Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas. The two types of pancreatic glands - exocrine and endocrine - form different types of tumors.
Types of Pancreatic Tumors
Exocrine Tumors
These are by far the most common type of pancreatic cancer. About 95% of them are adenocarcinomas, which usually begin in the ducts (tubular canals) of the pancreas, but sometimes form in the cells that make the pancreatic enzymes. Treatment of exocrine tumors depends on the stage, or extent, of the cancer. Many adenocarcinomas are not discovered until a late stage, because symptoms rarely appear early.
Less common exocrine tumors include adenosquamous carcinoma, squamous cell carcinomas, signet ring cell carcinomas, and undifferentiated carcinomas. Another type of exocrine tumor, which can cause early symptoms such as jaundice, is ampullary cancer, which develops where the bile duct and pancreatic duct come together and empty into the duodenum.
Endocrine Tumors
Known as neuroendocrine tumors or islet cell tumors, these are much less common, but often have a better prognosis. These can arise in the cells that make insulin or glucagon, as well as cells that make the hormones gastrin and somatostatin, or in vasoactive intestinal peptides.
IPMN
Another type of tumor involving the pancreas is called an intraductal papillary mucinous neoplasm (IPMN). These are often pre-malignant, and therefore have a higher cure rate than the previously mentioned types of pancreatic cancer. Imaging studies can usually determine if you have IPMN.
Pancreatic Cancer Diagnosis
Pancreatic cancer is usually diagnosed with tests and procedures that produce pictures of the pancreas and the area around it. The two most common procedures are an endoscopic ultrasound and a CT scan. A biopsy (the removal of a small sample of the tumor with a fine needle) may also be taken during an imaging exams. If pancreatic cancer is diagnosed, the information gathered will pinpoint the location, size and stage of the cancer. This information will help your medical team design your specific treatment plan.
Endoscopic Ultrasound
In this procedure, you will receive intravenous sedation so that an endoscope (a thin, lighted tube) can be inserted into the abdominal area, next to the pancreas. The endoscope has a special miniaturized ultrasound built onto the tip, so that physicians can detect even the smallest of growths. This procedure also differentiates between a tumor and a non-cancerous stone that might be blocking the bile duct. If the physician sees a pancreatic mass, a needle can be inserted into the mass to take a biopsy, which is immediately evaluated by a pathologist. UC San Diego physicians are regional experts in endoscopic ultrasound.
CT (Computed Tomography) scan
During a CT scan, a series of detailed pictures are taken of areas inside the body, from different angles. UC San Diego’s CT scanners are able to obtain detailed images of the pancreas and adjacent organs and vessels. You will receive an intravenous (IV) contrast injected into your vein, allowing radiologists to precisely determine the extent of the cancer and any involvement of adjacent organs.
MRI (Magnetic Resonance Imaging)
In selected patients, an MRI scan may be performed instead of or along with a CT scan. UC San Diego is a leader in MRI, with multiple scanners available to provide high-resolution imaging of the pancreas. An MRI provides detailed information about all parts of the pancreas, including areas that are hard to see on a CT scan, such as pancreatic ducts and channels. As with a CT scan, you will receive an intravenous (IV) contrast injected into your vein.
Pancreatic Cancer Treatment
After your diagnosis, your physician will discuss your treatment options, which may include surgery, infusion therapy or radiation therapy. Your treatment will be customized to your condition.
Surgery
If at all possible, your doctor will recommend
surgery such as Whipple to remove the tumor. However, only about 20% of pancreatic cancers can be removed by surgery, due to the aggressiveness of this type of cancer and the stage at which it is often discovered. If your tumor can be surgically removed, you may also receive either infusion therapy or radiation therapy, or both.
Infusion Therapy
Unfortunately, many cases are not discovered until the cancer has spread. In advanced cancers of the pancreas that have grown too far to be completely removed by surgery, the standard treatments are chemotherapy with the drug Gemcitabine and Erlotinib or the combination of radiation therapy and chemotherapy with Gemcitabine or 5-Fluorouracil (5-FU). In some cases of widespread, metastatic cancer of the pancreas, additional medications may be considered, as well.
Radiation Therapy
Radiation therapy is the use of radiation to treat tumors in patients with cancer. With pancreatic cancer, radiation therapy may be delivered before or after surgery or to patients who are not candidates for surgery.
Radiation is personalized to the individual patient in a multi-step process that includes consultation with a radiation oncologist, followed by a simulation visit. During this simulation visit, your radiation oncologist will precisely outline the areas in your body that require treatment. Following the simulation, your radiation oncologist will lead a team of specialists to create a personalized radiation treatment plan. The goal is to treat your pancreatic tumor with radiation while avoiding nearby normal organs.
At UC San Diego Health, the standard course of radiation includes 15-30 minute sessions daily for five weeks, often received at the same time as infusion therapy. We use advanced types of radiation therapy, including:
For select patients, we offer
stereotactic body radiation therapy (SBRT), which uses advanced imaging and tracking techniques to safely deliver higher doses of radiation over a shorter period of time, often a week or less.
Irreversible Electroporation
Irreversible electroporation (IRE) is a new treatment for locally advanced pancreatic tumors that cannot be completely removed with surgical resection due to involvement of adjacent blood vessels, such as the superior mesenteric artery and portal vein. IRE is similar to thermal ablation therapies commonly used for liver tumors, such as radiofrequency and microwave ablation, in that it can be used to definitively treat tumors with the goal of cure.
However, since it does not involve heat, it is safe and effective near blood vessels. Needle probes are inserted around the tumor to apply an electrical current across the tumor, which results in tumor cell death without injury to the adjacent blood vessels. This treatment is appropriate for some patients who do not have distant metastatic (stage IV) disease but whose tumors are still locally advanced after receiving standard treatment with chemotherapy and/or radiation therapy. In select patients, surgical resection can be combined with IRE to treat limited vascular involvement with the goal of decreasing the risk of local recurrence.
Clinical Trials
Another treatment option your physician may discuss with you is participation in one of our
clinical trials. This is your access to the most promising new therapies being tested. The decision to enter a clinical trial is always up to you.
Palliative Care
Palliative care is designed to relieve suffering and improve the quality of your life by treating physical and emotional symptoms caused by your cancer or its treatment. Palliative care is not reserved for end-of-life care. We encourage patients with survivable cancers to seek palliative care, and to seek care early in cancer treatment.