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Treatment Options for Pancreatic Cancer

Surgery

20% of pancreatic cancer patients may be eligible for surgery, data shows that up to half of those patients are told they are ineligible. The Pancreatic Cancer Action Network strongly recommends you see a surgeon who performs a high volume of pancreatic surgeries (more than 15 per year) to determine eligibility.

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For eligible patients, surgery is the best option for long-term survival of pancreatic cancer. Data shows high volume surgeons at high volume hospitals have higher success rates and fewer complications. The Pancreatic Cancer Action Network strongly recommends you have a high-volume pancreatic surgeon (more than 15 surgeries per year) perform the surgery.

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  • Whipple Procedure (Pancreaticoduodenectomy): This extensive surgery is primarily used for tumors located in the head of the pancreas. It involves the removal of the head of the pancreas, the duodenum, a portion of the bile duct, and sometimes a portion of the stomach. The remaining organs are then reconstructed to allow for digestion.

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  • Distal Pancreatectomy: This surgery removes the body and tail of the pancreas. It is often used for tumors located in these areas. The spleen may also be removed if it is involved.

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  • Total Pancreatectomy: In cases where the cancer has spread throughout the pancreas, a total pancreatectomy involves removing the entire pancreas, the spleen, and sometimes parts of the stomach and small intestine. Total pancreatectomy results in diabetes because the pancreas is responsible for producing insulin.

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Whipple Procedure (Pancreaticoduodenectomy)

The Whipple procedure is the most common surgery for tumors located in the head of the pancreas. It's a complex and extensive operation that involves several steps:

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  • Removal of the Head of the Pancreas: The surgeon removes the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder, the common bile duct, and sometimes a portion of the stomach.

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  • Reconstruction: After removing these organs, the surgeon reconstructs the digestive system. The remaining part of the pancreas, the remaining stomach, and the remaining small intestine are reconnected to allow for digestion to continue.

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  • Biliary Reconstruction: The common bile duct is reconnected to the small intestine to allow bile to flow into the intestine for digestion.

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  • Pancreatic Reconstruction: The remaining part of the pancreas is reconnected to the small intestine, allowing pancreatic enzymes to enter the digestive tract and aid in digestion.

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Recovery from a Whipple procedure can be challenging, and patients may experience changes in digestion and the need for enzyme replacement therapy to aid digestion.

Distal Pancreatectomy

  • This surgery is performed when tumors are located in the body or tail of the pancreas. It involves removing the affected part of the pancreas, which may also include the spleen if it's involved.

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  • Distal pancreatectomy is generally associated with a shorter recovery period compared to the Whipple procedure.

Total Pancreatectomy

  • Total pancreatectomy is an extensive surgery where the entire pancreas is removed, along with the spleen and sometimes portions of the stomach and small intestine.

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  • This procedure is considered when the cancer has spread throughout the pancreas or when there are multiple tumors within the pancreas.

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  • A major consequence of total pancreatectomy is the development of diabetes because the pancreas is responsible for producing insulin. Patients who undergo this procedure will require lifelong insulin therapy.

Complications of Pancreatic Surgery

Pancreatic surgery is highly complex and can be associated with various complications, including:

  • Pancreatic Fistula: This is a leakage of pancreatic juices after surgery. It can be managed with drainage and sometimes requires additional procedures.

  • Infection: Postoperative infections can occur and may require antibiotics.

  • Bleeding: Although rare, bleeding can occur during or after surgery.

  • Delayed Gastric Emptying: Some patients may experience slow stomach emptying after surgery, which can lead to nausea and vomiting.

Minimally Invasive Surgery

In recent years, minimally invasive techniques such as laparoscopic and robotic-assisted surgeries have been used for some pancreatic surgeries. These techniques can result in shorter hospital stays and faster recoveries.​The choice of surgery depends on factors such as the location of the tumor, its size, the stage of the disease, and the patient's overall health. Additionally, postoperative care and recovery management are critical aspects of achieving the best possible outcome after pancreatic surgery. Patients should work closely with their healthcare team to address any concerns and ensure a smooth recovery process.

IRE of the Pancreas

IRE (Irreversible Electroporation) is a relatively new and innovative technique used for the treatment of pancreatic cancer, particularly in cases where surgery is not an option due to the tumor's location or the patient's overall health. IRE is a non-thermal, minimally invasive procedure that uses electrical pulses to destroy cancerous cells. IRE does not injure surrounding non-cancerous cells, blood vessels and other vital structures. It has been in patients since 2008 in the treatment of some types of cancers. One of the largest unmet needs in cancer that IRE has been used is in locally advanced (Stage III) pancreatic cancer.  Studies have demonstrated its safety with encouraging improvement in overall survival. There are limitations to the treatment and every patient does not qualify.

Radiation Therapy

External Beam Radiation: High-energy X-ray beams are directed at the tumor to kill cancer cells or shrink the tumor. Radiation therapy may be used before surgery to shrink the tumor or after surgery to destroy remaining cancer cells.

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Brachytherapy: This involves placing radioactive materials directly into or near the tumor. It can be used in cases where external beam radiation is not suitable.

Chemotherapy

Chemotherapy drugs are used to kill cancer cells or inhibit their growth. In pancreatic cancer, chemotherapy is often administered in cycles, and different drug combinations may be used. Commonly used drugs include gemcitabine, fluorouracil (5-FU), and nab-paclitaxel.

Targeted Therapy

Targeted therapies are drugs that specifically target molecules involved in cancer growth. Erlotinib and cetuximab are examples of targeted therapies used in pancreatic cancer treatment. They are often used in combination with chemotherapy.

Immunotherapy

Immunotherapy drugs, such as checkpoint inhibitors (e.g., pembrolizumab), are being studied in clinical trials for pancreatic cancer. These drugs aim to stimulate the immune system to recognize and attack cancer cells.

Radiation Therapy

External Beam Radiation: High-energy X-ray beams are directed at the tumor to kill cancer cells or shrink the tumor. Radiation therapy may be used before surgery to shrink the tumor or after surgery to destroy remaining cancer cells.

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Brachytherapy: This involves placing radioactive materials directly into or near the tumor. It can be used in cases where external beam radiation is not suitable.

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