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Pancreatic Cancer

About Pancreatic Cancer

Pancreatic cancer occurs when cancer cells develop in the tissues from which the pancreas is made.

This type of cancer is aggressive, since most of the patients are diagnosed in an advanced stage, where the disease is considered incurable, for the most part.

Pancreas cancer is hard to diagnose early since its symptoms do not usually appear in early stages.

In many cases until the patient is diagnosed with a pancreatic cancer there are already metastases elsewhere in the body (stage 4 metastatic pancreatic cancer).

The patient’s life expectancy is poor and currently stands on less than one year; this is with the support of the standard treatments.

To improve patients’ chances, the American Society for Clinical Oncology, ASCO, that includes various specialists in its panel, such as oncologists, radiologists, gastrologists among others, guides oncologists to inform pancreatic cancer patients in all topics related to clinical trials in every stage of their disease.

The National Cancer Institute, NCI, of the United States, stresses that for pancreatic cancer patients, the preferred treatment option is to join one of the many clinical trials around the world and thus increase the chances of success over the standard protocols.

Types of pancreatic cancer

Three sub-types of pancreatic cancer can be distinguished, based on the location of the tumor

  • Tumor in the pancreas head – mostly expressed with jaundice and inflammation of the pancreas parenchyma due to blockages it creates in the biliary and pancreatic ducts
  • Tumor in the pancreas body
  • Tumor in the pancreas tail

The pancreatic tumor may spread locally to adjacent blood vessels, lymph nodes, liver and less commonly to the lungs and bones.

Causes of Pancreatic cancer

Among the causes we may count

  • smoking
  • Obesity
  • Diabetes
  • Pancreatic inflammations
  • Other cancers.

Pancreatic cancer symptoms

Pancreatic cancer is usually discovered in later stages, as this is an internal organ.

The disease may be suspected in cases where one or more of the following symptoms appear and do not pass:

  • Jaundice (yellowing of the skin and the white of the eyes)
  • Pain in the upper or middle abdomen and in the back
  • An unexplained loss of weight
  • Loss of appetite
  • Diabetes
  • Fatigue
  • Depression

If the cancer is metastatic, meaning has sent metastases to distant organs such as the liver, lungs, bones, it might cause the following:

  • Bone pain (such as back pain or pain in the thighs)
  • Changes in the nervous system, such as: headaches, weakness or numbness of the arm or leg, dizziness, balancing issues or attacks
  • Appearance of lumps close to the body’s surface

Treatment goals

The treatment goals of pancreatic cancer may be

  • Curing (in very specific cases and depending on the stage in which the cancer was discovered and diagnosed, as well as its location in the pancreas)
  • Prolongation of life
  • Survival
  • Control of the cancer
  • Decreasing metastases size
  • Improve quality of life as much as possible.

Standard treatments

A number of therapies are possible, and many patients shall receive more than one type of therapy.

Pancreatic cancer surgery

Surgery is performed on patients that were diagnosed in stages 1 or 2 and may cure the patient if the cancer has not spread to other organs and is located in the pancreas alone.

In such a condition, a surgery is feasible with the intention not to harm the entire pancreas and preserve its normal functionality as much as possible.

A full removal of the tumor may assure a speedy recovery.

“Whipple surgery” 

(Whipple procedure pancreaticoduodenectomy) 

Pancreas head removing surgery, together with a part of the small intestine (the duodenum), gallbladder and the biliary and lymph ducts.

The surgery is possible when the tumor is small in size and has not yet metastasized.

When the tumor is located in the pancreas body or tail, a resection of this part of the pancreas will be performed.

This surgery is designated to remove a affected lobe of the pancreas with the goal to preserve its normal functionality.

A full removal of the tumor may assure a speedy recovery.

Regrettably, pancreatic cancer is mostly discovered when the cancerous cells have already spread to other organs and created metastases. In this condition the patient is deemed inoperable – the intention is to the metastatic stage, stage 4 patients.

