Treatment Of Resectable Or Borderline Resectable Pancreatic Cancer
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.
Stage Information For Pancreatic Cancer
In This Section
|T0 = No evidence of primary tumor.
|Tis = Carcinoma in situ. This includes high-grade pancreatic intraepithelial neoplasia , intraductal papillary mucinous neoplasm with high-grade dysplasia, intraductal tubulopapillary neoplasm with high-grade dysplasia, and mucinous cystic neoplasm with high-grade dysplasia.
|T1 = Tumor 2 cm in greatest dimension.
|T1a = Tumor 0.5 cm in greatest dimension.
|T1b = Tumor > 0.5 cm and < 1 cm in greatest dimension.
|T1c = Tumor 12 cm in greatest dimension.
|T2 = Tumor > 2 cm and 4 cm in greatest dimension.
|T3 = Tumor > 4 cm in greatest dimension.
|T4 = Tumor involves celiac axis, superior mesenteric artery, and/or common hepatic artery, regardless of size.
|NX = Regional lymph nodes cannot be assessed.
|N0 = No regional lymph node metastases.
|N1 = Metastasis in one to three regional lymph nodes.
|N2 = Metastasis in four or more regional lymph nodes.
|M1 = Distant metastasis.
Lynparza Is The First Maintenance Therapy Approved By The Fda For Use In Pancreatic Cancer
The goal of maintenance therapy is to extend the time that a patients cancer will remain stable, or without tumor progression.
Chemotherapy can cause side effects that may make long-term use challenging. So, it is not uncommon for patients who have remained stable on chemotherapy to stop treatment entirely to give their bodies a break.
When a patients cancer is stable after a time on chemotherapy, a maintenance therapy may be used in place of chemotherapy or instead of going off treatment entirely.
Also, because targeted therapies attack specific features of cancer cells, they generally do not harm healthy cells. So, they usually cause fewer side effects than other treatments like chemotherapy.
The clinical trial that tested Lynparza showed that the drug significantly extended the period of time before a patients tumor progressed again.
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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:
- Having a personal history of diabetes or chronicpancreatitis.
- Having a family history of pancreatic cancer or pancreatitis.
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A new vaccine using the same mRNA technology as the Pfizer jab against COVID-19 could be a breakthrough in the fight against pancreatic cancer.
In a promising early study conducted by German company BioNTech which partnered with Pfizer to develop the lifesaving COVID shot half of the patients remained cancer-free 18 months after having their tumors removed and receiving the jabs.
The groundbreaking trial led by Dr. Vinod Balachandran at the Memorial Sloan Kettering Cancer Center in Manhattan presented its promising results at the American Society of Clinical Oncology conference in Chicago on Sunday.
Doctors said the results showed that the vaccine could train the immune system to kill pancreatic cancer cells by boosting immune cells that target tumors.
The trial was carried out on 16 patients, each of whom was given eight doses of the individualized vaccine made using the mRNA genetic code found in each of their tumors.
The patients received their jabs after undergoing surgery to remove a tumor.
Results showed the jab produced a T cell response in eight out of the 16 patients, who remained cancer-free throughout the duration of the trial.
The remaining patients who did not respond to the vaccine either died or saw their cancer return.
Unlike some of the other immunotherapies, these mRNA vaccines do appear to have the ability to stimulate immune responses in pancreatic cancer patients, Balachandran said of the promising preliminary results.
Treating Cancer Of The Ampulla Of Vater
The ampulla of Vater is the area where the pancreatic duct and the common bile duct empty into the duodenum . Cancer at this site can start in the pancreatic duct, the duodenum, or the common bile duct. In many patients, ampullary cancer cant be distinguished from pancreatic cancer until surgery has been done.
These cancers often cause early symptoms such as jaundice, so they are often found while they are still resectable. Surgery with the Whipple procedure is often successful in treating these early stage cancers. Adjuvant chemoradiotherapy is often recommended after surgery.
More advanced ampullary cancers are treated like pancreatic cancer.
Pancreatic Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Pancreas
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:
- To make juices that help digest food.
- To make hormones, such as insulin and glucagon, that help control blood sugar levels. Both of these hormones help the body use and store the energy it gets from food.
For information on pancreatic cancer in children, see the PDQ summary on Childhood Pancreatic Cancer Treatment.
