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Pancreatic Cancer Chemo Not Working

What Is Locally Advanced Pancreatic Cancer

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Locally advanced cancer is cancer that has spread outside the pancreas. It may have spread to the large blood vessels near the pancreas, or to a number of lymph nodes. It is stage 3 cancer.

Occasionally, stage 3 cancer is borderline resectable cancer. This means that the cancer has grown very close to the major blood vessels near the pancreas. You may be able to have surgery to remove the cancer, but it depends which blood vessels are affected. Some surgeons class this as stage 2 cancer.

Treatment For Pancreatic Cancer

Pancreatic cancer can be difficult to treat.

The treatment you have will depend on:

  • the size and type of pancreatic cancer you have

It may include surgery, chemotherapy, radiotherapy and supportive care.

The specialist care team looking after you will:

  • explain the treatments, benefits and side effects
  • work with you to create a treatment plan that is best for you
  • help you manage any side effects, including changes to your diet to help you digest your food

You’ll have regular check-ups during and after any treatments. You may also have tests and scans.

If you have any symptoms or side effects that you are worried about, talk to your specialists. You do not need to wait for your next check-up.

Before You Start Chemotherapy

You need to have blood tests to make sure its safe to start treatment. You usually have these the day before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Your doctors and pharmacists work out your chemotherapy dose based on your blood test results, your weight, height and general health.

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Patient Population And Diagnosis

Pancreatic ductal adenocarcinoma is largely a disease of old age, with an average age of diagnosis of 71 years. Yet the presenting symptoms are nonspecific such as weight loss and abdominal pain . This population of patients is accustomed to aches and pains, and so in most cases, the earliest signs of malignancy go unnoticed a high level of perception is required to avoid delays in diagnostic workup. Furthermore, in contrast to breast, prostate, melanoma and testicular cancers, there are no simple examinations that can elevate the level of suspicion: the pancreas is too deep to palpate and there is no specific blood test available for PDA. Other symptoms at diagnosis can include new onset of diabetes , unexplained jaundice and unprovoked thrombosis the most specific of these is unexplained painless jaundice, but many other explanations are possible. Thus, by the time that a patient seeks medical advice and their GP successfully navigates the diagnostic maze, often many months have passed and the patients condition has further deteriorated.

What Stage 4 Pancreatic Cancer Means

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Doctors use stages when they talk about how cancer has grown or spread. Stage 4 is the last stage. It means that cancer cells have spread to other parts of the body. When this happens, cancer is called metastatic.

One way to stage cancer is called the TNM system. It has 3 parts:

  • T : This part is based on how big a tumor is and where it has spread to. The T rating goes from T0 to T4. In stage 4 pancreatic cancer, the primary tumor can have any T rating.
  • N : Lymph nodes help filter substances in the body. When cancer cells get to the lymph nodes, it’s easier for them to spread. Stage 4 pancreatic cancer can have an N rating of N1 or N2 .
  • M : Metastasis means cancer has spread to other organs and lymph nodes. There are only two M stages: M0 or M1. Any pancreatic cancer with an M1 rating is at stage 4.

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Stage 4 Pancreatic Cancer Symptoms

One reason that pancreatic cancer gets diagnosed late is that it can be easy to miss the signs. A person may not know that they have cancer because they do not feel sick. Even if they do have symptoms, they might not bother them much.

The symptoms of pancreatic cancer usually do not start until the cancer cells have gotten into other organs. The intestines are often one of the first places cancer goes. It can also go to the liver, lungs, bones, and even the brain.

Once cancer goes to other parts of the body, a person can start to feel very sick. They can also have serious medical conditions, such as:

Treatment Options By Stage Of Pancreatic Cancer

Different treatments may be recommended for each stage of pancreatic cancer. Your doctor will recommend a specific treatment plan for you based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier in this page. Clinical trials may also be a treatment option for each stage.

Below are some of the possible treatments based on the stage of the cancer. The information below is based on ASCO guidelines for the treatment of pancreatic cancer. Your care plan may also include treatment for symptoms and side effects, an important part of pancreatic cancer care. Also, patients with any stage of pancreatic cancer are encouraged to consider clinical trials as a treatment option. Talk with your doctor about all of your treatment options. Your doctor will have the best information about which treatment plan is recommended for you.

Potentially curable pancreatic cancer

Locally advanced pancreatic cancer

Metastatic pancreatic cancer

Your treatment plan may include a combination of the treatments discussed above. Treatment options for people with metastatic pancreatic cancer depend heavily on a patients overall health, preferences, and support system.

Information below is based on the ASCO guideline, Metastatic Pancreatic Cancer. Please note that this link takes you to another ASCO website.

Depending on factors such as your preferences, characteristics, and your comorbidity profile, first-line options include:

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When To Stop Cancer Treatment

When you have cancer and you have tried many treatments without success, its hard to know when to stop treatment. Sometimes, even with the best care, cancer continues to spread. It is hard to accept, but the best thing for you at that point may be to stop the cancer treatment. Instead, you could focus on getting care to keep you comfortable and out of pain.

