Pancreatic Cancer
The most common is cancer of the exocrine pancreas

PANCREATIC CANCER TREATMENT

Navneet Sharda MD lectures on cancer topics

Dr. Navneet Sharda

Dr. Navneet Sharda  provides this information as an educational source. It is not intended as a substitute for a consultation with a qualified healthcare provider.

Worldwide, Pancreatic cancer makes up 2–3% of all cancers. In the USA, pancreatic cancer has become the third highest cause of cancer death. Typically, Pancreatic cancer spreads rapidly to nearby organs.  It is seldom detected in its early stages due to almost no early symptoms and poor screening tests.  Treatment is complex and requires meticulous attention to details, as outlined here.

 

 

 

Understanding the stage of the cancer is necessary to determine which type of surgery might be most suitable. Laparoscopy is done sometimes to help determine the extent of the cancer and if surgical therapy can even be performed.  During the laparoscopy, the surgeon makes a few small cuts in the abdomen and inserts long rod-like instruments. One of these has a small video camera on the end so the surgeon can see inside the abdomen. The surgeon can look at the pancreas and other organs for tumors and take biopsy samples of abnormal areas to find out how far the cancer has spread.

 

SURGICAL TREATMENT OF PANCREATIC CANCER

Whipple procedure (pancreaticoduodenectomy) is the most common operation to remove a cancer of the exocrine pancreas.  Earlier I had informed you that most pancreatic cancers are located in the head of the pancreas.  During the Whipple operation, the surgeon removes the head of the pancreas with or without the body of the pancreas. Diagram of Whipple Surgery by Dr. Nav ShardaNearby structures such as part of the small intestine, bile duct, gallbladder, lymph nodes and part of the stomach get removed during the surgery. This operation is usually done through a middle incision down the abdomen. The remaining bile duct and pancreas are then attached to the small intestine so that bile and digestive enzymes can still go into the small intestine. The remaining pieces of the small intestine are then reattached so that food can pass through the digestive tract. Some doctors at major cancer centers sometimes are able to do the operation through the laparoscope. In general, people having this type of surgery do better when it’s done at a hospital that does at least 15 to 20 Whipple procedures per year. Complications from the surgery can include infections, bleeding, leaking from the various connections made during surgery, weight loss, changes in bowel habits and diabetes

In distal pancreatectomy, the surgeon removes only the tail of the pancreas or the tail and a portion of the body of the pancreas. The spleen is usually removed as well. This operation is used more often to treat pancreatic neuroendocrine tumors (NETs) found in the tail and body of the pancreas.Dr. Sharda outlines distal pancreatectomy

The spleen helps the body fight against infections, so infection risk with certain bacteria may increase. Doctors recommend that patients get relevant vaccines before this surgery due to above reason.

Total pancreatectomy removes the entire pancreas, gallbladder, part of the stomach and small intestine, and the spleen. This surgery might be an option if the cancer has spread throughout the pancreas but can still be removed. This type of surgery is used less frequently than the other surgeries as there doesn’t seem to be a major advantage in removing the whole pancreas, and it can have major side effects. It is possible to live without a pancreas, but requires a lot of medical attention. Navneet Sharda outlines total pancreatectomyThere are side effects like developing diabetes, which can be hard to manage as patients are totally dependent on insulin shots. After the surgery, people also need to take pancreatic enzyme pills to help them digest certain fatty and high protein foods.

When the cancer is too advanced to be removed completely, any surgery being considered would be palliative (intended to relieve or prevent symptoms). Here the surgeon might do less extensive palliative operations; like bypass surgery or stent placement, to relieve or prevent symptoms. The most common approach to relieving a blocked bile duct is stenting. Nav Sharda MD shows a stent for pancreatic cancer therapyA stent (small tube, usually made of metal) is put inside the duct to keep it open. Often this is part of an ERCP. In people who are healthy enough, another option for relieving a blocked bile duct is surgery to make a tract for the flow of bile from the common bile duct into the small intestine, bypassing the pancreas. Sometimes a less extensive procedure like Enucleation (removing just the tumor) can be used to remove pancreatic NETs. This operation may be done using a laparoscope, so the incision size is small.