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New Discovery Sheds Insights Into Pancreatic Cancer Treatment
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Fibroblasts and cancer-associated fibroblasts were found to influence pancreatic cancer progression. The cells can trace pancreatic cancer origin back to a structure that forms during embryonic development. Despite accounting for only about 3% of all cancers in the U.S., it causes about 7% of cancer deaths. According to the American Cancer Society, more than 50,000 people are expected to die from pancreatic cancer in the U.S. in 2023.
Help Getting Through Cancer Treatment
People with cancer need support and information, no matter what stage of illness they may be in. Knowing all of your options and finding the resources you need will help you make informed decisions about your care.
Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms. Communicating with your cancer care team is important so you understand your diagnosis, what treatment is recommended, and ways to maintain or improve your quality of life.
Different types of programs and support services may be helpful, and can be an important part of your care. These might include nursing or social work services, financial aid, nutritional advice, rehab, or spiritual help.
The American Cancer Society also has programs and services including rides to treatment, lodging, and more to help you get through treatment. Call our National Cancer Information Center at 1-800-227-2345 and speak with one of our trained specialists.
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About 4% To 7% Of Pancreatic Cancer Patients Have A Germline Brca Mutation
Lynparza is approved for patients with BRCA mutations that they were born with, called germline mutations. The only way to know if you are eligible is to get appropriate testing.
This approval highlights the effectiveness of treatment based on the biology of a patient and their tumor.
PanCAN recommends both germline testing and molecular profiling for all pancreatic cancer patients. Patients can receive both types of testing through PanCANs Know Your Tumor® precision medicine service. These tests may also be available through your doctor or hospital.
Even if a patient does not qualify for Lynparza, this testing may reveal other biological characteristics that may be targeted with treatment through other approved drugs, clinical trials or off-label treatment.
Cris Impact On Pancreatic Cancer
At the Cancer Research Institute, we are dedicated to improving the quality of life and prognostic landscape for patients diagnosed with this destructive disease. With the aid of our donor network, we continue to provide funding to leading scientists working in the field of pancreatic cancer research and treatment.
CRI discoveries and ongoing work in pancreatic cancer research and treatment include:
See what pancreatic cancer-specific research were currently funding. With your help, we can fund more research and revolutionize the way cancer is treatedcuring more people and saving more lives.
- Oncolytic Virus Therapy
Targeted antibodies are proteins produced by the immune system that can be customized to target specific markers on cancer cells, in order to disrupt cancerous activity, especially unrestrained growth. Antibody-drug conjugates are equipped with anti-cancer drugs that they can deliver to tumors. Bi-specific T cell-engaging antibodies bind both cancer cells and T cells in order to help the immune system respond more quickly and effectively. Antibody targets under evaluation in pancreatic cancer clinical trials include:
- EpCAM: a pathway that controls cell growth and adhesion
- FGF/FGF-R: a pathway that controls cell growth, death, and migration
- Nectin-4: a pathway that controls cell growth and adhesion
- VEGF/VEGF-R: a pathway that can promote blood vessel formation in tumors
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Matching Treatment To An Individual Cancer
This is a large programme of research aiming to understand more about the individual make up of pancreatic cancers. The researchers want to collect samples of pancreatic cancer tissue to examine its genetic make up.
Genes contain coded messages that tell cells how to behave. They control the growth and development of cells.
The researchers hope that understanding more about the genetic make up of pancreatic cancers will help doctors decide the best treatment. The researchers also want to learn more about when, how and why people develop pancreatic cancer. And to predict who is more at risk of developing it.
The researchers are doing their research in 2 stages. The PRECISION Panc study is stage 1. Based on the information from the tissue samples, they will ask people to join a study to have treatment in stage 2.
In stage 2, the researchers will look at new treatments for pancreatic cancer.
- PRIMUS 001 for people with pancreatic cancer that has spread
- PRIMUS 002 for people with pancreatic cancer that can be removed with surgery
PRIMUS 003 looked at second treatments for pancreatic cancer that had spread elsewhere in the body. This part of the study has now closed.
Treating Pancreatic Cancer Based On Extent Of The Cancer
This information is about treating exocrine pancreatic cancer, the most common type of pancreatic cancer. See Pancreatic Neuroendocrine Tumor for information about how that type is typically treated.
Most of the time, pancreatic cancer is treated based on its stage how far it has spread in the body. But other factors, such as your overall health, can also affect treatment options. Talk to your doctor if you have any questions about the treatment plan they recommend.
It can be hard to stage pancreatic cancer accurately using imaging tests. Doctors do their best to figure out before treatment if there is a good chance the cancer is resectable that is, if it can be removed completely. But sometimes cancers turn out to have spread farther than was first thought.