The following explains how to know when it is time to stop treatment and focus on end-of-life care. You can use this information to talk with your doctor about your options and choose the best care for you.

Cancer responds best to treatment the first time.

When you treat a tumor for the first time, there is hope that the treatment will destroy the cancer cells and keep them from returning. But if your tumor keeps growing, even with treatment, there is a lower chance that more treatment will help.

This is especially true for solid-tumor cancers, like breast, colon, and lung cancer, and sarcoma. Doctors know a lot about how these cancers grow or shrink over time and how they respond to treatment. They have found that treatment after treatment offers little or no benefit.

When is it time to think about stopping cancer treatment?

Still, almost half of people with advanced cancer keep getting chemotherapyeven when it has almost no chance of helping them. They end up suffering when they should not have to.

How do you know when to stop treatment?

Hospice care improves your quality of life.

Chemo Not Working What To Do Next Please Help

Is pancreatic cancer a death sentence?

So on Thursday, after 3months of treatment, I was informed by my oncologist that the Gem/Abraxane is also NOT working.The mass in my pancreas grew with 8mm, the lesions in my liver stayed relatively stable, with one of the two showing growth of 2mm

I asked if they can do radiation and she said she will come back to me.

Can they do radiation? What about ablation radiation?? Surely there must be something more we can do????

Please help!!!!

I keep asking the same thing- they changed chemo but I would rather go straight to the radiation

keep asking and seek a second opinion. I had radiation and chemo. My tumor was gone said he did not think they could not do more radiation. But I pushed and he put me in the tumor board. I asked about surgery and cryoablation. No on the ablation because nobody had done it. My insurance is Kaiser. I had a call from the radiation oncologist and he said we could try it. Keep advocating for yourself. I am going back on chemo next week.

After first line chemotherapy regimens of Folfirinox and Genzar/Abraxane are no longer effective, there are second, third and fourth-line chemo drug combinations available.

God bless allI will keep you updated

Thank you so much for your post.

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How Pancreatic Cancer Is Treated

In cancer care, different types of doctors and other health care professionals often work together to create a patients overall care and treatment plan that combines different types of treatments and supportive care. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, patient navigators, social workers, pharmacists, counselors, dietitians, and others.

The common types of treatments used for pancreatic cancer are described below, followed by a general outline of treatments by stage. The current treatment options for pancreatic cancer are surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. Your care plan also includes treatment for symptoms and side effects, an important part of cancer care.

When detected at an early stage, pancreatic cancer has a much higher chance of being successfully treated. However, there are also treatments that can help control the disease for patients with later stage pancreatic cancer to help them live longer and more comfortably.

Dealing With Symptoms Of Advanced Cancer

You may think that symptoms will get worse as cancer progresses. This isn’t always the case. You may have a few symptoms or none at all. Common symptoms include:

If you have any of these symptoms, it’s important to tell your provider. Don’t downplay symptoms. There are many treatments that can help you feel better. You should not have to be uncomfortable. Relieving symptoms can help you enjoy your life more fully.

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Potential New Therapies Help Outsmart Pancreatic Cancer

Pancreatic cancer is challenging to treat. A Johns Hopkins surgeon details the latest treatment breakthroughs.

Research teams around the world are working to uncover novel ways to attack this disease. Every day doctors learn more about how new treatments, such as immunotherapies, could help treat pancreatic cancer more effectively.

Pancreatic Cancer Prognosis & Survival

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Each year more than 50,000 people in the United States are now diagnosed with pancreatic cancer . The prognosis is such that most of these people will have passed by the end of the first year. In the U.S., pancreatic cancer is 9th or 10th most commonly diagnosed cancer , but the fourth leading cause of cancer death in men and women.

Each year more than 50,000 people in the United States are now diagnosed with pancreatic cancer . The prognosis is such that most of these people will have passed by the end of the first year. In the U.S., pancreatic cancer is 9th or 10th most commonly diagnosed cancer , but the fourth leading cause of cancer death in men and women.

The prognosis of pancreatic cancer is a very tough, though the survival rates have been incrementally improving particularly over the past ten to fifteen years. It is important to realize that each person is individual each cancer is different. Statistics can only indicate what tends to happen in the aggregate, and not in the case of an individual person.

The median survival duration from the time of diagnosis until demise is arguably the worst of any of the cancers certainly of the major cancers. The median survival for untreated advanced pancreatic cancer is about 3 1/2 months with good treatment this increases to about eight months, though many will live much longer. We have encountered nine and eleven and twelve year survivors.

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Our Approach To Pancreatic Cancer

Johns Hopkins pancreatic surgeons perform a variety of innovative techniques to treat pancreatic cancer, including operations using both traditional open methods and minimally invasive methods. During one appointment at our multidisciplinary clinic, patients will meet with experienced specialists who will care for them at every stage of the journey.

