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The most common surgery for those with pancreatic cancer is the pancreaticoduodenectomy, or Whipple surgery. With this procedure surgeons remove:
The Pancreatic Head: The portion of the pancreas that is located within the curve of the duodenum.
A portion of the Duodenum: The initial section of the small intestine that curves around the pancreatic head. It is located near midline, in the upper portion of the abdomen. It is within the duodenum that most of the chemical digestion takes place as digestive juices begin to mix with food.
A portion of the Bile Duct: The common bile duct carries bile from the gallbladder to the duodenum or upper portion of the small intestine.
The Gallbladder: The Gallbladder is responsible for storing bile prior to its release into the intestine.
A portion of the Stomach: The Pylorus is the section of stomach that opens into the duodenum and can be thought of as a canal. This section is removed during the Whipple procedure.
The lymph nodes at the head of the pancreas are also removed during the surgery. Following the various removal procedures the surgeon then reconstructs the digestive tract so that digestive enzymes, bile and stomach contents will once again begin to flow normally. This procedure can take anywhere from 6 to 8 hours and patients can expect to remain hospitalized for two or more weeks.
Complications that patients may face include:
Gastroparesis: The most common complication, also known as delayed gastric emptying. This condition is when the stomach takes an abnormally long amount of time to empty its contents. It may also be referred to as "paralysis of the stomach".
Pancreatic Fistula: The leakage of pancreatic juices occurs at the suture site where the portion of the pancreas that was cut was reattached to the intestine. This is a serious complication.
Distal Pancreatectomy: With this procedure surgeons remove the bottom half or tail portion of the pancreas. After surgical removal, the edge of the pancreas that has been cut is sutured shut. There are various ways of performing this procedure:
Open distal pancreatectomy and splenectomy: The body and tail of the pancreas are removed as well as the spleen.
Spleen preserving distal pancreatectomy: Only the pancreas is removed.
Laparoscopic distal pancreatectomy: The pancreas or a portion is removed through two small incisions. These patients often report less pain, remain hospitalized for a shorter amount of time and recover quicker than those undergoing Open distal pancreatectomy procedures.
For those with exocrine pancreatic cancer, chemotherapy is a common form of treatment. This approach uses various drugs to combat and attack the cancerous cells. Chemotherapy has been known to slow, stop and even shrink pancreatic cancer tumors, however it must be understood that this is not a "cure".
Chemotherapy treatment may occur as a stand alone procedure or in addition to surgery. There are a variety of chemotherapy drugs approved for treatmeant and various other drugs are currently undergoing clinical treatment trials. Common chemotherapy drugs that will be encountered are:
Gemcitabine or Gemzar®: This is a antimetabolite chemotherapy drug given intravenously (IV).
Fluorouracil (5-FU): This is an antineoplastic or cytotoxin chemotherapy drug given intravenously (IV).
Albumin-bound paclitaxel or ABRAXANE®: This is an antineoplastic or cytotoxin chemotherapy drug given intravenously (IV).
When chemotherapy is given to a patient before surgery this is known as neoadjuvant chemotherapy. Patients may receive neoadjuvant chemotherapy for a variety of reasons. This may be due to the size of the tumor, an attempt to shrink the tumor or stop its growth, and provide patients with more surgical options.
When chemotherapy is given after a patients surgery it is known as adjuvant chemotherapy. Patients may recieve adjuvant chemotherapy in order to keep the cancer from returning. It is also given in order to combat any potential cancerous cells that are left behind after surgery.
Chemotherapy may also be given when the cancer is so advanced that it can not be completely resected, or if performing surgery on a patient is not an option.
Radiation Therapy is the use of ionizing radiation to kill, reduce, or control cancer cells. The use of radiation therapy in combating pancreatic cancer can occur independently of or in concert with other forms of treatment, such as chemotherapy. When the two forms of treatment are given together they are known as Chemoradiation Therapy.
Radiation Therapy can occur at a variety of times during treatment such as before or after surgery. When radiation therapy is given before surgery it is usually done so in an attempt to shrink the size of the tumor or stop its growth. This is known as neoadjuvant radiation therapy because it is given before the surgery. When a patient recieves radiation therapy after surgery this is known as adjuvant radiation therapy. This can be used to prevent cancer cells from coming back and to combat possible cells left behind after a patients surgery.
External Beam Radiation Therapy
External Beam Radiation Therapy is the most common form of radiation therapy given to pancreatic cancer patients. As it is a local treatment, External Beam Radiation Therapy concentrates a single, or multiple, high-energy beams of X-Ray radiation at the site of the tumor or tumor bed. This concentrates the effect of the radiation allowing it to do the most good while minimizing the radiations effect on other portions of the body.
Another form of Radiation Therapy is known as Internal Beam Radiation Therapy. Internal Radiation is an uncommon form of treatment for pancreatic cancer. This form of treatment involves a radioactive substance inserted directly into the body at the site of the tumor or tumor bed. The frequency with which this type of treatment occurs can vary and depends on factors such as the amount of radiation required and the delivery method of the radioactive substance.
There are also systemic treatments in which a radioactive substance is injected in the patient or swallowed. This course of treatment allows the substance to travel throughout the blood to destroy cancer cells.
Treatment courses for External Beam Radiation Therapy can vary however a general practice includes treatment once a day for five days in a row. Patients receive treatment for multiple subsequent weeks and while the treatment itself usually is short in duration, the overall visit to the treatment facility can take a bit longer. However, patients should be relieved to understand that overnight stays in the hospital are not necessary for this course of treatment.
Skin Changes at the site of treatment
Nausea and vomiting
Change in bowel habits
For more information please visit:
Wake Forest University Baptist Medical Center & Comprehensive Cancer Center
American Cancer Society
National Cancer Institute
Surveillance, Epidemiology, and End Results Program