Treatment of pancreatic cancer can be broadly classified into 4 categories
Chemotherapy , and
Surgery remains the main modality of treatment of pancreatic cancer. Complete surgical removal of the cancer, in cases where the cancer is localized and has not metastasized, is the only hope of cure in pancreatic cancer.
Surgery for pancreatic cancer is a difficult procedure to perform requiring considerable amount of skill and experience on the part of the surgeon. Surgery for pancreatic cancer involves considerable risk of complications to the patient, which may be fatal in some cases. The fatality rates due to surgical complication may be as high as 15% in the hands of inexperienced surgeons. whereas surgeries performed by more experienced surgeons and at facilities with sophisticated facilities the fatality rates after surgery are as low as 5%.
Surgery may be used as a single modality or combined with chemotherapy and radiotherapy.
Surgeries performed for pancreatic cancer can be broadly classified into two groups.
curative surgeries, aimed at complete cure of the cancer
palliative surgeries, for palliation of symptoms.
Curative surgeries can be attempted in patients where the cancer is localized to pancreas with no evidence of any metastatic spread of the disease to other organs in the body, on CT and MRI investigations.
Complete resection of the tumor is the only effective treatment option for pancreatic cancer, at present. Unfortunately such curative surgeries are only possible in 10-15% of patients only, as the disease is most often diagnosed at an advanced stage. Even in cases where the cancer has apparently been completely removed and there is no evidence of metastatic spread on investigations like CT and MRI 5-year survival rate is only 20%. One of the important reasons for this low survival rate is the inability of the currently available chemotherapeutic drugs to completely kill the cancerous cells, which may not be detectable with investigations like CT and MRI due to their small number, at the metastatic sites.
3 procedures fall in the category of curative surgeries .
Pancreaticoduodenectomy (Whipple procedure) : This is the most commonly performed surgery and involves removal of the head of the pancreas, part of the small intestine, stomach and lymph nodes near the pancreas. The gall bladder and part of the common bile duct is also removed and the remaining bile duct is attached to the small intestine to maintain the flow of bile from liver to the intestine.
Distal pancreatectomy : during this procedure the tail and the body of the pancreas is removed. Spleen is also removed as well during this procedure. This procedure is most often used for tumors originating in the tail and body of the pancreas.
Total pancreatectomy : During this procedure the whole of the pancreas along with spleen, part of the stomach , part of small intestine and gall bladder and common bileduct and nearby lymph nodes are removed. This procedure is seldom used nowadays in the treatment of pancreatic cancer as it doesn’t seem to provide any additional survival benefit over other procedures. Diabetes mellitus which is a complication of this surgery, due to complete removal of the pancreas, the source of insulin, can be very hard to manage in the patients of pancreatic cancer and the patients become completely dependent on external insulin after surgery.
As it is obvious from the above discussion curative surgery can’t be performed in majority of the patients as the cancer, at the time of diagnosis, has metastasized to other organs in the body. But surgery an be performed in these patients also, with the aim of alleviating the symptoms.
One of the common symptom of pancreatic cancer is jaundice, a result of the blockage of the common bile duct. This can also cause pain and digestive problems. Two procedures are commonly employed to relieve this symptom.
Surgery to reroute the flow of the bile from the common bile duct directly to the small intestine bypassing the pancreas. The downside of this procedure is a large incision on the abdomen and the patient may be required to stay in the hospital for a long time. One of the benefits of this procedure is that nerves which are affected by the cancer and responsible for pain can be severed or injected with alcohol to rid the patient of pain caused by the cancer.
Another procedure, which actually doesn’t involve any surgery, but involves placement of a stent, usually made of metal, in the common bile duct endoscopically to prevent the narrowing of the lumen of the common bile duct due to compression from the surrounding cancer. The stent may be clogged after sometimes and may need replacement or clearing.
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