The pancreatic cancer treatment depends on the overall stage, a location of the tumor, the performance status of the patient, along with other factors. Surgical resection (complete removal) of tumors limited to the superficial layer of pancreatic duct cells generally provides long-term survival. However, a very few pancreatic cancers are diagnosed at an early stage and are considered surgically resectable. Most of the pancreatic cancers are diagnosed at a higher stage when they have invaded in important nearby structures or have spread to distant organs and are considered unresectable. In such cases, treatments like chemotherapy, radiotherapy, and some palliative therapies are mostly employed, which have limited efficacy in the treatment of pancreatic cancer. Based on the results obtained from various clinical research studies carried out so far, the following are the preferred pancreatic cancer treatment approach for different stages of cancer:
|Stage||TNM Score||Preferred Treatment|
|I||T1-2 N0 M0||Tumors are considered resectable
Radical pancreatic resection such as Whipple procedure (resection of pancreas and duodenum), or partial pancreatic resection (depending on location, extent of tumor, etc) is considered the preferred treatment approach in case of resectable tumors
|II||T1-3 N0-1 M0||Tumors are considered borderline resectable
Chemotherapy with or without radiation therapy is generally employed followed by surgery (if disease become resectable)
|III||T4 N0-1 M0||Tumors are considered unresectable
Chemotherapy and/or radiation therapy is generally warranted along with palliative therapy such as surgery (biliary/gastric bypass) or endoscopic biliary stent placement
|IV||Any T Any N M1
|Chemotherapy is the mainstay of treatment in case the disease has spread to distant body parts
Along with the chemotherapy, palliative therapy to relieve pain or stent placement may be employed as and when required
|Recurrent||Any T Any N Any M||Chemotherapy and/or radiation therapy is generally employed along with palliative therapy such as surgery (biliary/gastric bypass) or endoscopic biliary stent placement|
Following is the brief description of various pancreatic cancer treatment:
1.Surgery: Surgery provides significantly longer survival and is considered as the treatment of choice for resectable pancreatic cancers. Radical pancreatic resection such as Whipple procedure or partial pancreatic resection are some common surgical procedures employed with a curative intent for resectable or borderline resectable pancreatic cancer. For unresectable pancreatic cancers, surgery is employed for palliation of symptoms, which may include biliary/gastric bypass surgery and biliary stent placement to relieve bile duct blockage.
2.Chemotherapy: Chemotherapy means treatment with anti-cancer drugs that kill or decrease the growth of rapidly growing cancer cells. It is considered to be the mainstay of treatment for advanced stage disease that has spread to distant body parts. Depending on the physician’s preference and patient’s condition, it may also be combined with other treatment options to accelerate the benefit achievement. It may be associated with side effects due to its effect on normal body cells apart from cancerous cells.
3.Targeted Therapy: Targeted drugs are designed to target a specific gene or protein characteristic of the pancreatic cancer cells. With the advancement in diagnostic techniques, a number of genetic abnormalities for pancreatic cancer have been identified that can be targeted with the help of targeted drugs. For example, erlotinib targets epidermal growth factor receptor (EGFR). They are generally used alone or in combination with chemotherapy for the treatment of higher stage disease.
4.Radiation Therapy: Radiation therapy (or radiotherapy) uses high-energy radiation directed to the affected area to kill cancerous cells. It can be employed either by using an external radiation source (external beam radiation therapy) or by directly placing the source of radiation near the cancer tissue (brachytherapy). Radiotherapy is commonly combined with other treatment options such as surgery and/or chemotherapy for higher stage disease. Sometimes, it is used as palliative therapy to relieve pain, bleeding, and obstructive problems associated with the advanced-stage disease.
5.Palliative Treatments: These may help in improving the overall quality of life by providing relief from the symptoms caused by esophageal cancer. However, they do not directly treat esophageal cancer. They are generally given as supportive care for advanced staged cancer. These include but not limited to: bypass surgery and placing stents to remove the blockage in the bile duct, using drugs to reduce pain and other symptoms, and external-beam radiation therapy to temporarily decrease the number of cancer cells.
It is very important to assess the benefits of each treatment option versus the possible risks and side effects before making a treatment decision. Sometimes patient’s choice and health condition are also important to make a treatment choice. Following are ultimate goals for pancreatic cancer treatment:
- Prolongation of life.
- Reduction of symptoms.
- Improvement of overall quality of life.
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