Treatment Of Pancreatic Cancer

Only stage I patients are surgically resectable, patients with the other stages are not. In a large series there were only about 25% of all patients whose pancreatic cancer could be resected (Ref.1, p.858). The surgery required for stage I patients is a horrendous one that lasts on average 7 hours and should only be done in a large Cancer Center, where the mortality rate for pancreatic cancer surgery is now only about 5% (used to be in the 20% to 30% range).

Surgery for pancreatic cancer, stage I (Whipple procedure)
1st step:	pancreaticoduodenectomy: this includes removal of gallbladder, stomach outlet, common bile duct, head of pancreas with the cancer in it, all parts of the duodenum and the fist part of the small intestine
the actual surgery
2nd step:	choledochojejunostomy: this reconnects the common bile duct stump to the small bowel
reconstruction
3rd step:	pancreaticojejunostomy: the cancer-free tail of the pancreas is connected to the small bowel
further reconstruction
4th step:	gastrojejunostomy: the stomach is sown to a loop of the small bowel
last part of reconstruction

With this Whipple procedure the cancer that would have certainly have spread, has been eliminated. However, there is still a high recurrence rate, as microscopic metastases will regrow later on. In one trial the treating physicians compared a group of patients with stage I pancreatic cancer, when they were treated only surgically, with a comparable group treated with subsequent radiation and chemotherapy to eradicate this problem. Here are the survival data for this group of stage I pancreatic cancers

*Effect of radiation and chemotherapy on pancreatic cancer*
Protocol of treatment:	2-year survival:	5-year-survival:
Whipple surgery alone	18%	7%
Whipple surgery + radiation + chemo-Rx	43%	20%

It is clear that there is a 25% survival advantage after 2 years and a 13% survival advantage after 5 years. However, compared with other cancers, the overall survival rates are still very disappointing. When compared though to survival rates of patients receiving no treatment for stage I pancreatic cancer, 100% of them usually die within 8 to 12 months.

Unfortunately chemotherapy and radiotherapy are not changing the survival figures for patients with stage II or III pancreatic cancer. Surgery has been shown to actually worsen the survival outlook in these patients and this is why at present this is not recommended.

The only hope for future breakthroughs in therapy for pancreatic cancer is a new approach, which includes some form of stimulation of the paralyzed immune system. Such research is on the way as can be seen from Ref. 3 and 4.

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Pancreatic cancer

Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

1. Cancer: Principles &Practice of Oncology.4th edition. Edited by Vincent T. DeVita, Jr. et al. Lippincott, Philadelphia,PA, 1993. Chapter on Cancer of the pancreas.

2. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Chapter on Cancer of the pancreas.

3. T Nishihara et al. Jpn J Cancer Res 2000 Aug;91(8):817-824.

4. L Staib et al. Int J Cancer 2001 Apr 1;92(1):79-87.

Last Modified: Feb. 1, 2008