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Immunotherapy For Pancreatic Cancer Is Currently In Clinical Trials Providing Potential New Options For Patients With This Difficult
The pancreas is an organ of the digestive system located behind the stomach, bordering the spleen and small intestine. It has two primary functions: an endocrine function that releases insulin and glucagon into the bloodstream and an exocrine function that produces digestive enzymes that are released into the small intestine.
The incidence of pancreatic cancer is rising, and some reports project that the number of new pancreatic cancer cases and pancreatic cancer deaths will more than double by 2030. Pancreatic ductal adenocarcinoma accounts for more than 90% of pancreatic cancer cases.
Pancreatic cancer is very difficult to detect or diagnose at early stages of disease. It often develops without early symptoms, there is no widely used method for early detection, and although some risk factors have been identified , few patients diagnosed with pancreatic cancer have identifiable risk factors.
Pancreatic cancer is one of the worlds most lethal cancers and the fourth-leading cause of cancer-related death in the United States. Each year, an estimated 460,000 people globallyand 60,000 in the U.S.are diagnosed with pancreatic cancer, and it causes approximately 430,000 deaths worldwide and 48,000 in the U.S.
Pancreatic ductal adenocarcinoma is highly lethal for all stages combined, the 1- and 5-year relative survival rates are 27% and 9%, respectively, making it the only cancer with an overall 5-year survival rate in the single digits.
Cancer Cells Overcoming Isolation Stress
We focused on pancreatic cancer,one of the most lethal cancers and one that is notoriously resistant to chemotherapy and often not curable with surgery. Almost 90% of pancreatic patients will succumb to cancer recurrence or metastasis within five years after diagnosis.
We wanted to study how tumor formation is affected by what we call isolation stress, when cells are deprived of nutrients or oxygen supply because of poor blood vessel formation or because they cannot benefit from making contact with nearby cancer cells. To study how cancer cells respond to these situations, we recreated different forms of isolation stress in cell cultures, in mice and in patient samples by depriving them of oxygen and nutrients or by exposing them to chemotherapeutic drugs. We then measured which genes were turned on or off in pancreatic cancer cells.
We found that pancreatic cancer cells challenged with conditions that mimic isolation stress gain a new receptor on their surface that unstressed cancer cells dont typically have: lysophosphatidic acid receptor 4, or LPAR4, a protein involved in tumor progression.
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Testing Treatments For Early
Therapies for early-stage disease that are being tested in clinical trials right now are
- neoadjuvant chemotherapy This form of chemotherapy is given before surgery, with the goal of improving outcomes by shrinking the tumor before its removed. Pre-surgical chemotherapy also may help by killing cancer cells that have escaped from the tumor that would continue to grow as the patient recovers from surgery.
Pancreatic Cancer Treatment Options
Traditional treatments for pancreatic cancer include surgical resection, radiation, ablative treatments, and chemotherapy.
Currently, the only treatment for pancreatic cancer that has any chance of curing the patient of the disease is the complete surgical removal of the pancreas, a procedure for which fewer than 20% of those diagnosed are eligible. Many patients who do proceed with surgery will ultimately relapse, pointing to the urgent need for more effective treatments that are more likely to prevent eventual relapse.
Immunotherapy is a class of treatments that take advantage of a persons own immune system to help kill cancer cells. There are currently two FDA-approved immunotherapy options for a small subset of patients with pancreatic cancer, and many more are being investigated in clinical trials.
- Dostarlimab : a checkpoint inhibitor that targets the PD-1/PD-L1 pathway approved for subsets of patients with advanced pancreatic cancer that has DNA mismatch repair deficiency
- Pembrolizumab : a checkpoint inhibitor that targets the PD-1/PD-L1 pathway approved for subsets of patients with advanced pancreatic cancer that has high microsatellite instability , DNA mismatch repair deficiency , or high tumor mutational burden
Due to its consistently poor outlook and the current lack of effective treatment options, pancreatic cancer patients are highly encouraged to seek clinical trials in all cases.
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Certain Factors Affect Prognosis And Treatment Options
The prognosis and treatment options depend on the following:
- Whether or not the tumor can be removed by surgery.
- The stage of the cancer .
- The patients general health.
- Whether the cancer has just been diagnosed or has recurred .
Pancreatic cancer can be controlled only if it is found before it has spread, when it can be completely removed by surgery. If the cancer has spread,palliative treatment can improve the patient’squality of life by controlling the symptoms and complications of this disease.