CHEMOTHERAPY

Navneet Sharda MD chemotherapy for pancreatic cancer
Chemotherapy uses anti-cancer drugs injected into a vein or taken by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment potentially useful for cancers that have spread beyond the organ they started in. Chemotherapy can be given before surgery (sometimes along with radiation – Chemoradiation) to try to shrink the tumor. This is known as neoadjuvant treatment. It can also be used after surgery (sometimes along with radiation) to try to kill any cancer cells that have been left behind. This type of treatment, called adjuvant treatment, might lower the chance of cancer recurrence. Chemotherapy is a common treatment when the cancer is advanced and can’t be removed completely with surgery, or if surgery isn’t an option for some other reason.  It is often given with radiation.
In people who are healthy enough, 2 or more drugs are usually given together. For people who are not healthy enough for combined treatments, a single drug can be used. Doctors give chemotherapy in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Each chemotherapy cycle typically lasts for a few weeks.

SIDE EFFECTS OF CHEMOTHERAPY

Chemotherapy drugs can cause side effects. These depend on the type and dose of drugs given and how long treatment lasts. Common short-term side effects are as follows.
Mouth sores
Diarrhea or constipation
Nausea and vomiting
Loss of appetite
Hair loss
Increased chance of infection
Bleeding or bruising after minor cuts or injuries
Fatigue and shortness of breath
Some chemotherapy drugs can cause other specific side effects like numbness, tingling, or even pain in the hands and feet (called peripheral neuropathy). When needed to start chemotherapy, you need to ask the cancer care team about the drugs being used and what side effects to expect.
Most side effects go away once treatment is stopped. You should tell your doctor or nurse if you do have side effects, as there are often ways to help with them.

RADIATION THERAPY

Nav Sharda MD linear accelerator with patient

Dr. Sharda with radiation therapy patient

Radiation therapy uses high-energy x-rays to kill cancer cells.   These X rays are called ionizing radiation as they create ions (free radicals) in the tissues they are focused upon.  This causes damage to the DNA of those cells and they undergo apoptosis.  It is important to map out the cancer with a CT simulator and design treatment that is specific to the patient anatomy to optimize the therapy.  This type of therapy is often called SBRT or IMRT and can be helpful in treating exocrine pancreatic cancers. Radiation might be given after surgery (known as adjuvant treatment) to try to lower the chance of the cancer coming back.
The radiation is typically given with chemotherapy as this makes both treatments work better. For borderline resectable tumors, chemoradiation can be given as neoadjuvant therapy to shrink the tumor enough to allow surgery. It is also used as part of the main treatment in people whose cancers have grown beyond the pancreas and can’t be removed by surgery (locally advanced/unresectable cancers). Radiation is commonly used to help relieve symptoms such as pain in people with advanced c

Navneet Sharda MD las vegas new technology CT scanner

Dr. Sharda shows off his new CT scanner.

ancers or in people who aren’t healthy enough for other treatments like surgery. Pancreatic neuroendocrine tumors (NETs) don’t respond well to radiation, so it’s not often used to treat

 

these tumors.  The type of radiation most often used to treat pancreatic cancer, known as external beam radiation therapy, focuses radiation from a source outside of the body on the cancer. Before your treatment starts, your radiation team will take careful measurements to find the correct angles for aiming the radiation beams and the proper dose of radiation. This planning session, called simulation, usually includes getting imaging tests such as CT or MRI scans. The treatment is much like getting an x-ray, but the radiation is stronger. The procedure itself is painless. Each treatment lasts only a few minutes, although the preparation usually takes longer. Most often, radiation treatments are given 5 days a week for 6 or 7 weeks.

