The pancreas is an abdominal organ positioned horizontally behind the lower portion of the stomach. Typically, pancreatic cancer begins in the tissue structures or the pancreatic duct. As with most cancers, early detection is optimal for successful treatment. Unfortunately, early detection is rare for this type of cancer, as the early symptoms of pancreatic cancer are subtle, most patients are already in advanced stage disease when diagnosed (Mayo Clinic Staff, 2014). Although pancreatic cancer survival rates are improving, the disease is usually incurable
Causes of Pancreatic Cancer
According to researchers at Johns Hopkins University (2014), as with most cancers, it is ...view middle of the document...
The reasons for poor survival rates in those with pancreatic cancer are two-fold. First, the early signs and symptoms of pancreatic cancer, if there are any, are often too subtle to arouse concern. Second, when symptoms do appear, the disease has usually advanced to distant organs. For these reasons, pancreatic cancer is lethal and largely incurable (Mayo Clinic staff, 2014). The Mayo Clinic (2014) states the following as the most common symptoms:
• Upper abdominal pain that radiates to the back
• Unexplained weight loss
• Blood clots
• Bowel obstruction
Standards of Care and Treatment
The prognoses for all stages of pancreatic cancer are poor, regardless of treatment. According to the Surveillance, Epidemiology, and End Results program of the National Cancer Institute, the survival rate for pancreatic cancer is just 6.7% at the five-year mark (Surveillance, Epidemiology, and End Results 2014). The charts below demonstrate the incidence and mortality rates within races in the United States.
In January 2013, the Gastrointestinal Cancers Symposium convened in San Francisco, Ca, which highlighted research that could offer pancreatic ductal adenocarcinoma patients better treatment options and potentially better outcomes. For some time, only gemcitabine was the approved drug for use in pancreatic cancer, along with the combination of drugs called FOLFIRONIX. The highlight of the meeting was the Adenocarcinoma Clinical Trial (MPACT) presented during the Symposium. The global study of 861 patients with metastatic pancreatic adenocarcinoma found that nab-paclitaxel plus gemcitabine more than doubled 2-year survival, compared with gemcitabine alone (Hughes, 2013). Medical history has documented the poor outcomes for those in all stages of pancreatic cancer and barring new, more promising treatment, the following is the current standard of care. The following guidelines for treatment are from the National Cancer Institute.
Stages I and II
• Surgery: radical pancreatic resection that includes:
Whipple procedure: removes the head of the pancreas, duodenum, part of the bile duct, gallbladder, and often part of the stomach
• Total pancreatectomy
• Distal pancreatectomy for tumors of the body and tail of the pancreas
• Postoperative chemo-radiation therapy
• Postoperative chemotherapy
The diagram below shows normal anatomical structures on the left, and on the right, the anatomy following Whipple surgery. Note the missing lower portion of the stomach and other anatomical gastrointestinal structures. The Whipple procedure is complex and carries a relatively high risk of life threatening complications, even when performed by experienced surgeons (American Cancer Society, 2014).
• Palliative surgery (not curative, but to relieve pain)
• Chemo-radiation for those without metastatic disease
• Chemotherapy, most notably FOLFIRINOX
• Palliative therapy and supportive care
• Chemotherapy – Low...