Sunday, February 25, 2024

Chemo For Pancreatic Cancer Stage 4

Pancreatic Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Pancreas

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The pancreas is agland about 6 inches long that is shaped like a thin pear lying on its side. The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail. The pancreas lies between the stomach and the spine.

The pancreas has two main jobs in the body:

The digestive juices are made by exocrine pancreas cells and the hormones are made by endocrine pancreas cells. About 95% of pancreatic cancers begin in exocrine cells.

This summary is about exocrine pancreatic cancer. For information on endocrine pancreatic cancer, see the PDQ summary on Pancreatic Neuroendocrine Tumors Treatment.

For information on pancreatic cancer in children, see the PDQ summary on Childhood Pancreatic Cancer Treatment.

Bile Duct Bypass Surgery

is an option if the tumor is blocking the common bile duct.

The liver normally releases a substance called bile, which helps with digestion. Bile is stored in the gallbladder. It then travels through the common bile duct to the intestines. From there, its removed from the body in the stool.

When a tumor blocks the small intestine, bile can build up in the body and cause jaundice, which is the yellowing of the skin and eyes.

Treating Resectable Pancreatic Cancer

People whose pancreatic cancer is considered resectable may undergo one of three surgeries:

Whipple procedure : A surgeon removes the head of the pancreas and sometimes the body of the pancreas, parts of the stomach and small intestine, some lymph nodes, the gallbladder, and the common bile duct. The remaining organs are reconnected in a new way to allow digestion. The Whipple procedure is a difficult and complicated surgery. Surgeons and hospitals that do the most operations have the best results.

About half the time, once a surgeon sees inside the abdomen, pancreatic cancer that was thought to be resectable turns out to have spread, and thus be unresectable. The Whipple procedure is not completed in these cases.

Distal pancreatectomy: The tail and/or portion of the body of the pancreas are removed, but not the head. This surgery is uncommon for pancreatic cancer, because most tumors arising outside the head of the pancreas within the body or tail are unresectable.

Total pancreatectomy: The entire pancreas and the spleen are surgically removed. Although once considered useful, this operation is uncommon today.

Chemotherapy or radiation therapy or both can also be used in conjunction with surgery for resectable and unresectable pancreatic cancer in order to:

  • Shrink pancreatic cancer before surgery, improving the chances of resection
  • Prevent or delay pancreatic cancer from returning after surgery

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Patients May Want To Think About Taking Part In A Clinical Trial

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Treatment Of Locally Advanced Pancreatic Cancer

Chemotherapy For Pancreatic Cancer Stage 4

For information about the treatments listed below, see the Treatment Option Overview section.

Palliative therapy can be started at any stage of disease. See the Palliative Therapy section for information about treatments that may improve quality of life or relieve symptoms in patients with pancreatic cancer.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

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Locally Advanced Pancreatic Cancer

This type of pancreatic cancer has grown into nearby tissues, organs or a major blood vessel. Although it may be possible to remove the tumor, surgeons may not be able to extract all of the cancer via surgery. Chemotherapy or radiation therapy may be used to shrink the tumor, so it may be surgically removed.

Alternative Pancreatic Cancer Treatments Designed To Provide Options Forinoperable Tumors

A pancreatic cancer diagnosis should not limit your options to fight for your life. To help pancreatic cancerpatients,even those with unresectable tumors, we deliver unique targeted therapies and minimally invasive surgical options atEnvita Medical Centers, a world-class Integrative center for Precision Oncology.

Treating late-stage and complicated cancers for over 20 years, we understand how utilizing research-based newtreatments, in combination with the latest in conventional medicine and natural therapies, may improve the chances ofapositive outcome. Our powerful and personalized combination treatments have proved beneficial even in stage IVpancreatic cancer, when the Whipple procedure, often considered potentially lifesaving, is not a viable optionanymore.

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Treatment Of Metastatic Or Recurrent Pancreatic Cancer

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of pancreatic cancer that has metastasized or recurred may include the following:

Palliative therapy can be started at any stage of disease. See the Palliative Therapy section for information about treatments that may improve quality of life or relieve symptoms in patients with pancreatic cancer.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

General Information About Pancreatic Cancer

Understanding stage IV pancreatic cancer
In This Section

Estimated new cases and deaths from pancreatic cancer in the United States in 2022:

  • New cases: 62,210.
  • Deaths: 49,830.

