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Clinical Outcomes

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Pancreatic Cancer

The pancreas is a gland, about six inches long, located in the abdomen. It is shaped like a flat pear and is surrounded by the stomach, small intestine, liver, spleen, and gallbladder.

The pancreas is classified as both an exocrine gland and endocrine gland. Exocrine cells of the pancreas produce enzymes that mix with food in the intestines and help with digestion. When food enters the stomach, exocrine cells release the pancreatic enzymes into a system of small ducts that lead to the main pancreatic duct. The pancreatic duct runs the length of the pancreas and carries pancreatic enzymes and other secretions, collectively called pancreatic juice, into the intestines.

The endocrine function of the pancreas produces hormones — mainly insulin and glucagon — that go into the bloodstream. Together, these two hormones work to maintain the proper level of sugar in the blood.

Risk Factors for Pancreatic Cancer

  • Smoking – Smoking is a significant risk factor in about 25 percent of all pancreatic cancer cases. People who smoke cigarettes are twice as likely to develop pancreatic cancer as those who do not smoke.
  • Age – The chance of developing pancreatic cancer increases with age. Most people diagnosed with pancreatic cancer are over age 60.

Diagnosing Pancreatic Cancer

More than 95 percent of pancreatic cancers are classified as exocrine tumors because they start in the cells that produce digestive enzymes, including insulin. Cancer of the pancreas is sometimes called a "silent" disease because it doesn’t usually cause symptoms in early stages. Symptoms that commonly lead to diagnosis include:

  • Jaundice (yellowing of the skin)
  • Abdominal (belly) or back pain
  • Diabetes
  • Unexplained weight loss
  • Loss of appetite

If you experience one or more of the symptoms mentioned, it does not mean that you have pancreatic cancer. There are other common medical problems or conditions that also cause these symptoms. Therefore, anyone experiencing these symptoms should consult with a doctor.

Diagnosing pancreatic cancer can be difficult because symptoms are not always obvious and usually develop gradually. If you have symptoms that suggest pancreatic cancer, a variety of tests may be performed to make an accurate diagnosis.

First, the doctor will ask about your medical and family history and will perform a physical exam. The doctor will examine your body, including skin and eyes, and feel the abdomen to check for changes in the area near the pancreas, liver and gallbladder. Visual evidence of a pancreatic tumor is often first noted on a radiographic study such as a computed tomography (CT) scan or magnetic resonance imaging (MRI).

Treating Pancreatic Cancer

Depending on the type and stage of the cancer, patients may be treated with surgery, radiation therapy, chemotherapy, targeted therapy and/or palliative therapies. Some patients may receive more than one or a combination of these treatments.

  • Surgery–Surgery to remove a tumor offers the best chance for long-term control of all types of pancreatic cancer. If we believe we can completely remove a tumor by surgery, it is called resectable. About 15 percent to 20 percent of patients with pancreatic cancer have resectable tumors.

  • The Whipple Procedure, or pancreaticoduodenectomy, is the most commonly performed surgery to remove tumors in the pancreas. In a standard Whipple procedure, the surgeon removes the head of the pancreas, the gallbladder, part of the duodenum (the uppermost portion of the small intestine), a small portion of the stomach called the pylorus, and the lymph nodes near the head of the pancreas. The surgeon then reconnects the remaining pancreas and digestive organs so pancreatic digestive enzymes, bile, and stomach contents will flow into the small intestine during digestion. The surgery usually lasts between 3 and 6 hours.

  • Neoadjuvant Therapy–Cancer treatment given before the surgery is called neoadjuvant therapy. It generally involves chemotherapy alone or chemotherapy with radiation. Neoadjuvant treatment can reduce the size of the tumor so it is more easily removed during surgery. It can also reduce the chance of cancer recurrence.

  • Chemotherapy–Chemotherapy is cancer treatment that uses drugs to kill cancer cells by damaging their ability to grow and divide. We call drug treatments systemic therapy, because they go everywhere in the body to attack all cells, including cancer cells and healthy cells. Chemotherapy often prevents pancreatic tumors from growing and sometimes shrinks them.

  • There are two chemotherapy drugs approved by the U.S. Food and Drug Administration (FDA) to treat pancreatic cancer. In 1996, gemcitabine (Gemzar®) was approved as the standard treatment for pancreatic cancer. Prior to gemcitabine, 5-fluorouracil (5-FU) was used as the first-line treatment (the first drug used in each patient). Both of these medicines are still used today. In addition, clinical trials are in progress to study other chemotherapy agents and the effectiveness of various drug combinations.

    Chemotherapy may be given alone or in combination with surgery, targeted therapy (drug treatments aimed at specific cell processes or molecules), immunotherapy (the use of antibodies that attack very specific parts of cells), and/or radiation. Chemotherapy may enhance the effect of the radiation on the tumor. The chemotherapy drugs most commonly used to enhance radiation therapy are 5-fluorouracil (5-FU) and gemcitabine (Gemzar®).

    Chemotherapy drugs are usually administered through a vein into the bloodstream (intravenously), but some can be given by mouth (orally). Usually, patients receive chemotherapy as an outpatient treatment at a hospital, clinic or doctor’s office. The time needed for each treatment session depends on the type of chemotherapy.

  • Radiation Therapy–Radiation therapy uses high-energy X-rays or other types of high energy waves to kill cancer cells or prevent them from growing. Radiation treatment often prevents pancreatic tumors from growing and sometimes shrinks them. Since radiation therapy only affects the cancer cells in the area where it is aimed, it is considered a local treatment, like surgery.

  • Adjuvant Chemotherapy or Radiation Therapy–Adjuvant treatments are given after all the cancer we can see has been removed by surgery or treated with radiation. Often, adjuvant chemotherapy or radiation therapy is given after pancreatic cancer surgery to reduce the risk of cancer recurrence, or reappearance. Recurrence can occur when a microscopic amount of the cancer spreads prior to the surgery. The aim of adjuvant therapy is to kill microscopic cancer cells while their numbers are small and these treatments are more effective, thereby preventing tumor recurrence.

The graph below shows the overall survival for all patients under age 80 with pancreatic cancer by stage. These results compare favorably with the results of pancreatic patients in treatment trials, indicating the ability of our multidisciplinary teams to provide complex, integrated treatment programs.

Clinical Trials

Pancreatic cancer clinical trials, or research studies, are necessary to determine whether new treatments developed in the laboratory are beneficial to people with pancreatic cancer. The Food and Drug Administration (FDA) reviews and analyzes data from successful clinical trials to determine whether to approve an experimental treatment to treat a specific disease or disorder, such as pancreatic cancer.

  • Clinical trials are the only way that researchers can get the information to find effective new treatments for pancreatic cancer. Currently, only about 3 percent of adult cancer patients enroll in a clinical trial, which slows progress in finding better treatments. Many patients are not aware that taking part in a research study is an option.

  • It is important for you to know that inactive treatments, or placebos, are never used in place of effective cancer treatments in clinical trials. Participants in a cancer clinical trial will receive either the standard treatment or the new treatment.

  • Clinical trials for pancreatic cancer may be carried out using completely new treatments or to see whether treatments that work for other cancers or conditions are effective against pancreatic cancer.

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