Adenocarcinoma Pancreas Treatment

Pancreatic cancer is considered resectable if the tumor appears to be localized to the pancreas without invasion into important surrounding structures such as the mesenteric blood vessels (that supply blood to the intestines) which are located adjacent to the head portion of the pancreas. Furthermore there should be no evidence of metastatic spread to liver or lining of the intestines. Surgical removal of the tumor is a treatment of choice for patients with resectable pancreatic cancer. The surgery involves removal of all tumor that is visible at the time of surgery and the type and extent of surgery depends on the location of tumor in the pancreas. Since pancreatic adenocarcinoma is an aggresive disease, radical surgery is necessary to remove all the tumor.

Metastatic Adenocarcinoma Pancreas

Surgery Treatment of pancreatic cancer depends on the stage of the cancer. The Whipple procedure is the most common surgical treatment for cancers involving the head of the pancreas. This procedure involves removing the pancreatic head and the curve of the duodenum together (pancreato-duodenectomy), making a bypass for food from stomach to jejunum (gasto-jejunostomy) and attaching a loop of jejunum to the cystic duct to drain bile (cholecysto-jejunostomy).

It can only be performed if the patient is likely to survive major surgery and if the cancer is localized without invading local structures or metastasizing. It can therefore only be performed in the minority of cases.

Chemotherapy In patients not suitable for resection with curative intent, palliative chemotherapy may be used to improve quality of life and gain a modest survival benefit. Gemcitabine was approved by the United States Food and Drug Administration in 1998 after a clinical trial reported improvements in quality of life and a 5-week improvement in median survival duration in patients with advanced pancreatic cancer. This marked the first FDA approval of a chemotherapy drug primarily for a non-survival clinical trial endpoint. Gemcitabine is administered intravenously on a weekly basis. Addition of oxaliplatin (Gem/Ox) conferred benefit in small trials, but is not yet standard therapy.[50], a recently published study ECOG 6201 failed to show superiority of GEMOX over gemcitabine alone (Poplin et al., JCO 2009, Louvet et al. JCO 2005). Fluorouracil (5FU) may also be included, however no large randomized study has shown significant survival benefit from this addition(Berlin et al. JCO 2002). One sofar unpublished trial has shown a trend (p=0.08) towards a significant benefit from adding capecitabine to gemcitabine (Cunningham et al. JCO 2009). Meta-analysis has, however, shown benefit from combination therapy, especially in fit (PS 0-1) patients (Sultana et al. BJC 2009, Cunningham et al. JCO 2009).