Treating pancreatic cancer

June 12, 2013 By Bret Schipper, M.D.

Pancreatic cancer can be among the most challenging cancers to treat, largely because it often doesn't produce symptoms until the disease is advanced. But there are treatment options that can fight pancreatic cancer and help achieve a cure for some, or improve the quality of life of others when a cure is not possible.

Located behind the stomach, the pancreas is about 6 inches long, with a wider end called the head, a middle section called the body and a narrow end called the tail. The pancreas contains two main types of cells: exocrine cells that secret juices that aid in digestion; and endocrine cells that secrete hormones, like insulin, that help regulate blood sugar.

Pancreatic cancer occurs when cells mutate and lose the ability to self-regulate. When the innate mechanisms of checks and balances that control cells' growth and behavior fail, the cells grow uncontrollably and form tumors.

There are two types of pancreatic cancer: The most common is pancreatic exocrine cancer or pancreatic adenocarcinoma. These mutating cells line the ducts of the pancreas. A second, rarer type is pancreatic endocrine cancer, which can form in the hormone-producing cells. Treatment options depend on the stage and location of the cancer and may include:

• Surgery, which can be used in the early stages of pancreatic cancer to remove all or most of the cancer. If the cancer is confined to the head of the pancreas and hasn't spread, surgeons may perform a Whipple procedure, in which they remove the head of the pancreas, first part of the small intestine, gallbladder, part of the bile duct, and a small portion of stomach. A pylorus-preserving Whipple procedure leaves the stomach intact. For a tumor in the tail of the pancreas a distal pancreatectomy can be performed. In this procedure the surgeon removes the tail and a small portion of the body of the pancreas and may also remove the spleen. Sometimes small tumors of certain types can be enucleated (destroyed in place) and the surgeon does not need to remove the surrounding normal pancreatic tissue.

• Radiation therapy and chemotherapy may be appropriate for later stages of pancreatic cancer, and can be used in combination with surgery in early-stage cancer.

• Clinical trials may be a good option for some patients with pancreatic cancer. These studies involve volunteers and test new drugs or treatment approaches. Through clinical trials, patients have access to promising new treatments they might not get outside the trial, along with constant monitoring and care.

Bret Schipper, M.D., is a surgical oncologist at The Hospital of Central Connecticut. For information on Hospital of Central Connecticut physicians, please contact our free Need-A-Physician referral service by phone 800.321.6244 or online.