Pancreatic Cancer Treatment

Dr Tan Yu-Meng
Director, Consultant General Surgeon

What Is Pancreatic Cancer?

Pancreatic cancer arises when cells in the pancreas, a glandular organ behind the stomach, begin to proliferate and form a mass. The pancreas performs two critical functions: it produces enzymes that help in digestion (exocrine function) and hormones, such as insulin, that regulate sugar in the bloodstream (endocrine function).

Risk Factors for Pancreatic Cancer

Risk factors for pancreatic cancer include smoking, chronic pancreatitis, family history of the disease, certain genetic disorders, obesity, and diabetes.

Diagnosis

The diagnosis of pancreatic cancer typically begins with a review of the patient’s medical history and a physical examination, focusing on signs and symptoms like jaundice, abdominal pain, or unexplained weight loss. If pancreatic cancer is suspected, several diagnostic tests and procedures are used to confirm the diagnosis and stage the disease. Imaging tests are crucial for visualizing the pancreas and surrounding organs to check for any abnormalities. These tests may include:

Computed Tomography (CT) Scans

These scans provide detailed cross-sectional images of the body and can help identify the size and location of cancer in the pancreas.

Magnetic Resonance Imaging (MRI)

MRI offers detailed images of soft tissues in the body and can be useful in looking at the pancreas and nearby blood vessels.

Positron Emission Tomography (PET) Scans

Often combined with CT scans (PET-CT), these tests can detect areas of cancer spread.

Endoscopic Procedures

These involve using a tube-like instrument to examine internal organs and tissues.

Endoscopic Ultrasound (EUS)

Involves passing an endoscope equipped with an ultrasound probe into the stomach and duodenum to get close to the pancreas, and obtain images or aid in biopsies.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Used primarily to diagnose and treat problems in the bile ducts, including blockages caused by pancreatic tumors.

Biopsy

A procedure to remove a small sample of tissue from the pancreas for examination under a microscope. Biopsies can be performed during EUS or through a needle inserted into the pancreas during a CT scan.

Blood Tests

Certain blood tests can help in diagnosing pancreatic cancer. For instance, the levels of carbohydrate antigen 19-9 (CA 19-9) can be elevated in pancreatic cancer, although this is not specific to the disease and can be increased in other conditions as well.

Laparoscopy

This minimally invasive surgery allows doctors to look at the pancreas and other organs. It can help determine the extent of the cancer and whether it is operable.

Types of Pancreatic Cancer

Pancreatic cancer can be classified into different types depending on the origin of cancer cells.

This is the most common type of pancreatic cancer, accounting for about 90% of cases. It originates in the exocrine cells, which produce digestive enzymes. These tumors are typically located in the head of the pancreas.

These are less common, making up about 5% of pancreatic cancers. PNETs originate from the endocrine cells of the pancreas, which produce hormones like insulin and glucagon.

Rare pancreatic cancers that start in the acinar cells, which make the digestive enzymes. These are less likely to spread and may have a better prognosis than adenocarcinomas.

Standard Treatment Options

Treatment for pancreatic cancer depends on the stage and type of the cancer, as well as the patient’s overall health. Here are the primary treatment options:

Surgery

Surgery is the most effective treatment for pancreatic cancer, especially when the cancer is localized. Types of surgery include:

  • Pancreaticoduodenectomy (Whipple procedure): The Whipple procedure is the primary surgical treatment for pancreatic cancer. It involves the removal of the head of the pancreas containing cancerous cells, part of the small intestine, and other nearby tissues to eliminate the cancer and prevent its spread.
  • Distal Pancreatectomy: Involves the removal of the tail and a portion of the body of the pancreas.
  • Total Pancreatectomy: The entire pancreas is removed, along with parts of the stomach, small intestine, and other nearby organs.

Radiation Therapy

This treatment uses high-energy rays to kill cancer cells or slow their growth. It can be used before surgery to shrink tumors or after surgery to destroy any remaining cancer cells.

Chemotherapy

Chemotherapy uses drugs to destroy cancer cells or stop them from growing. It can be administered before surgery (neoadjuvant therapy) to shrink the tumor, or after surgery (adjuvant therapy) to eliminate remaining cancer cells.