SIDE EFFECTS OF RADIATION THERAPY

Side effects from radiation therapy for pancreatic cancer are as follows.
Skin problems (redness to blistering and peeling)
Diarrhea
Nausea and vomiting
Fatigue
Low blood cell counts
Radiation can also lower blood counts, which can increase the risk of serious infection. Usually these effects go away within a few weeks after the treatment is complete. Ask your doctor what side effects to expect and how to prevent or relieve them.

Treating pancreatic cancer symptoms

Pancreatic cancer often causes bothersome symptoms like jaundice, blockage of the bowels, pain, and weight loss. Treatments are available to relieve these symptoms.

Jaundice — Jaundice is caused by a blockage of the flow of bile through the common bile duct into the intestine. The most common treatment is a stent, which is a small tube that is inserted into a duct to keep it open. The stent can usually be placed in a procedure called ERCP (endoscopic retrograde cholangiopancreatography). More information on this procedure is available separately in the discussion above.
Bowel blockage — About 15 to 20 percent of people with pancreatic cancer will develop a blockage in the upper intestine (duodenum) caused by the tumor. Surgery can be done to create a detour between the stomach and a lower part of the intestine.
Pain — Pain is a common problem in people with pancreatic cancer. In some people, pain medicine alone is all that is needed. Radiation therapy can also help relieve pain by shrinking the tumor.
A new treatment called celiac plexus block might also be a good option to control pain. This procedure uses injections of alcohol into nerves that transmit pain signals. The alcohol kills the nerves, preventing them from telling the brain to feel pain.
Weight loss — Weight loss is common in people with pancreatic cancer. Taking a pancreatic enzyme replacement can help your body to absorb fat. Enzyme replacements are usually taken in a capsule on a daily basis.
If nausea and vomiting is a problem, there are several medicines that can reduce these symptoms and improve the appetite.

HOW CAN YOU REDUCE YOUR RISK OF DEVELOPING PANCREATIC CANCER?
There are many things to do for lowering the risk of getting pancreatic cancer. Smoking is the most important avoidable risk factor for pancreatic cancer. Risk is reduced by quitting smoking. Getting to and staying at a healthy weight might also help lower your risk. While the effects of getting physical activity, and eating well on pancreatic cancer risk are not as clear, both of these can help you stay at a healthy weight.
Eat a healthy diet, with an emphasis on plant foods. This includes at least 2½ cups of vegetables and fruits every day. Choose whole-grain breads, pastas, and cereals instead of refined grains, and eat fish, poultry, or beans instead of processed meat and red meat. Heavy alcohol use has been tied to pancreatic cancer in some studies but not in others. Heavy alcohol use can lead to conditions such as chronic pancreatitis and cirrhosis, which are known to increase pancreatic cancer risk. Avoiding workplace exposure to certain chemicals may reduce your risk for pancreatic cancer.

 

 

 

 

Navneet Sharda MD, Nav Sharda MD, Dr. Sharda las vegas and henderson

Navneet Sharda, MD

 

Cancer Care Centers is located in Las Vegas under the supervision of Cancer Specialist Dr. Nav (Navneet) Sharda. Cancer Care Centers specialize in treatment of various types of cancers like glioblastoma multiforme, meningioma, tonsil, tongue, laryngeal, parotid, neck, lung, breast, lymphoma, non hodgkins lymphoma, hodgkins disease, hodgkins lymphoma, skin cancer, melanoma, esophageal, gastric, pancreatic, colon, renal, kidney, ovarian, sarcoma, uterine cancer, cervical cancer, vaginal, brain, breast, vulvar cancer, bone metastasis, bone, osteosarcoma, endometrial cancercarcinoma, tumor, malignant and cancerous Cancers. We offer threapy like chemotherapy, radiotherapy, radiation therapy, radiation oncology, oncology, oncologist, immunotherapy, brachytherapy, stereotactic radiosurgery, IMRT, intensity modulated radiation therapy, conformal therapy, anaplastic astrocytoma, gioblastoma.

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