Pancreatic Cancer

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Treatment

The choice of treatment for pancreatic cancer depends largely on the stage of the disease. Treatment options include surgery, chemotherapy, radiation, and biological therapy (also known as immunotherapy).

Surgery
Surgery for pancreatic cancer often is used to treat Stage 1 cancer that is resectable. In some cases, the surgeon performs a resection, which is the removal of a small part of the pancreas.

More extensive surgery, called the Whipple procedure, involves removal of the pancreas head and nearby structures (e.g., the duodenum). It also may be necessary to remove the entire pancreas, as well as the spleen, gallbladder, and bile duct. Sometimes, the tumor cannot be completely removed. Most specialists believe that partial removal is not beneficial.

In some cases, a combination of therapies, such as radiation and chemotherapy, given before or after surgery, can increase survival.

Any form of surgery has potential side effects. Surgery for pancreatic cancer often involves a large incision in the abdomen. The healing process for major surgery can be very involved.

Patients may experience postsurgical pain, weakness, fatigue, loss of appetite, and infection. Medications often are used to treat side effects from surgery. Depending upon such factors as the patient's age, general state of health, type of surgery, and extent of cancer, side effects and recovery time vary considerably.

Following surgery for pancreatic cancer, the pancreas often no longer produces digestive juices and hormones. This can lead to digestive problems and/or diabetes, conditions that may be treated with changes in diet, medications, or hormone replacement.

Chemotherapy
Chemotherapy involves using drugs to destroy cancer cells. Chemotherapy may be used alone, or in combination with other treatments, to treat pancreatic cancer.

The method of administration varies, depending upon the type of drug. In some cases, chemotherapy drugs are delivered through a needle in a vein, which is known as intravenous, or IV. Other drugs can be swallowed (oral). Chemotherapy may be administered on an outpatient basis or during a stay in the hospital.

Because chemotherapy drugs travel through the bloodstream to every system of the body, chemotherapy is a systemic treatment. Widespread movement of the drugs throughout the body can cause many different side effects.

Cancer cells divide very rapidly. Chemotherapy drugs destroy cancer cells because they target cells that are dividing rapidly. However, there are many types of beneficial cells in the body that also divide rapidly and these cells can also be negatively affected by chemotherapy. Some of these cells and the side effects include the following:

• Lining of digestive tract–nausea, vomiting, diarrhea, poor appetite, mouth sores
• Hair roots–loss of hair
• Blood cells–anemia (weakening of red blood cells' ability to carry oxygen), reduced blood clotting ability, and reduced immune (disease-fighting) response

Medicines and other treatments can help reduce side effects of chemotherapy. Factors such as the patient's age and overall health, and the types and quantity of drugs can affect the severity of chemotherapy side effects.

Radiation Therapy
Radiation therapy involves using radioactive substances (i.e., high-energy rays, or radiation) to destroy cancer cells. In this treatment, special machines are used to direct radiation at the parts of the body with cancerous tumors, to destroy cancer cells while minimizing damage to healthy tissue.

Unlike chemotherapy, radiation is not carried throughout the body. As such, it is known as local therapy, rather than systemic therapy. However, there are still potential side effects associated with radiation therapy.

Side effects include fatigue, localized hair loss, changes to appearance of skin, and digestive problems. Medicines and other treatments can reduce the intensity of the side effects. As with other cancer treatments, the incidence of side effects varies with patient health and the exact nature of the treatment.

Biological or Immunotherapy
This form of therapy involves using drugs to boost the body's natural immune response (ability to fight disease). Examples of these drugs are interferon and monoclonal antibodies, which work with the body's immune system to block the growth of cancer cells. Biological therapy can be used alone or in combination with other therapies.

Immunotherapy can cause side effects that are similar to influenza (the flu), including fever, aches, weakness, fatigue, and chills. Patients may also experience skin problems such as easy bruising or rashes, as well as diarrhea and nausea.

Treatment of Pain
In pancreatic cancer, tumor growth can result in abnormal levels of pressure on nerves, which can cause pain. Pain is a major concern for patients who have pancreatic cancer. Treatments can help reduce pain when the reduction of the tumor (e.g., through surgery, chemotherapy, or radiation) relieves pressure on the nerves.

Over-the-counter and prescription pain relief medications can be used alone or in combination to reduce pain. The most common side effects of pain medications are fatigue and constipation. Frequent periods of rest and taking laxatives as directed by a physician can moderate these side effects.

When pain medications alone are ineffective, the oncology team may may decide to use other treatments that affect the nerves directly. These treatments include alcohol injections in a nerve to inhibit pain response and surgically severing nerves to prevent transmission of pain impulses.

Prognosis

Despite the many recent advances in cancer treatment , pancreatic cancer remains difficult to treat. There are several reasons for this, including tumor-related issues (i.e., low chemotherapy sensitivity, early metastasis, and low likelihood of resection at time of presentation) and treatment-related issues (i.e., limited effective chemotherapy drugs, non-optimal use of available treatments, severe side effects, and poor rate of participation in clinical trials).

There are many new and exciting avenues of therapy that are being studied, ranging from gene therapy to monoclonal antibodies to new combinations of chemotherapy drugs. Some of these experimental treatments may prove to be beneficial, and others may not provide significant improvement over today's therapies. Clinical trials are very important parts of pancreatic cancer research. Patients should speak with a physician about available clinical trials. Further research may provide more information about the causes for cancer of the pancreas and may lead to more effective preventive measures.

Prevention

Pancreatic cancer cannot always be prevented. As with many types of cancer, disease prevention involves moderating lifestyle and avoiding environmental exposure and other known risk factors. Quitting smoking, eating a low fat and low sugar diet, and minimizing long-term exposure to petroleum derivatives may reduce the risk for developing pancreatic cancer.

Follow-up Treatment
Patients who have pancreatic cancer cases, must receive effective follow-up care. Regular examinations are necessary to determine whether the cancer has returned or has advanced. Many of the same methods used to diagnose cancer (e.g., CT scans, MRI scans, x-rays) may be used to evaluate the patient's recovery. Ongoing treatments, such as hormone replacement therapy, also require regular monitoring.

Pancreatic Cancer, Treatment, Prognosis, Prevention reprinted with permission from oncologychannel.com
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