensions and a Visual Analog Scale . Both questionnaires, which have been translated to Spanish and validated in the Spanish population , were administered during routine follow-up visits at baseline and at each visit during the Treatment Period.
Why Is Stage Iv Hard To Treat
Pancreatic cancer is hard to treat at any stage. The more the cancer spreads, the more challenging treatment becomes.
Surgery is the best option for long-term survival of pancreatic cancer. Because stage IV cancer has spread to different parts of the body, it cannot be removed by surgery.
Some patients also respond better to a certain treatment than others for unknown reasons. Stage IV patients may have to try different treatments before one works for them.
Also, a dense tissue layer, called the stroma, surrounds pancreatic tumors. This makes it hard for treatment to reach the tumor. Researchers are studying ways to get treatment through the stroma to make it more effective.
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Pancreatic Cancer Nutrition: 12 Pancreatic Diet Tips
People diagnosed with Pancreatic cancer often find it difficult to maintain their weight and follow a healthy diet. The pancreas is an organ located in the abdomen, behind the stomach near the small intestine, gallbladder and duodenum. It has an essential role to help convert the food we eat into fuel for the bodys cells. Food may not be digested properly if the pancreas is not functioning due to cancer.
The pancreas has two main functions: an exocrine function that helps in digestion of food and an endocrine function that regulates blood sugar. Even if patients continue to eat and digest food normally, pancreatic cancer releases compounds into the bloodstream that break down muscle and fat, causing patients to lose weight and muscle mass, as well as feel fatigued.
Dietitians work closely with your care team to help you maintain good nutrition and maximize your health. They can assess your needs and design a diet plan that best meets your needs, including supplementary insulin or pancreatic enzymes. Dietitians can also help you alter the consistency, fiber content or fat content of your diet to prevent you from becoming malnourished.
Pancreatic Cancer: How Staging Works
The Importance of Staging
After youre diagnosed with pancreatic cancer, your doctor will work to identify your cancers exact stage. Knowing a cancers stage is vital to understanding and making decisions about your treatment options, as well as to predict your outlook.
Learn how staging works and understand how to make sense of the terms, letters, and numbers that doctors use to talk about pancreatic cancer.
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Study Design And Population
This was an observational, prospective, multicenter study including patients with histologically confirmed mPAC from 12 Spanish centers, who had started first-line chemotherapy. Adult patients with a Karnofsky Index 70 and a life expectancy 6months, who attended routine follow-up visits between October 2014 and October 2015, were consecutively included in the study. No other recruitment sources were considered. Patients that were pregnant or breastfeeding, participating in a clinical trial, or unable to understand or answer questions related to their health were excluded from the study. Baseline demographic and clinical data were collected from the medical records at the initiation visit . Assessments, which were scheduled to match routine visits, were performed at baseline, at Days 15 and 30, and every 4 weeks up to 6months after starting chemotherapy . After this time, patients were followed up every 6months for up to 18months to assess survival .
Improved Survival With Folfirinox Compared To Gemzar For Treatment Of Metastatic Pancreatic Cancer
The results of this Phase III study were presented at the annual meeting of the American Society of Clinical Oncology and published in the New England Journal of Medicine suggest that the combination known as FOLFIRINOX may be more effective than Gemzar. A large trial compared overall survival among patients treated with FOLFIRINOX to Gemzar alone. The study involved 342 patients with metastatic pancreatic cancer.6
- Survival among patients receiving FOLFIRINOX was just over 10 months compared with approximately seven months among those receiving Gemzar alone.
- Progression-free survival was also significantly improved among the FOLFIRINOX group: six months versus three months.
- Side effects of therapy with FOLFIRINOX were greater than those observed with Gemzar alone but were considered manageable.
Herceptin® : Herceptin is a monoclonal antibody, which is a type of targeted therapy that binds to the HER2 receptor, in approximately 20% of patients with pancreatic cancer. This binding action appears to stimulate the immune system to attack and kill the cancer cells to which Herceptin is bound.
