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• Types of Cancer
• Pancreatic Cancer
• Am I at risk?
• Can I get screened?
• How do you diagnose it?
• What are the Symptoms of Pancreatic Cancer?
• What are the treatment options?
• What is Pancreatic Cancer?

Treatments for pancreatic cancer are based on the stage of the cancer at the time of diagnosis. Your physician will recommend an individualized treatment plan that may include surgery, radiation therapy, or chemotherapy, or several of these options used in combination. The use of multiple treatments is known as combined modality therapy. Determination of your best treatment plan is based on the stage of your cancer, as well as your age, other medical conditions, and your attitude toward the available options.

Surgical Procedures

For patients with early-stage pancreatic cancer, surgery alone may offer a cure. For patients at high risk of relapse, radiation and chemotherapy may be administered after surgery to prevent recurrence. The use of postoperative therapy is known as adjuvant therapy.

Once cancer has reached an advanced stage, the tumor may no longer be "resectable" (conducive to surgical removal). Instead of surgery, patients may undergo combined radiation therapy and chemotherapy as the primary treatment.

The two major surgical procedures for pancreatic cancer are:

Whipple Procedure (or pancreatoduodenectomy) - The Whipple Procedure is a highly complex surgery that entails removal of the head of the pancreas, portions of the stomach and small intestine, the gallbladder, and the bile duct. After surgery, enough of the pancreas usually remains to produce digestive enzymes and hormones.

Total Pancreatectomy - Patients with more advanced pancreatic cancer may undergo a total pancreatectomy in which the entire pancreas is removed, along with portions of the stomach and small intestine; the gall bladder; common bile duct; spleen; and adjacent lymph nodes. This procedure is practiced only in very selected patients.

Laparoscopic approach - Laparoscopic surgery is the surgery performed through small incisions using a telescope connected to a videocamera which transmits images from inside your abdomen to a monitor. The surgery is then performed using long instruments that are passed through four or five small incisions (1/4 to 1/2 inch each). This results in significantly lesser trauma to your body and much quicker recovery. For selected cases, laparoscopic surgery could be performed to diagnose and/or to treat pancreatic cancer. Only in a few centers around the country do surgeons have the expertise to perform advanced laparoscopic pancreatic surgery as it is practiced at John Muir Health.

Chemotherapy or radiation therapy followed by surgery - In very selected cases in which the cancer appears to be out of the reach of surgical treatment, chemo or radiation therapy could be done first with the intention to decrease the size of the tumor and re-consider surgery accordingly. In some patients the response to the treatment makes the tumor smaller and amenable for surgical removal.

Chemotherapy

Chemotherapy - or the use of drugs that kill cancer - appears to be most effective against pancreatic cancer when used in combination with radiation therapy. Combination therapy may be used as a primary treatment for patients who cannot undergo surgery. For certain patients, a postoperative regimen of chemotherapy and radiation therapy - known as adjuvant therapy - may be recommended.

For patients with advanced or metastatic cancer, chemotherapy is sometimes used without radiation to help relieve painful symptoms, such as painful swallowing. Often, several different chemotherapy drugs will be used in tandem, including the newest agents such as gemcitabine. Through its active research program, with regional and national affiliations, John Muir Health can also provide patients with access to investigational chemotherapeutic agents.

Radiation Therapy

Radiation therapy appears to be most effective against pancreatic cancer when used in combination with chemotherapy. Depending on the stage of the cancer, combined radiation and chemotherapy may be administered as the primary treatment for pancreatic cancer, or as post-surgical regimen in patients at high risk of recurrence. In some advanced cancers, radiation therapy may be used as a stand-alone treatment to help alleviate symptoms.

The type of radiation therapy used to treat pancreatic cancer is external beam radiation, in which the pancreas is radiated from outside the body via a precisely targeted beam of radiation from special equipment called a linear accelerator. Before radiation therapy, patients may be given radiosensitizing chemotherapy drugs, which help to enhance the cancer-killing efficiency of radiation.

Our state-of-the-art equipment includes five linear accelerators and two dedicated CT scanners to ensure the most precise and effective radiation therapy available. The advanced radiation therapy capabilities at John Muir Health include:

• Three-Dimensional Conformal Treatment - This sophisticated form of external beam therapy uses a computerized treatment planning system that optimizes radiation therapy by pinpointing the location of the tumor with the highest level of precision possible. This capability is very important in planning the most effective therapies for pancreatic cancer. Special features on the linear accelerator called multi-leaf collimators enable the radiation beam to be "shaped" to closely conform to the contours of the tumor. This permits a higher dose of radiation to be administered directly to the pancreas, while diminishing the radiation dose to surrounding tissue, thereby increasing cancer-killing effectiveness while minimizing toxicity.
• Intensity-Modulated Radiation Therapy (IMRT) is a newly introduced enhancement of the technology used in three-dimensional conformal therapy. Specialized treatment planning software is used to development a precise plan that "modulates" or varies the radiation used in each treatment session. The highest possible doses of radiation can be applied directly to the pancreas, while lower doses are applied to areas adjacent to organs and critical structures that need to be protected.

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