This year in the United States, doctors will diagnose approximately 45,220 people with pancreatic cancer. Cancer of the pancreas claims 38,460 American lives annually and is the fourth leading cause of cancer related deaths. If detected early upto 20 percent of patients can be cured with surgical intervention, according to America’s top cancer doctor and surgical oncologist, Anton Bilchik, MD.
Pancreatic cancer is an uncontrolled growth of cells in the pancreas, which is responsible for producing insulin that controls blood sugar and enzymes to digest food. Pancreatic cancer usually begins in the ducts that carry the digestive enzymes. Left untreated, it can spread quickly to the lymph nodes, bile ducts, blood vessels, nearby small intestine, and liver.
Certain factors increase the risk for pancreatic cancer, including:
- Long-term diabetes
- Certain genetic disorders
- Chronic pancreatitis
Early detection is difficult because pancreatic cancer often does not cause symptoms right away. When symptoms do appear, they are often vague or too mild to notice. Symptoms include yellowing of the skin or eyes, pain in the abdomen and back, fatigue, and weight loss. Furthermore, the pancreas is located behind the stomach and other organs, in a place that is difficult for doctors to feel or see during a routine examination.
Physicians use physical exams, blood tests, imaging tests, and biopsies to diagnose pancreatic cancer. Blood tests include amylase and lipase that measure how well the pancreas functions, metabolic panels to test a variety of liver and kidney functions, and tumor marker tests such as CA 19-9 and CEA. The physician may order CT scans, ultrasound, or special MRIs to visualize the pancreas and surrounding structures.
Available treatments for pancreatic cancer
If possible, surgical resection offers the best chance for cure. This can be performed laparoscopically. Chemotherapy and radiation may provide additional survival benefit. Resection may include removal of the body or tail of the pancreas (distal pancreatectomy) or the head of the pancreas (the Whipple procedure).
In the Whipple procedure, the surgeon removes a small part of the pancreas, small intestine, bile duct, and stomach. In a distal pancreatectomy, the surgeon removes sections of the pancreas and sometimes the entire spleen. In a total pancreatectomy, the surgeon takes out the entire pancreas, part of the small intestine, some of the stomach, the common bile duct, gall bladder, spleen and nearby lymph nodes.
The size of the tumor does seem to affect survival rates – although larger tumors are more resistant to treatment. Survival is impacted by lymph node involvement and aggressive pathological. Removal of some of the surrounding blood vessels can be safely performed in attempt to remove all visible tumor.
Radiation and chemotherapy is often recommended after surgery, to destroy any residual surrounding tumor cells. The most commonly used chemotherapy drugs for pancreatic cancer are gemcitabine and 5-fluorouracil, known as 5-FU. More recently combination chemotherapy including oxaliplatin and irinotecan or gemcitabine and nab-paclitaxel have been shown to improve survival in patients with more advanced disease. For unresectable cancers stents, or flexible tubes, may need to be placed in the bile duct to keep fluids moving, reduce pain from pressure and eliminate bile backing up (jaundice).
While pancreatic cancer is a serious and life-threatening illness, early detection and aggressive treatment greatly improves survival rates. Anyone facing pancreatic cancer should consider all approaches to treatment and should be seen at a center with special expertise in pancreatic cancer surgery and treatments.