The pancreas is a glandular organ located in the posterior aspect of the abdomen. It lies between the liver and the spleen, and just below and behind the stomach. The pancreas produces digestive enzymes (exocrine function), which are emptied into the small bowel, as well as the hormone insulin (endocrine function), which enters the blood stream.
Adenocarcinoma is a type of cancer that begins in the cells that line the glands and ducts within the pancreas. It accounts for 90% of cancers originating in the pancreas. Other types of cancer, such as islet cell tumors, also originate in the pancreas, but are not included in this overview. This treatment overview deals only with adenocarcinoma of the exocrine pancreas, which will be referred to as pancreatic cancer. There are approximately 37,000 individuals diagnosed with cancer of the pancreas in the United States each year, and approximately 34,000 individuals succumb to the disease annually. Pancreatic cancer is the fourth leading cause of cancer death in the United States.1
The treatment of pancreatic cancer may consist of surgery, chemotherapy, and radiation therapy, and is likely to involve several different types of physicians. These physicians may include a gastroenterologist, a surgeon, a medical oncologist, a radiation oncologist, or other specialists. Care must be carefully coordinated between the various treating physicians involved in management of cancer of the pancreas.
In order to understand the best treatment options available for treatment of pancreatic cancer, it is important to first determine where the cancer has spread in the body. The initial growth of pancreatic cancer occurs within the pancreas and may cause blockage of the pancreatic or biliary ducts and produce jaundice, a condition where the skin turns yellow. More advanced cancers may invade adjacent organs, such as the liver, bile ducts, and intestine or spread to lymph nodes, the lining of the abdominal cavity, or other organs in the body via the blood system. Pancreatic cancer cells have a propensity to spread via the blood to the liver and, less commonly, to the lungs.
Pancreatic cancers may cause blockage of the pancreatic and biliary ducts and produce jaundice.. A gastroenterologist may attempt to relieve jaundice using a special procedure where a scope is passed through the stomach into the area of the blockage. This procedure is known as endoscopic retrograde cholangiopancreatography (ERCP). An ERCP can also be used to sample (biopsy) any suspicious lesions in the area. Determining the extent of the spread or the stage of the cancer is of initial importance to determine whether the cancer can be removed surgically. Determining the stage of the cancer requires a number of tests including CT/MRI scans of the abdomen and other more-specialized procedures. Endoscopic ultrasound (EUS) may be used to determine the size of the cancer and whether surrounding lymph nodes may be enlarged. To exclude the possibility of blood vessel involvement, your physicians may pursue a visceral angiogram or MR angiography, which can detect irregularities in arteries.
Upon completion of the clinical “staging evaluation,” your physicians will determine whether the cancer can be removed by surgery. If there is no spread to other organs such as the liver, stomach, or spleen, and no involvement of major blood vessels, then surgery is performed through an abdominal incision to remove the cancer. The most common surgical procedure is a pancreaticoduodenectomy, or Whipple procedure. This procedure involves removal of a portion of the pancreas, duodenum, stomach, and the entire gallbladder. The exact surgical procedure may differ based on the location and extent of the cancer within the pancreas. Recent clinical studies have suggested that surgery is underutilized in patients with early-stage cancer of the pancreas, and that there is an opportunity to improve care of pancreatic cancer patients in the United States by offering surgery to all appropriate patients with early-stage operable disease.2
Following surgical removal of pancreatic cancer, a final “pathologic” stage will be determined. If the cancer cannot be removed by surgery, then the results of the clinical staging evaluation will be used to assign a stage. The stage is a number from I to IV used to describe the extent of cancer. All new treatment information concerning pancreatic cancer is categorized and discussed by stage. In order to learn more about the most recent information available concerning the treatment of pancreatic cancer, click on the appropriate stage.
Stage I: Cancer is confined to the pancreas.
Stage II: Cancer may extend to the duodenum, bile ducts, or fat surrounding the pancreas, but does not invade any local lymph nodes.
Stage III: Cancer invades one or more of the local lymph nodes and has extended to major blood vessels.
Stage IV: Cancer has spread to the stomach, bowel, or distant locations in the body, which may include the liver, lungs, bones, or other sites.
Recurrent/Relapsed: The pancreatic cancer has been detected or returned (recurred/relapsed) following an initial treatment.
2 National failure to operate on early stage pancreatic cancer. Annals of Surgery. 2007;246:173-180.
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