Pancreatic Cancer Treatment

Pancreatic Cancer Treatment

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    A Surgery, answered on behalf of
    Who Is a Surgery Candidate for Pancreatic Cancer?
    Most people with pancreatic cancer are not good surgical candidates. Frederick Cason, MD from Oak Hill Hospital, goes into detail about disease confined to the pancreas and how that makes someone a good surgical candidate.
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    Onivyde (irinotecan) is a medication intended for the treatment of advanced pancreatic cancer -- that is, pancreatic cancer that has metastisized to other parts of the body. Onivyde is given as an intravenous infusion, and is FDA-approved for administration with fluorouracil (another anticancer drug) and leucovorin (a drug that protects healthy cells). It is intended for patients who have already tried gemcitabine-based chemotherapy. It is generally given once every two weeks. Onivyde, in combination with fluorouracil and leucovorin, causes severe diarrhea in 13% of patients; healthcare providers will administer loperamide to treat the diarrhea in this case. Fatal neutropenic sepsis -- infection from very low white blood cell counts -- in less than 1% of patients receiving Onivyde. About 1 in 5 patients receiving Onivyde with fluorouracil and leucovorin will face neutropenia, so white blood cell counts are watched closely. 
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    With the Whipple procedure, surgeons remove the head and sometimes the body of the pancreas, the lower portion of the stomach, the duodenum, and lymph nodes near the pancreas. Surgeons also remove the gallbladder and part of the common bile duct, and connect the remaining bile duct to the small intestine so that bile can enter the small intestine from the liver.

    For patients in whom the cancer has spread beyond the pancreas, other laparoscopic techniques are employed. Laparoscopic distal pancreatectomy is performed on patients with neuroendocrine pancreatic tumors and cysts. In this procedure, we remove the body and tail of the pancreas while preserving the spleen.

    Removing the tail was once considered too challenging due to its proximity to the splenic artery and vein. However, our surgeons have perfected the technique involved and now commonly perform spleen-preserving distal pancreatectomy with less blood loss, shorter hospital stays, and lower leak rates than patients operated on in open procedures.

    Central pancreatectomy may be performed to eliminate a cancer in the pancreas' body or neck without removing the healthy tail of the organ, enabling the patient to retain a functioning pancreatic head and tail and their respective functions.

    Total pancreatectomy surgery involves removing all or part of the pancreas, part of the stomach and small intestine, the common bile duct, gallbladder, spleen, and neighboring lymph nodes.
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    As with many cancers, surgery, chemotherapy and radiation are used alone or in combination to treat pancreatic cancer. There are, however, many surgical options to consider for pancreatic cancer, depending on the type and extent of the disease. The following are available surgical options:
    •Whipple Surgery - During this procedure, surgeons remove the head of the pancreas, most of the duodenum (a part of the small intestine), a portion of the bile duct, the gallbladder, and associated lymph nodes. In some cases, the entire duodenum and a portion of the stomach must be removed. In these instances, surgeons reconstruct the digestive tract. Surgeons at Johns Hopkins honed the procedure, drastically reducing the mortality rate associated with the surgery.
    •Distal Pancreatectomy - Surgeons remove tumors of the body and the tail of pancreas and leave the head of the pancreas intact.
    •Total Pancreatectomy - This procedure is the least common of all of the surgeries and is used when tumors extend throughout the pancreas. In a total pancreatectomy, surgeons remove the entire pancreas and the spleen, gallbladder, common bile duct, and portions of the small intestine and stomach.
    •Minimally-Invasive Pancreas Removal - Offered at only a select group of cancer centers like Johns Hopkins, this procedure can reduce blood loss, risk of infection and speed recovery. Eligibility depends on the tumor’s location, size and other medical factors.
    •Palliative Surgical Procedures - These operations, such as a biliary and gastric bypass (double bypass) or a celiac nerve block, are performed to improve a patient's quality of life by reducing disease symptoms and pain.
    Chemotherapy and radiation can also be employed - usually in combination with surgery - to cure the cancer (in early-stage diagnoses) or to prolong life:
    •Chemotherapy - The leading chemotherapy agent is a drug called gemcitabine or Gemzar, and combined with a drug called taxol, also known as Abraxane, has shown increases in survival length.
    •Radiation - Employing multiple beams of radiation, treatment can be very focused on the tumor, while limiting exposure to normal tissue. Stereotactic radiation therapy provides high doses of radiation over a shorter period of time than traditional radiation.
    A pancreatic cancer vaccine, developed at Johns Hopkins Kimmel Cancer Center, is being tested with promising results, showing a modest, yet real improvement in survival time.
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    The treatments for pancreatic cancer include those that remove the cancer, those that prevent the cancer from advancing, and those that relieve symptoms. If the pancreatic cancer is discovered in stage 0, when the abnormal cells are still in the pancreas and have not moved beyond it, surgery may be an option. Depending on where the tumor is located, the surgery may remove either the head, body, or tail of the pancreas. Other organs, or parts of organs, such as the spleen, stomach, and intestines, may need to be removed as well. Be aware that only a small percentage of pancreatic cancers are discovered in time to be surgically removed.

    Radiation therapy and chemotherapy, often combined with a surgical procedure, may also be used. In addition, there are a variety of newer treatment options under investigation. These include new drugs, new surgeries, and genetic approaches to treating pancreatic cancer. They also include biologic therapies, in which the person's own immune system is stimulated to fight the cancer.

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    Although surgery is the most successful treatment of stage 0 pancreatic cancer, it may not be possible for every person. A number of different drugs may be used to treat stage 0 pancreatic cancer, either in addition to surgery or, if surgery is not possible, to keep the cancer from advancing.

    Drugs used in chemotherapy are used to kill the cancerous cells in the pancreas. Other drugs may be used to prevent cancer cells from growing, reproducing, and spreading to other parts of the body.

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    Although alternative treatment options for cancer seem numerous, none of these have been shown to have an effect on pancreatic cancer. However, alternative medicine may offer relief from the emotional and physical stress of being diagnosed with stage 0 pancreatic cancer. These include art and music therapy, meditation, and relaxation.

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    The treatments for pancreatic cancer include those that remove the cancer, those that prevent the cancer from advancing, and those that relieve symptoms. If the pancreatic cancer is discovered in stage 1, surgery may be an option. Depending on where the tumor is located, the surgery may remove the head, body, and/or tail of the pancreas. Other organs, or parts of organs, such as the spleen, stomach, and intestines, may need to be removed as well. Be aware that only a small percentage of pancreatic cancers are discovered in time to be surgically removed.

    Radiation therapy and chemotherapy, often combined with a surgical procedure, may also be used. In addition, there are a variety of newer treatment options under investigation. These include new drugs, new surgeries, and genetic approaches to treating pancreatic cancer. They also include biologic therapies, in which the person's own immune system is stimulated to fight the cancer.

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    Although surgery is the most successful treatment for stage 1 pancreatic cancer, it may not be possible for every person. A number of different drugs may be used to treat stage 1 pancreatic cancer, either in addition to surgery, or if surgery is not possible, to keep the cancer from advancing. Drugs used in chemotherapy are used to kill the cancerous cells in the pancreas. Other drugs may be used to prevent cancer cells from growing, reproducing, and spreading to other parts of the body.

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    Although alternative treatment options for cancer seem numerous, judging from advertisements on televisions and the Internet, none of these have been shown to have an effect on pancreatic cancer. However, alternative medicine may offer relief from the emotional and physical stress of being diagnosed with stage 1 pancreatic cancer. These therapies include art and music therapy, meditation, and relaxation.