HPB SURGERY
Pancreatic Cancer
Pancreatic cancer is a relatively rare form of cancer but is often aggressive and has a high mortality rate. According to the Canadian Cancer Society, an estimated 6,800 Canadians were diagnosed with pancreatic cancer in 2021, and approximately 5,500 died from the disease. Pancreatic cancer is the fourth leading cause of cancer death in Canada.
Risk factors for pancreatic cancer include age, smoking, obesity, a family history of the disease, chronic pancreatitis, and certain genetic mutations. Symptoms of pancreatic cancer may include abdominal pain, weight loss, jaundice, nausea, and vomiting.
The diagnosis of pancreatic cancer is typically made through imaging tests such as CT scans, MRI, and ultrasound. A biopsy may also be performed to confirm the diagnosis and determine the type of pancreatic cancer. The standard of care treatment for pancreatic cancer in Canada typically involves a combination of surgery, chemotherapy, and radiation therapy. The specific treatment plan depends on the stage and location of the cancer.
Surgery is the preferred treatment option for pancreatic cancer, particularly for tumors that are localized and have not spread to other organs. The most common surgical procedure is the Whipple procedure, which involves the removal of the head of the pancreas, part of the small intestine, and the gallbladder. Other types of surgery may be recommended based on the location and size of the tumor.
Chemotherapy is often given before or after surgery to help shrink the tumor and prevent it from spreading to other parts of the body. The drugs used in chemotherapy for pancreatic cancer may include gemcitabine, 5-fluorouracil, nab-paclitaxel, and oxaliplatin. These drugs work by killing cancer cells or stopping them from dividing.
Targeted therapy may also be used in some cases of pancreatic cancer. This involves drugs that target specific proteins or genes that are involved in the growth and spread of cancer cells. For example, erlotinib is a targeted therapy drug that inhibits the activity of the epidermal growth factor receptor (EGFR) protein, which is overexpressed in some types of pancreatic cancer.
Immunotherapy is another treatment option for some patients with pancreatic cancer. This involves drugs that stimulate the immune system to recognize and attack cancer cells. For example, pembrolizumab is an immunotherapy drug that targets the programmed cell death protein 1 (PD-1) receptor, which is overexpressed in some types of pancreatic cancer.
Radiation therapy may also be used in combination with chemotherapy to kill cancer cells and shrink the tumor. This involves high-energy radiation beams that are directed at the tumor to destroy cancer cells.
In cases where the cancer has spread beyond the pancreas, treatment may focus on managing symptoms and improving quality of life. This may involve palliative care, which aims to relieve pain and other symptoms and provide emotional support for the patient and their family.
The prognosis for pancreatic cancer remains poor, particularly for patients with advanced or metastatic disease. The five-year survival rate for pancreatic cancer in Canada is only 10%, compared to 88% for breast cancer and 67% for colon cancer. However, advances in treatment and early detection may improve outcomes for some patients.
One of the challenges in treating pancreatic cancer is that it is often diagnosed at a late stage, when the cancer has already spread to other parts of the body. This highlights the importance of early detection and screening for individuals who are at high risk of developing the disease. Another challenge in treating pancreatic cancer is that the cancer cells can be resistant to chemotherapy and other treatments. Researchers are exploring new treatments that can overcome this resistance and improve outcomes for patients with pancreatic cancer.