If you have cancer of the pancreas, you already know you’re in for the fight of your life. It’s relatively well known that few people conquer this aggressive type of cancer long-term, and you may wonder what’s next.
It’s helpful to know what’s around the corner with this diagnosis, says R. Matthew Walsh, MD, General Surgery Chair at Cleveland Clinic. He says doctors continue to search for the best advances to give them the upper hand in the difficult battle.
What tests can you expect?
You’ve likely already had a physical exam and blood test to identify pancreatic cancer. More tests will help determine severity:
• Tumor marker test: Your doctor will test a blood, urine or tissue sample for substances produced by tumors.
• Diagnostic imaging: MRI, CT and PET scans, abdominal ultrasounds and endoscopic ultrasounds can gather detailed pictures of any tumors or changes in your pancreas.
• X-ray procedures: Sometimes pancreatic cancer causes bile blockage, resulting in jaundice. During an X-ray procedure called endoscopic retrograde cholangiopancreatography (ERCP), a catheter inserted via an endoscope injects dye into the pancreatic ducts to locate blockages. If an ERCP isn’t possible, a percutaneous transhepatic cholangiography (PTC) can x-ray liver and bile ducts to find blockages. During a PTC, clinicians inject dye through a thin needle inserted below the ribs into the liver.
• Laparoscopy: Surgeons make small incisions in the abdomen so a thin, lighted camera can shine a light on organs to illuminate signs of disease that has spread.
• Biopsy: Clinicians remove cells or tissue samples and examine them for signs of cancer. There are several types of biopsies for pancreatic cancer. Fine- or core-needle biopsies remove pancreatic cells during an X-ray or ultrasound.
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What impacts prognosis?
After your diagnosis, your doctor will likely discuss treatment and recovery options. The next steps will depend on answers to these questions:
• Is your tumor operable?
• In what stage is your cancer (how large is the tumor and has the cancer spread to nearby tissues, lymph nodes or other locations in the body)?
• Are you generally healthy?
• Is this an initial diagnosis or a recurrence?
Pancreatic cancer can only truly be controlled if it’s identified before it spreads and when surgery is possible. Otherwise, your doctor will likely discuss options to maximize your quality of life by controlling symptoms and complications.
What does treatment look like?
Pancreatic cancer surgery is complicated, Dr. Walsh says. Several blood vessels that feed the stomach, small intestines, liver and spleen wrap the pancreas. CT scans and MRI images help surgeons decide whether they can successfully remove a tumor.
“We’re doing better at telling whether tumors can be taken out,” he says. “This allows us to get patients through surgeries with fewer complications.”
Doctors sometimes perform surgery laparoscopically. As with testing, it involves small incisions instead of a large one. Patients generally recover more quickly from this less invasive type of surgery.
Doctors and researchers continue to investigate other treatments for pancreatic cancer, including radiation therapy and chemotherapy. Studies and clinical trials are underway on:
• Chemotherapy drugs such as capecitabine and gemcitabine
• Combining surgery, chemotherapy, and radiation therapy
• Targeted therapies that take advantage of the differences in pancreatic cancer cells versus normal cells
• Promising therapies designed to boost the immune system
What are the options for palliative care?
Delivered by your oncology team, palliative care lessens the impact of pain and complications from cancer. Patients who receive palliative care tend to spend less time in intensive care and in the hospital overall, Dr. Walsh says.
In addition to medications that control nausea and vomiting, here are two palliative treatment options:
• Pain management: You can receive pain medication by mouth, from injections or through the skin with patches or creams. In some cases, portable or implantable infusion devices are appropriate.
• Nerve blocks: A particular type of X-ray assisted injection — a neurolytic celiac plexus block — deposits pain medication directly into the nervous system, blocking pain signals sent to the brain. Alcohol neurolysis of celiac plexus also reduces pain and lowers the amount of medicine used by 50 to 70 percent.
As with any cancer, your individual diagnosis and prognosis drive your treatment approach and regimen. Your doctor will help you and your family determine which combination of testing and treatment is best for you.