Cancer Therapies

Pancreatic cancer and role of radiation

Pancreatic cancer arises in the pancreas, an important organ in the abdomen that releases enzymes that aid digestion and hormones that help manage blood sugar.

Typically, pancreatic cancer spreads rapidly to nearby organs and is rarely detected in the early stages. It is important to be screened for early detection of pancreatic cancer especially those with a family history of pancreatic cysts or pancreatic cancer.

One sign of pancreatic cancer is diabetes and should be evaluated in depth if it is also accompanied with weight loss, jaundice or pain in the upper abdomen that spreads to the back. Unfortunately, signs and symptoms occur when pancreatic cancer is in the advanced stages. The stages of pancreatic cancer are:

Stage I. Cancer is limited only to the pancreas, and the tumor can be removed by surgery.
Stage II. Cancer has spread from the pancreas to the adjacent tissues and organs. At this stage, lymph nodes may or may not be involved and surgery to remove all tumor tissues is still a viable option.
Stage III. Cancer has spread beyond the pancreas and into the major blood vessels around the pancreas (locally advanced pancreatic cancer). Lymph node involvement also may have occurred. At this stage, surgical resection may still may or may not be possible. Radiotherapy is most often used to treat this stage of the disease
Stage IV. Cancer has spread to distant sites beyond the pancreas, including liver, lungs and the lining that surrounds abdominal organs (peritoneum). This is the inoperable (advanced pancreatic cancer) stage of pancreatic cancer

Treatments include surgery, chemotherapy, radiation therapy or a combination of these. Surgical methods include the Whipple procedure (pancreaticoduodenectomy) in which the pancreas, the first part of the small intestine (duodenum), the gallbladder and part of the bile duct and or part of the stomach is removed and the healthy parts are then rejoined to allow digestion.

Distal pancreatectomy involves resecting the left side of the body and tail of the pancreas, and possible splenectomy. Total pancreatectomy involves taking out the entire pancreas, after which lifelong insulin and enzyme replacement is a must. Stage III involves spread of the cancer to important blood vessels (locally advanced cancer) and few specialized centers perform delicate reconstructive surgery, carrying major bleeding risk. In advanced pancreatic cancer, chemotherapy is often used to control cancer growth and prolong survival with a single or a combination of drugs.

Chemotherapy can be given on its own or combined with radiation therapy (chemo radiation). Chemotherapy drugs make the cancer cells more sensitive to radiotherapy, so that radiotherapy is more effective. Studies have shown that chemo radiation can be an effective treatment for locally advanced pancreatic cancer. Sometimes chemo radiation is given prior to surgery to help shrink the tumor, to make the operation less risky.
The role of radiotherapy is valuable in management of pancreatic cancer. Radiation therapy is the mode of treatment in advanced cancer that has spread beyond the pancreas, to control symptoms such as pain and improve the quality of life in patients. Radiation is also used after surgery to reduce the risk of pancreatic cancer recurrence.
A recent study has indicated that the elderly with inoperable pancreatic cancer and unable to tolerate chemotherapy, can benefit from stereotactic body radiation therapy, which involves giving radiotherapy from many different positions around the body and the beams meet at the tumour. This procedure is a relatively tolerable and more convenient option for patients with pancreatic cancer.Another new study has recently concluded that higher doses of radiotherapy may prolong survival for patients with early-stage pancreatic cancer.