pancreatic cancer:stages and treatment

If the doctor finds pancreatic cancer, the patient will have more tests to find out if the cancer has spread from the pancreas to the tissues around it or to other parts of the body. This process of testing is called staging, and it helps the doctor plan the patient’s treatment. The following stages are used to describe exocrine cancer of the pancreas:

Stage I: Cancer is found only in the pancreas itself and not in other organs.

Stage II: Cancer has spread to nearby organs, such as the duodenum or bile duct, but has not entered the lymph nodes.

Stage III: Cancer has spread to lymph nodes near the pancreas. The cancer may or may not have spread to nearby organs.

Stage IVA: Cancer has spread to organs, such as the stomach, spleen, and colon, that are near the pancreas, but it has not spread to distant organs, such as the liver or lungs.

Stage IVB: Cancer has spread to organs, such as the stomach, spleen, or colon, that are near the pancreas or to places far away from the pancreas, such as the liver or lungs.

Recurrent: The cancer has come back (recurred) after it has been treated. It may come back in the pancreas or in another part of the body.
Islet cell cancers of the pancreas are usually grouped into three stages: those occurring in one site within the pancreas; those occurring in several sites within the pancreas; and those that have spread to lymph nodes near the pancreas or to distant sites.

Surgery may be used to take out the tumor. A doctor may take out the cancer using one of the following operations:
Whipple Procedure (pancreaticoduodenectomy): In this procedure, the surgeon removes the head of the pancreas, part of the small intestine, and some of the nearby tissues. Enough of the pancreas is left to continue making digestive juices and insulin. This is the most common procedure used for removing cancer of the exocrine pancreas

Pancreatectomy: The surgeon removes the whole pancreas, part of the small intestine, part of the stomach, the bile duct, the gallbladder, the spleen, and most of the lymph nodes in the area.
Distal Pancreatectomy: The body and tail of the pancreas are removed. This procedure is most commonly used for islet cell (endocrine) cancer of the pancreas and is rarely used for cancer of the exocrine pancreas.
If the cancer has spread and it cannot be removed, the doctor may do surgery to relieve symptoms. If the cancer is blocking the small intestine and bile builds up in the gallbladder, the doctor may do surgery to go around (bypass) all or part of the small intestine. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine. This is called biliary bypass.
Surgery or X-ray procedures may also be done to put in a tube (catheter) to drain bile that has built up in the area. The catheter may drain through a tube to the outside of the body or it may go around the blocked area and drain the bile to the small intestine. In addition, if the cancer is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally.

Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).

Chemotherapy is the use of drugs to kill cancer cells. Most anticancer drugs are injected into a vein (IV) or a muscle; some are given by mouth. Chemotherapy is a systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body to kill cancerous cells. It is generally given in cycles: A treatment period is followed by a recovery period, then another treatment period, and so on.

The use of biological therapy (using the body’s immune system to fight cancer) is being tested for pancreatic cancer. Biological therapy searches for ways that the cancer tissue is different from normal pancreas tissue, and tries to get the body to fight the cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body’s natural defenses against disease. Biological therapies are sometimes called biological response modifier (BRM) therapy or immunotherapy