When Your Cancer Treatment Stops Working

Cancer treatments can keep cancer from spreading and even cure early-stage cancer for many people. But not all cancer can be cured. Sometimes, treatment stops working or the cancer reaches a stage where it cannot be treated. This is called advanced cancer.

When you have advanced cancer, you move into a different stage of life. It is a time when you start to think about the end of life. This is not easy, but it doesn’t mean you don’t have options. Some people live for years with advanced cancer. Learning about advanced cancer and knowing your options can help you make decisions that work best for you.

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Advantages To Giving Chemotherapy Before Surgery

Although adjuvant chemotherapy has been shown to extend survival of patients with early-stage pancreatic cancer, Dr. Rudloff noted that waiting until after surgery to give chemotherapy has potential problems and might lead to inferior outcomes. When patients have surgery first, a proportion have complications and then arent healthy enough to receive chemotherapy, or there is a significant delay in starting chemotherapy, he said.

Almost all patients with early-stage disease likely have tiny, undetectable deposits of pancreatic cancer cells, called micrometastases, in other organs at the time of diagnosis, added Dr. Rudloff. So, if patients arent healthy enough to receive chemotherapy after surgery, they are at higher risk of their disease recurring earlier and having worse outcomes, he explained.

In addition, said Geertjan van Tienhoven, M.D., Ph.D., of the Academic Medical Center in Amsterdam, who presented results from the neoadjuvant chemotherapy study at ASCO, in some patients the tumor is too close to blood vessels to be safely removed completely . Giving chemotherapy before surgery may shrink such tumors enough to make complete removal safe.

Many oncologists who treat pancreatic cancer have already been giving neoadjuvant treatment, hoping to allow more patients to undergo surgery, explained Dr. Ocean. And now there’s data showing that we should, she said.

Extremely Unusual To Get 132 Rounds Of Chemo

‘Softening’ pancreatic cancer to improve chemotherapy response

Shes done extremely well, Schulick said. Marybeth is one of those rare patients who are getting more common who have a great response to chemotherapy.

Even, so, its extremely unusual for any patient to get 132 rounds of chemo, said Cheryl Meguid, a nurse practitioner who runs the pancreatic cancer clinic and moved with Schulick and the team from Johns Hopkins to Colorado.

Thats the most Ive ever heard of. This is a very aggressive type of chemo. Its very hard to tolerate. Its incredible. Shes a miracle, Meguid said.

Both Meguid and Schulick said Marybeths excellent response paved a path for other patients. Chemotherapy medications continue to improve, along with the understanding of how best to use them. Pancreatic cancer remains quite deadly, but some other patients, like Marybeth, are beating the odds.

Ive been doing this for three decades, and in the last 10 years, Ive seen more people completely respond. Its a game changer, Schulick said.

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When Might Chemotherapy Be Used

Chemo is often part of the treatment for pancreatic cancer and may be used at any stage:

  • Before surgery : Chemo can be given beforesurgery to try to shrink the tumor so it can be removed with less extensive surgery. Neoadjuvant chemo is often used to treat cancers that are too big to be removed by surgery at the time of diagnosis .
  • After surgery : Chemo can be used after surgery to try to kill any cancer cells that have been left behind or have spread but cant be seen, even on imaging tests. If these cells were allowed to grow, they could form new tumors in other places in the body. This type of treatment might lower the chance that the cancer will come back later.
  • For advanced pancreatic cancer: Chemo can be used when the cancer is advanced and cant be removed completely with surgery, or if surgery isnt an option, or if the cancer has spread to other organs.

When chemo is given along with radiation, it is known as chemoradiation. It helps the radiation work better, but can also have more side effects.

Why You Might Have Chemotherapy

Although chemotherapy can’t cure advanced pancreatic cancer, it can help to control or shrink the cancer for a time. This can reduce or control symptoms and improve your quality of life.

Unfortunately chemotherapy doesn’t help everyone with pancreatic cancer. Some people will feel better with treatment and some may live longer. But some people having chemotherapy won’t get much benefit at all. You might want to consider the benefits and disadvantages of treatment before deciding whether to have it. Your doctor and specialist nurse will talk to you about this.

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Further Improving Pancreatic Cancer Treatment

Together, the two trials immediately raise additional questions, Dr. Rudloff said. They include whether mFOLFIRINOX should replace gemcitabine as neoadjuvant therapy and whether using newer types of radiation therapy, such as stereotactic body radiation therapy, in neoadjuvant treatment regimens could further improve outcomes.

While waiting for further trials, more oncologists will probably start to use mFOLFIRINOX both in the neoadjuvant and adjuvant settings, speculated Dr. Ocean. “The challenge will be to accurately predict which patients will be able to handle this more intensive regimen, especially after a major surgery such as a Whipple or pancreatic cancer resection,” she said.

Moving forward, Dr. Rudloff added, more laboratory studies and clinical trials are needed to develop completely new therapies for pancreatic cancer.

What we need in pancreatic cancer, without any question, are better drugs, he said. And while these studies represent progress, it is incremental. There’s so much room for improvement.

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