The incidence of carcinoma of the pancreas has markedly increased over the past several decades and ranks as the fourth leading cause of cancer death in the United States. Despite the high mortality rate associated with pancreaticcancer, its etiology is poorly understood.

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Smoking And Health History Can Affect The Risk Of Pancreatic Cancer

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer not having risk factors doesnt mean that you will not get cancer. Talk with your doctor if you think you may be at risk.

Risk factors for pancreatic cancer include the following:

Treating Locally Advanced Cancer

Locally advanced cancers have grown too far into nearby blood vessels or other tissues to be removed completely by surgery, but have not spread to the liver or distant organs and tissues. Surgery to try to remove these cancers does not help people live longer. Therefore, if surgery is done, it is to relieve bile duct blockage or to bypass a blocked intestine caused by the cancer pressing on other organs.

Chemotherapy, sometimes followed by chemoradiation, is the standard treatment option for locally advanced cancers. This may help some people live longer even if the cancer doesnt shrink. Giving chemo and radiation therapy together may work better to shrink the cancer, but this combination has more side effects and can be harder on patients than either treatment alone. Sometimes, targeted therapy may be added to chemotherapy before chemoradiation is given.

Other times, immunotherapy given alone may also be an option.

Surgery might be done after chemo or chemoradiation, if imaging shows the cancer has become smaller and can be removed completely by surgery.

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Pancreatic Cancer Treatments By Stage

The best treatment for pancreatic cancer depends on how far it has spread, or its stage. The stages of pancreatic cancer are easy to understand. What is difficult is attempting to stage pancreatic cancer without resorting to major surgery. In practice, doctors choose pancreatic cancer treatments based upon imaging studies, surgical findings, and an individualâs general state of well being.

If Treatment Does Not Work

Man Rings Victory Bell to Mark 5 Year Survival of Stage IV Pancreatic ...

Recovery from pancreatic cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team and family and friends to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people want and need support to help them cope with the loss. Learn more about grief and loss.

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Stages Of Pancreatic Cancer

Any N

The cancer has spread to distant sites such as the liver, peritoneum , lungs or bones . It can be any size and might or might not have spread to nearby lymph nodes .

* The following additional categories are not listed on the table above:

  • TX: Main tumor cannot be assessed due to lack of information.
  • T0: No evidence of a primary tumor.
  • NX: Regional lymph nodes cannot be assessed due to lack of information.

Life Expectancy Of Stage 4 Pancreatic Cancer

The life expectancy for stage 4 pancreatic cancer is considered one of the lowest, since the disease is considered one of the worst of the existing types of cancer. As of now, many medical resources pin the median survival rate for stage 4 pancreatic cancer patients to be about three to five months, depending on the condition of the patient.

The lower life expectancy is due to the fact that the cancer, at this point, spreads to the surrounding organs. Since this happens, its difficult for a patient to recover from the cancers damage, even if undergoing treatment.

Treatment for stage 4 pancreatic cancer often involves chemotherapy and the administration of pain-relieving drugs for patients. Patients also receive palliative surgery, which may include a biliary bypass, gastric bypass and/or an endoscopic stent placement.

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Is Stage 4 Cancer Terminal

Terminal cancer cannot be cured or treated. A person with terminal cancer is actively dying and will usually not live for more than a few months.

Stage 4 pancreatic cancer is not always called terminal. While the cancer is at an advance or late stage, some people do live longer than a few months with it.

What Are Treatments For Stage Iv Pancreatic Cancer

Dr. Choti on Future Treatment of Patients With Stage IV Pancreatic Cancer

Stage IV patients usually get a treatment that travels through the bloodstream to reach cancer cells that are in many places throughout the body. Stage IV treatment is usually chemotherapy. Clinical trials may also give you more choices.

The cancer cannot be removed by surgery at this stage.

The Pancreatic Cancer Action Network strongly recommends:

  • Discussing your treatment goals with your healthcare team and knowing all of your options
  • Clinical trials at diagnosis and during every treatment decision
  • Molecular profiling of your tumor to help determine the best treatment options
  • Symptom management and supportive care early in your diagnosis as well as during and after treatment

For more information and resources about pancreatic cancer treatment, including clinical trials and molecular profiling, contact PanCAN Patient Services.

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Surgical Resection For Pancreatic Cancer

Considerations include the following:

  • Surgical resection is potentially the only curative treatment approach for pancreatic cancer however, most patients will present with disease that will not be cured with resection.

