Detection and Treatment of Pancreatic Cancer

By Avara, Ev

Each of us will be touched by cancer in our lifetime. Because of this, it is important to understand the different forms of cancer and the treatments available. Pancreatic cancer (pancreatic adenocarcinoma) is a silent and deadly form of cancer. If you or someone you know has this type of cancer, which is the fifth leading cause of cancer-related deaths in the United States, there are traditional and cutting-edge treatments available.

In 2007 there were approximately 37,000 documented cases of pancreatic cancer in the United States, which resulted in 33,350 deaths. It is most commonly found in people in their 60s or 70s; however, on rare occasions it has been found in people as young as 30. Most pancreatic cancer patients are cigarette smokers. Research shows that a smoker’s risk of developing pancreatic cancer is double that of a non-smoker.

“Other exposures such as alcohol abuse, caffeine or chemicals in certain foods have not been shown to increase one’s risk of developing this disease,” says Dr. David Zimmerman, with the Lutheran Cancer Center and FW Medical Oncology and Hematology. “But smoking, especially heavy smoking (two packs a day), increases one’s risk.”

Genetics also may play a part in the development of pancreatic cancer. “Molecular research has identified several genes that are associated with an increased risk for the development of pancreatic cancer,” explains Dr. Alan M. Yahanda of Indiana Surgical Specialists. “Inherited mutations or alterations in one of these genes may be seen in families in which there are several members with only pancreatic cancer or pancreatic cancer in association with other malignancies, such as melanoma and breast cancer.”

Early detection of pancreatic cancer is difficult. “Jaundice, or yellowing of the skin and eyes and a darkening of the urine, may be a noticeable symptom if the tumor is in the head of the pancreas where the common bile duct passes through the pancreas,” says Dr. Zimmerman. Other symptoms may include abdominal pain, back pain, unexplained nausea, loss of appetite or unintentional weight loss.

If cancer is suspected, a CT scan of the abdomen may be ordered by the doctor to get a closer look at the problem. Dr. Maurits J. Wiersema, with Indiana Medical Associates, says the CT can detect pancreatic mass lesions as small as two centimeters. “But,” he says, “a newer technology, endoscopic ultrasound (EUS), may be even more sensitive in detecting mass lesions as small as 0.5 centimeters. Additionally, the echoendoscope has a biopsy channel that permits a small gauge needle to be advanced under real-time ultrasound visualization through the intestinal wall to permit fine needle aspiration biopsy (EUS FNA) of the pancreas mass, lymph nodes or liver metastases.”

Once a diagnosis is made, treatment begins. Unfortunately, the three-year survival rate for pancreatic cancer is not promising. The national averages are 20.2 percent for Stage I cancer, 10.8 percent for Stage II cancer and 12.6 percent for Stage III cancer. In patients with Stage IV metastatic cancer, or cancer which has spread to other organs or tissues, the rate drops to 2.5 percent. Locally, the averages are a little better. Dr. Yahanda, who is the Cancer Liaison Physician for Parkview, says statistics from the Parkview Tumor Registry show the three-year survival rates for Stage I, II, III and IV pancreatic cancer are 27.4, 16.3, 12.8 and 6.4 respectively.

There are many different treatments for cancer. Some doctors consider pre-operative radiation (x-rays) and chemotherapy (drugs/ medications) to reduce the size of a tumor before putting the patient under the knife. “Studies have shown a better chance of obtaining a complete resection of the tumor after pre-operative therapy,” says Dr. David Hornback, of Radiation Oncology Associates. “However, no survival benefits have been seen.” He says this remains under investigation, but may be offered for patients who have borderline-resectable disease in hopes of shrinking the tumor and converting them to surgical candidates.

When surgery becomes the next option, removing the cancerous mass is the goal. The surgical approach for pancreatic cancer depends on its location within the gland. Anatomically, the pancreas can be divided into four regions – the head, neck, body and tail. Dr. Yahanda says, “Those cancers located in the head or neck of the pancreas are managed with an operation known as an ancreaticoduodenectomy. The operation is more commonly called a Whipple, named after the surgeon who first described the procedure in 1935.”

During this operation, the surgeon removes the head and neck of the pancreas, the entire duodenum and the lower portion of the bile duct. The gastrointestinal tract is then reconstructed by sewing the small intestine to the pancreas, bile duct and stomach. For those cancers located in the body or tail of the pancreas, patients undergo an operation known as a distal pancreatectomy, where two- thirds of the pancreas is removed. It also is customary to remove the spleen along with the end portion of the pancreas.

If the cancer surgeons do not feel that they can operate safely on a patient, then radiation and chemotherapy remain the best options. Unfortunately, some cancer patients cannot tolerate the side effects of these treatments, which often leave them feeling lethargic and extremely nauseated. Dr. Hornback says computer technology has made radiation treatments more targeted to cells affected by cancer. “Intensity Modulated Radiation Therapy (IMRT) allows us to wrap doses of radiation tightly around the tumor, while keeping doses to nearby, normalorgans to a minimum,” he says. “With this sophisticated radiation technique, we can deliver higher doses of radiation with fewer side effects.”

Pancreatic cancer has a high risk of recurrence and spreading after surgery and/or radiation and chemotherapy. Dr. Sreenivasa R. Nattam, of Fort Wayne Medical Oncology & Hematology, says that radiation therapy commonly is given postoperatively and is usually combined with chemotherapy. “Use of 5FU with Leucovorin is considered to be state-of-the-art approach and has demonstrated significantly improved survival,” he says. “This suggests a strong benefit to postoperative chemotherapy.”

At the Parkview Comprehensive Cancer Center, Dr. Hornback says, “We have the CyberKnife(R) – a robotic stereotactic radiosurgery machine that allows us to precisely target a tumor within the body or brain and deliver a high dose of radiation over the course of only three to five treatments.”

Overall, the cure rate for pancreatic cancer is still quite low, despite the advances in surgical techniques, radiation and chemotherapy. It is best to look at your family medical history to see if there is incidence of pancreatic cancer, melanoma or breast cancer. Also, if you are a heavy smoker, remember your risk of developing the disease doubles. FW Medical Oncology and Hematology has clinical trials available, which look to improve the outcomes of both metastatic and resectable disease. The doctors who contributed to this article remain optimistic about a cure and treatment. They will continue to study their patients to find out what else can be done to improve the pancreatic cancer survival rate.

Copyright Michiana Business Publications, Inc. Jan 2008

(c) 2008 Business People. Provided by ProQuest Information and Learning. All rights Reserved.