Researchers from Brown University reported that treatment of patients with advanced pancreatic cancers that overexpress HER2 with Gemzar plus Herceptin appears to produce longer survival than treatment with Gemzar alone. Approximately 72% of patients treated with the combination demonstrated an anticancer response. Approximately 24% of patients lived one year or more following treatment.7
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Stage 4 Pancreatic Cancer
- Cancer Treatment Expert
Stage 4 Pancreatic Cancer is an advanced stage of pancreatic cancer in which the tumor metastasizes to other organs. 53% of diagnosed pancreatic cancer cases are in the 4th stage. It is not possible to fully cure, but treatments increase the life expectancy of the patient while improving their quality of life.
Stage 4 pancreatic cancer is a stage in which pancreatic cancer metastasizes to organs such as the intestine, lung, liver and stomach. At this stage, the 5-year survival rate is approximately 3%. On average, most patients survive one year after diagnosis. The nature and spread of the cancer limit the available treatment options.
Metastatic Pancreatic Cancer Prognosis
One of the most significant problems with metastatic pancreatic cancer is that it does not usually cause any symptoms in its early stages. In the early stages of metastatic pancreatic cancer, it often remains undetected until it has already begun to spread. At this point, it becomes far more challenging to treat metastatic pancreatic cancer effectively, and the prognosis is generally poor.
The prognosis for metastatic pancreatic cancer is determined using something called the “five-year survival rate.” This prognosis means the percentage of people who will still be alive five years after their initial diagnosis.
The outlook for pancreatic cancer varies significantly depending on how advanced it is when first diagnosed. According to the American Cancer Society, the five-year survival rates for pancreatic cancer are as follows:
- Localized : 34%
- Locoregional : 12%
- Metastatic : 3%
Since pancreatic cancer is often not diagnosed until it has already begun to spread, the overall five-year survival rate is low. However, the prognosis can be significantly improved if symptoms are spotted early.
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What Is Metastatic Pancreatic Cancer
The word “metastatic” means cancer that spreads from one part of the body to another. Metastatic pancreatic cancer starts in the pancreas and spreads to the surrounding organs, including the liver, stomach, spleen and intestines.
The pancreas is a small gland which is shaped like a leaf and located just below the stomach. Its functions include excreting enzymes which aid the digestive process and the hormones insulin and glucagon, which help to control blood sugar.
The most common type of pancreatic cancer is called adenocarcinoma, and this starts in the enzyme-producing cells of the pancreas.
When pancreatic cancer begins to spread, it usually affects the lymph nodes and blood vessels surrounding the pancreas first. It is known as locally advanced or locoregional pancreatic cancer. At this stage, cancerous cells may also spread to the bile duct, stomach, or duodenum .
When cancerous cells spread further to affect the liver, spleen, large intestine, lungs, or peritoneum , this is known as metastatic pancreatic cancer.
Stage 4 Pancreatic Cancer Life Expectancy
Pancreatic cancer is known as a type of cancer that originates within the pancreas. Much like other forms of cancer, pancreatic cancer progresses into several different stages, which often indicate the progression of the severity of the disease. In most cases, pancreatic cancer that has progressed past a certain stage becomes fatal.
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Treating Metastatic Pancreatic Cancer
In metastatic pancreatic cancer, surgery is used only for symptom control, such as for pain, jaundice, or gastric outlet obstruction. Radiation may be used for symptom relief, as well.
Chemotherapy can also help improve pancreatic cancer symptoms and survival. Gemcitabine has been the most widely used chemotherapy drug for treating metastatic pancreas cancer. Other drug combinations include gemcitabine with erlotinib , gemcitabine with capecitabine, gemcitabine with cisplatin, and gemcitabine with nab-paclitaxel. If youâre in fairly good health you may receive FOLFIRINOX . Other combinations include gemcitabine alone or with another agent like –paclitaxel or capecitabine. Next line drug combinations to treat pancreatic cancer include oxaliplatin/fluoropyrimidine, or irinotecan liposome in combination with fluorouracil plus leucovorin. The drug olaparib has been approved for metastatic patients with the BRCA gene mutation whose cancer has responded well to chemotherapy.