Whipple Surgery Procedure

1. Incision: The surgery begins with the surgeon making an incision in the abdomen to access the pancreas.

2. Removal Of Tissues: The head of the pancreas, duodenum, gallbladder, and bile duct are removed. Parts of the stomach and nearby lymph nodes may also be excised.

3. Reconstruction and Suturing: After removing the necessary tissues, the surgeon reconstructs the digestive system by attaching the remaining pancreas, bile duct, and stomach to the small intestine, ensuring the continuation of digestive processes. Lastly, the surgeon sutures the incision made at the beginning of the surgery.

Advantages Of Whipple Surgery

Complete Removal of Cancerous Tissues

The primary advantage of Whipple surgery is the complete removal of the cancerous part of the pancreas, along with surrounding tissues. This offers the best chance for eradicating the cancer locally.

Improved Survival Rates

Whipple surgery can significantly improve survival rates for patients with pancreatic cancer, particularly those with tumors confined to the head of the pancreas and without metastatic disease.

Provides Detailed Analysis of Cancer

The surgery provides an opportunity for a thorough examination of the removed tissue, offering insights into the nature of the cancer, which can guide further post-operative treatment care.

Relief from Symptoms

Many patients experience relief from symptoms like jaundice, nausea, and abdominal pain after the removal of the tumor.

Common Side Effects After Whipple Surgery, and How To Manage Them

  • Digestive Issues: Patients may experience changes in digestive function, including diarrhea, constipation, or difficulty digesting certain foods. Dietary modifications and medications can help manage these symptoms. Due to altered digestion and absorption, patients may need supplements, particularly fat-soluble vitamins (A, D, E, and K). Patients should consult their dedicated healthcare provider to find the best post-operative diet for them.
  • Pain: Pain is a common postoperative symptom. A combination of medications, including opioids and non-opioid pain relievers, are used for pain management.
  • Pancreatic Insufficiency: The reduced size of the pancreas can lead to insufficient enzyme production, necessitating enzyme replacement therapy to aid digestion.
  • Diabetes: Some patients may develop diabetes or have worsening glycemic control post-surgery, requiring careful monitoring and management of blood sugar levels.
  • Dietary Changes: Patients often need to eat smaller, more frequent meals and may require supplemental pancreatic enzymes.

Dr Tan Yu-Meng

Director, Consultant General Surgeon

Dr Tan continues to be one of few surgeons in Asia who perform specialized surgery for peritoneal malignancies in Asia.

  • MBBS (Bachelor of Medicine & Surgery, First Class Honors & Distinction at the University of London) 1994
  • RCSEd (Fellow of the Royal College of Surgeons Edinburgh) 1999
  • Further training in advanced HPB surgery and liver transplantation at the world renowned Liver Unit of Queen Elizabeth Hospital in Birmingham, United Kingdom.
  • Further training in living donor liver transplantation in Japan.

With his interest in gastrointestinal and hepatobiliary-pancreatic (GI-HPB) surgery and the treatment of cancer, Dr Tan joined the department of surgical oncology at the National Cancer Centre in 2003 as a consultant.

Dr Tan’s interest in the management of peritoneal surface malignancies was part of his effort in leading a multidisciplinary team from NCC to Washington Cancer Institute to adopt the techniques and protocols of peritonectomy and HIPEC (Sugarbaker procedure) from Dr Paul Sugarbaker in 2009.

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    Pancreatic Cancer Treatment

    Frequently Asked
    Questions

    How long is the recovery after Whipple surgery?

    Recovery time varies, but patients typically spend about one to two weeks in the hospital and may take several months to fully recover. Consult your dedicated healthcare provider to obtain more details on your recovery timeline.

    Can pancreatic cancer recur after treatment?

    Yes, there is a risk of recurrence even after successful treatment, which is why regular follow-up care is essential to monitor for any signs of cancer returning.

    What are the risks associated with Whipple surgery?

    Common risks include infection, bleeding, blood clots, and complications related to anesthesia. There may also be leakage from surgical connections. Inform your dedicated healthcare provider immediately if leakage occurs.

    What is the success rate of Whipple surgery in treating pancreatic cancer?

    Success rates vary based on cancer stage and individual health factors. It’s most successful for early-stage, localized pancreatic cancer.