Two main types of treatment may be offered to patients before and after surgery

  • Treatment prior to surgery is known as ‘Neoadjuvant’ 

Usually this stage of treatment will involve chemotherapy and/or radiotherapy intended to reduce the tumor’s size and improve the success of surgery.

  • Post-surgery treatment, also known as ‘Adjuvant’ 

This treatment seeks to cure and prevent the appearance of metastases or recurrence of the tumor.

Radiotherapy

In cases of incomplete excision, or in cases of near-blood vessel infiltration, high-energy radiation will be used to kill cancer cells left in the pancreas after surgery.

Radiation may also slow down tumor re-growth remaining in the pancreas.

Chemotherapy

Metastatic pancreatic cancer will usually be treated with chemotherapy – a therapy which aims to shrink tumors and kill cancerous cells to allow control over the disease.

Chemotherapy carries serious side effects, while its effectiveness is insufficient in metastatic disease.

Chemotherapy’s impact has a range of side effects such as hair loss, loss of appetite, changes to bowel movements, fatigue, infection, hemorrhaging, incontinence, pain, and more.

Chemotherapy will be given with or without radiation

Examples of standard protocols for treating pancreatic cancer:

Gemzar® and one or two of this drugs:

  • Abraxane®
  • Capecitabine®
  • Tarceva®
  • Leucovorin
  • 5-FU
  • Irinotecan
  • Oxaliplatin

Clinical trials for pancreatic cancer

Facts

  1. The existing therapies used on stage 4 metastatic pancreatic cancer are not curative, and this is a source to the need for innovative and effective treatment strategies in order to fight the disease.
  2. The National Cancer Institute, NCI, highlights the fact that for a certain group of pancreatic cancer patients, the best treatment option is to join one of the many clinical trials existing worldwide aiming to increase their chances of therapeutic success.
  3. Currently, every patient will be offered the standard protocols described above. Sometimes the oncologist may suggest integrating these therapies with trials carried out in the institute.

The opportunity

  1. Advances in cancer therapies may be found in clinical trials prescribing cutting edge, innovative drugs, some of which have already been recognized by the US Food & Drug Administration, the FDA, as “breakthrough drugs” and require further information to be approved.
  2. An entire world of clinical trials, Compassionate drugs and advanced new cancer treatments are available worldwide.
  3. It is important to know and have access to cutting edge cancer treatments that best match the unique medical condition of the patient and increase chances in winning the fight against compared to the standard care offered.

Example demonstrating the contribution of clinical trial to the lives of pancreatic cancer patients

In a scientific publication published in the Journal of Clinical Oncology, JCO, it was approved that life expectancy of patients with metastatic pancreatic cancer who participated in clinical trials was significantly longer than those who received standard treatments.

The researchers reviewed 27 studies involving 8,438 pancreatic cancer patients. The results were compared with patients who did not participate in clinical trials. The data were taken from National Cancer Institute’s National Registry’s data base, the NCI.

This is an epidemiological data source that investigates the prevalence and survival rates of cancer patients in the United States, The Surveillance, Epidemiology, and End Results, SEER”.

“We found that survival among metastatic patients participating in clinical trials almost doubled that of patients treated with the standard of care protocols. The most significant differences in survival was observed in pancreatic cancer patients whose prognosis was the worst”, said Professor Sacker, one of the authors of the paper.

Note to remember!

Not every patient is eligible to enter a specific clinical trial. The eligibility conditions must be fully met and each case is reviewed separately to ensure that the clinical trial matches to the specific cancer patient and vice versa.

References

https://www.fda.gov/
https://www.ema.europa.eu/
https://www.health.gov.il/Pages/HomePage.aspx
https://www.pancan.org/
https://www.cancer.gov/types/
https://www.cancer.org/
https://www.cancerresearchuk.org/
https://www.mdanderson.org/

Dear Reader,
This information is provided as a source of knowledge and does not constitute a medical consultation. For professional medical advice, see your attending physician. Information regarding drugs and commercial names belongs to the pharmaceutical companies.

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