Factors That Influence Survival
A prognosis is a prediction made at diagnosis of how the disease will progress. The prognosis for every case of cancer is different and is affected by many factors not reflected in the SEER statistics. Chief among them is the stage and type of cancer, but other factors can also contribute.
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Medically Reviewed By Dr Ch Weaver Md Medical Editor Updated 2/2020
Pancreatic cancer is considered stage IV or metastatic if it has spread to distant locations in the body, such as the liver, lungs, or adjacent organs including the stomach, spleen, and/or the bowel. Sometimes it can only be determined that a pancreatic cancer is in stage IV once surgery is completed.
Pancreatic Cancer Diet Tips
Chemotherapy, radiation and surgery are treatments available for pancreatic cancer. Regardless of treatment type, pancreatic cancer takes a toll on the body and a persons ability to maintain a healthy diet and nutrition. Below are some tips patients with pancreatic cancer find helpful to optimize nutrition during and after treatment.
Monitor and maintain a healthy weight. It is normal to lose some weight after being diagnosed with pancreatic cancer and beginning treatment. Excessive weight loss and poor nutrition can cause a decrease in the bodys ability to fight infection and tolerate treatment. To help maintain a healthy weight:
Stay hydrated. Drink enough fluid during cancer treatment to prevent dehydration.
High-protein foods with every meal. Protein-rich foods help the body repair damaged cells and assist the immune system in recovering from illness. Lean proteins are easy to digest and should be included with each meal and snack.
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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.
Positron Emission Tomography Scan
For this nuclear medicine test, a small amount of radioactive sugar is injected through a vein before the body is scanned. The radioactive sugar collects mainly in cancer cells, which then show up on the images. This test is not as specific as CT scanning and is not used alone to diagnose pancreatic cancer. A PET scan is often done in combination with a CT scan.
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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.
Patient Characteristics And Treatment Outcome
Of the 120 patients recruited, four were excluded for not having a first-line chemotherapy regimen scheduled , being enrolled in a clinical trial , declining to participate in the study for personal reasons after signing the informed consent , and withdrawing for not having started treatment . The resulting study sample included 116 patients, of which 101 had concomitant diseases, with a median age of 65.0 years and a median Body Mass Index of 23.9 kg/m2. Table summarizes the demographic and clinical characteristics of study patients at baseline and main treatment characteristics.
Table 1 Characteristics of study patients and treatment
Of these 116 patients, 113 started chemotherapy in the study setting and were treated for a median of 3.9 months. Median OS was 9.0months and median PFS was 6.0months . ORR was 32.6%, with three and 24 patients achieving complete and partial responses, respectively 32 patients had stable disease. The number of patients assessed gradually declined during the Treatment Period due to death or disease progression , with 40 study patients remaining at the end of the 6-month treatment, and 22 completing all study visits.
Table 2 Common treatment-related adverse events of grade3 classified by System Organ Class and Preferred Term,
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Endoscopic Ultrasound And Fine Needle Biopsy
During this procedure, the doctor passes a thin, lighted tube called an endoscope through the patient’s mouth, down through the stomach and into the first part of the small intestine. At the tip of the endoscope is a device that uses ultrasound waves that produce patterns of echoes as they bounce off internal organs. These ultrasonic patterns can help identify small cancers that cannot be detected by a CT scan. Using X-ray or ultrasound techniques to help guide the needle, the doctor inserts a very thin needle into the pancreas to remove cells to be studied under the microscope.
What Is Pancreatic Cancer
The pancreas is the internal and external gland located at the back of the stomach. It controls the bloods level of insulin and glucose obtained from foods consumed. It produces enzymes for the digestion of food. In addition, it has many important functions such as breaking down proteins and digesting fatty substances. Uncontrolled growth of cells in this organ causes pancreatic cancer. It is a rapidly spreading and aggressive cancer type.
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