Pancreatic Cancer: A Review of Surgical Treatment Options

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Approximately 3% of all cancer patients are diagnosed with pancreatic cancer. Though multiple options exist, sometimes surgery is the best method of treatment.

For patients whose cancer has not yet spread, there are a surprising number of pancreatic cancer treatment options that attack the disease before it becomes unmanageable. Because surgery is so often paired with other treatments, it is important to know the full extent of your possible treatment pairings.

An Overview of Pancreatic Cancer

This disease occurs when abnormal cells develop in the pancreas and the body has an extremely difficult time regulating growth. Without any limitations, these cells spread to other organs, shut down their functions, and ultimately, lead to death. Adenocarcinoma is the cancer that forms in the pancreas, growing in the ductal cells. Neuroendocrine cancers begin in the islet cell region.

Symptoms of pancreatic cancer include:

  • Back pain
  • Nausea
  • Diarrhea
  • Difficulty eating
  • Rapid weight loss
  • Vomiting
  • Jaundice
  • Diabetes

Pancreatic cancer can be hereditary. Family genetics  are responsible for roughly 10% of cases; however, there are other risk factors for the disease. In conjunction with a genetic predisposition, these risk factors greatly increase your chance of developing the cancer:

  • Overeating
  • Diabetes
  • Chronic Pancreatitis
  • Tobacco Use

Treating Pancreatic Cancer

Your physician will help you understand the pros and cons of each pancreatic cancer treatment option in greater depth. In addition to the treatment, most people with pancreatic cancer need to manage their pain. Some of the treatments often need to be combined if their cancer has advanced to later stages. After confirming the cancer’s presence, you have several options:

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  • Ablative Techniques. Ablation and embolization seek to eradicate the tumors. This is a popular method if the tumor spreads to different organs, or if you need to target the liver. Ablative treatments use vast temperature differentials with radio waves, microwaves, and freezing the tumors (cryoablation). Ablative techniques often include side effects like internal bleeding, infection, and abdominal pain. These sound serious, but dire side effects are relatively uncommon.

Embolization involves the addition of chemicals intravenously to “starve” the cancer cells. If a tumor is too large for ablation and too widespread for other techniques, this treatment can shrink or kill multiple tumors.

  • Radiation – This technique targets exocrine pancreatic cancers using high-powered X-rays to eliminate cancer cells. Usually, radiation is combined with other techniques, and it is often paired with chemotherapy or used before surgery. Radiation weakens cancer cells and makes tumors easier to remove. When cancer spreads so much that surgery will not completely remove it, or if the patient is in advanced stages and too weak to operate, this can be an effective pancreatic cancer treatment.
  • Chemotherapy – These are the infamous anti-cancer drugs that come paired with extremely taxing side effects. Pills are excellent at attacking cancer cells because they assault cells that divide quickly. The reason there are so many side effects is because the lining inside your mouth and intestinal tracts, your hair, and bone marrow also reproduce quickly. Chemotheraphy can tank your blood count, cause your hair to fall out, facilitate internal bleeding, and cause other worrisome effects. It is effective post-surgery, killing the cells left behind that were too small to remove. This is called adjuvant treatment, and it is aimed at increasing the chances for remission.
  • Surgery – Surgery affords the patient the only prudent opportunity to fully remove exocrine pancreatic cancer. As you know, surgery involves opening the patient and physically removing tumors. When a patient becomes jaundice, this means cancer presented itself near or in front of the bile duct. These cells are called pancreatic neuroendocrine tumors (NETs), and surgery does an excellent job of attacking them.

Your Surgical Treatment Choices

There are three main surgery procedures used to combat pancreatic cancer:

1. Pancreaticoduodenectomy (Whipple Procedure) – This is the most common procedure used to remove cancer. Widely used when the cancer has not spread outside of the top of the pancreas, the operation takes anywhere from 4-7 hours. The head of the pancreas, located near the bile duct and gallbladder, is removed. A portion of the stomach and the lymph nodes are sometimes removed, too. This allows pancreatic enzymes to move back into the digestive tract. Candidates are selected if they are in good health and they are jaundiced.

pancreas-before-and-after-surgery

 

An alternative Whipple procedure is available, called a Pylorus Preserving Pancreatoduodectomy, or PPPD. This surgical treatment is used when the cancer has moved partially into the duodenum and/or the pylorus. Both can be removed during a PPPD. For both Whipple procedures, the expected recovery time is around 10 days to two weeks.

2. Total Pancreatectomy – This is a powerful surgery requiring the removal of multiple regions around the pancreas, including the bile duct, spleen, nearby lymph nodes, gallbladder, part of the stomach, duodenum, and the entire pancreas. This procedure is effective when tumors have spread outside of the pancreas to multiple organs, throughout the pancreatic duct, and in multiple places within the pancreas. The procedure is also used to combat intraductal papillary mucinous neoplasms, or IPMNs.

3. Distal Pancreatectomy – This procedure is used when tumors lay within the pancreas and grows in the tail end of the pancreas. Because the thin end of the pancreas is harder to remove, the tumor, the tail, and pancreas body are removed. The head, near the bile ducts, are left alone. The spleen is near the tail, therefore this organ will also be removed. This is considerably less invasive than both a Whipple procedure and total Pancreatectomy. Also, it is an easier surgery, so it is a faster procedure.

If for any reason, the spleen needs to be removed during one of these pancreatic cancer treatments, the patient will need to take antibiotics for the duration of their life. This is due to the increased chance of infection.

If you have pancreatic cancer and need a surgeon, only the very best will do. Dr. Fraiman built his career performing surgery on pancreatic and liver cancers, and he is considered the very best in his field. He comes armed with a top-notch medical team, including oncologists and radiation specialists to assist patients through every stage of the treatment process. Contact Dr. Fraiman today to put yourself in the very best pancreatic cancer care on the East Coast.

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