  • Surgical resection depends on the size and location of the tumor and should involve multidisciplinary consultation.

  • Pancreatic cancer primary tumor size measurements are often discordant between CT and pathologic specimen after resection. Dimensions of the primary tumor are increasingly relevant in an era of highly conformal radiotherapy.

Treatment Recommendations For Metastatic Disease

First-line treatment recommendations for advanced metastatic pancreatic cancer :

  • Paclitaxel protein bound 125 mg/m2 plus gemcitabine 1000 mg/m2 IV over 30-40 min on days 1, 8, and 15 of each 28-day cycle

  • Gemcitabine 1000 mg/m2 IV over 30 min weekly for 7 wk, followed by 1 wk off, then weekly for 3 wk every 28 d or

  • Gemcitabine 1000 mg/m2 IV over 30 min on days 1 and 15 plus cisplatin 50 mg/m2 IV over 1 h on days 1 and 15 every 28 d or

  • Gemcitabine 1000 mg/m2 IV weekly for 7 wk plus erlotinib 100 mg PO daily on days 1-56, followed by 1 wk off then gemcitabine 1000 mg/m2 IV on days 1, 8, and 15 every 28 d plus erlotinib 100 mg PO daily on days 1-28 for up to four cycles or

  • Gemcitabine 1000 mg/m2 IV weekly for 3 wk every 28 d plus capecitabine 1660 mg/m2/day weekly for 3 wk every 28 d or

  • For patients with stage IV disease, median overall survival on gemcitabine-based therapy is from 5.5 to 7 mo the nongemcitabine-based regimen FOLFIRINOX showed improved survival of 11.1mo : Oxaliplatin 85 mg/m2 IV on day 1 plus irinotecan 180 mg/m2 IV on day 1 plus leucovorin 400 mg/m2 IV on day 1, followed by 5-FU 400 mg/m2 IV bolus on day 1 and then 2400 mg/m2 IV infusion over 46 h on days 1 and 15

Second-line treatment recommendations for advanced metastatic pancreatic cancer:

Maintenance treatment:

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Precision Deployment Overcomes Treatment Challenges

The combination of a late or missed diagnosis along with the pancreas location and proximity to other organs makessurgical intervention difficult for most pancreatic cancer patients. Even when surgery and stenting procedures areperformed, studies show the recurrence of local andmetastatic disease post resection is considered to be the leading cause ofmortality in patients.

Traditional maximum dose untargeted chemotherapy is largely ineffective against pancreatic cancer due to thepancreasstroma, which acts as a protective barrier preventing most chemotherapies from being absorbed into the canceroustumors.These hurdles to care have made pancreatic cancer a truly complex condition to treat, but we at Envita focus ontreatingthe disease and its cause, going beyond just managing it or using palliative care to relieve symptoms.

Envitas proprietary interventional radiology technologies and unique treatment options help in overcoming many ofthechallenges of this aggressive cancer.

Here are some of our proprietary treatments:

Treating Locally Advanced Pancreatic Cancer

Chemotherapy For Pancreatic Cancer Stage 4

In locally advanced pancreatic cancer, surgery can’t remove the entire tumor. Since surgery to remove only part of the pancreatic cancer has been shown not to help, nonsurgical therapies are best.

Treatment consists of chemotherapy with or without radiation therapy. Either 5-FU or gemcitabine can extend life in people with locally advanced pancreatic cancer.

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Data Sources And Outcomes

The hospitals administrative database was used to identify eligible patients using the International Classification of Diseases Code C25.0 to C25.9 and who had a death registered on the database . Confirmatory data on further deaths were obtained through the state departments register of deaths. We captured basic demographic variables .

Clinical electronic and written case records and the hospital chemotherapy drug administration database were subsequently examined to identify key indicators of aggressive cancer care in the last 30days of life which included: intravenous chemotherapy use, multiple emergency department presentations and acute hospital admission , or intensive care admission . We included chemotherapy administration in external hospitals if these data were available in the clinical records, as patients may have chosen to receive treatment elsewhere. We further determined if referral to the hospitals palliative care service had occurred, the interval between referral to palliative care and death, and the place of death. We choose to define early palliative care based on the duration of continuity of palliative care before death . Thus early and late PCR were defined as more than 90days and less than or equal to 90days before death respectively.

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