Stage I and Stage II Pancreatic Cancer Treatment
Treatment Options for Stages I and II Pancreatic CancerTreatment options for stages I and II pancreatic cancer include the following:Surgery: radical pancreatic resection including:Whipple procedure (pancreaticoduodenal resection).Total pancreatectomy when necessary for adequate margins.Distal pancreatectomy for tumors of the body and tail of the pancreas.[1,2]Postoperative chemoradiation therapy: radical pancreatic resection followed by 5-fluorouracil (5-FU) chemotherapy and radiation therapy.[3,4,5,6,7]Postoperative chemotherapy: radical pancreatic resection followed by chemotherapy (gemcitabine or 5-FU/leucovorin).Surgery Complete resection can yield 5-year survival rates of 18% to 24%, but ultimate control remains poor because of the high incidence of both local and distant tumor recurrence.[9,10,11][Level of evidence: 3iA]Approximately 20% of patients present with pancreatic cancer amenable to local surgical resection, with operative mortality rates of
Treatment Option Overview
There are different types of treatment for patients with pancreatic NETs. Different types of treatments are available for patients with pancreatic neuroendocrine tumors (NETs). Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.Six types of standard treatment are used:Surgery An operation may be done to remove the tumor. One of the following types of surgery may be used:Enucleation: Surgery to remove the tumor only. This may be done when cancer occurs in one place in the
This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment
Stages of Pancreatic Neuroendocrine Tumors
The plan for cancer treatment depends on where the NET is found in the pancreas and whether it has spread. The process used to find out if cancer has spread within the pancreas or to other parts of the body is called staging. The results of the tests and procedures used to diagnose pancreatic neuroendocrine tumors (NETs) are also used to find out whether the cancer has spread. See the General Information section for a description of these tests and procedures. Although there is a standard staging system for pancreatic NETs, it is not used to plan treatment. Treatment of pancreatic NETs is based on the following: Whether the cancer is found in one place in the pancreas.Whether the cancer is found in several places in the pancreas.Whether the cancer has spread to lymph nodes near the pancreas or to other parts of the body such as the liver, lung, peritoneum, or bone.There are three ways that cancer spreads in the body.The three ways that cancer spreads in the body are:Through tissue.
Stage IV Pancreatic Cancer Treatment
Treatment Options for Stage IV Pancreatic CancerTreatment options for stage IV pancreatic cancer include the following:Palliative therapy.Chemotherapy: gemcitabine; gemcitabine and erlotinib; or oxaliplatin, irinotecan, leucovorin, and fluorouracil (5-FU) (FOLFIRINOX).[1,2,3,4,5,6,7,8,9,10]Palliative therapyPalliative therapy for advanced pancreatic cancer includes the following:Pain-relieving procedures (e.g., celiac or intrapleural block) and supportive care.Palliative surgical biliary bypass, percutaneous radiologic biliary stent placement, or endoscopically placed biliary stents.[12,13,14]ChemotherapyThe low objective response rate and lack of survival benefit with current chemotherapy indicates that clinical trials are appropriate treatment of all newly diagnosed patients. Occasionally, patients have palliation of symptoms when treated with chemotherapy with well-tested older drugs, such as 5-FU. Gemcitabine has demonstrated activity in patients with pancreatic
Cellular Classification of Pancreatic Cancer
Pancreatic cancer includes the following carcinomas:MalignantDuct cell carcinoma (90% of all cases).Acinar cell carcinoma.Adenosquamous carcinoma.Cystadenocarcinoma (serous and mucinous types).Giant cell carcinoma.Invasive adenocarcinoma associated with cystic mucinous neoplasm or intraductal papillary mucinous neoplasm.Mixed type (ductal-endocrine or acinar-endocrine).Mucinous carcinoma.Pancreatoblastoma.Papillary-cystic neoplasm (Frantz tumor). This tumor has lower malignant potential and may be cured with surgery alone.[1,2]Papillary mucinous carcinoma.Signet ring carcinoma.Small cell carcinoma.Unclassified.Undifferentiated carcinoma.Borderline Malignancies Intraductal papillary mucinous tumor with dysplasia.Mucinous cystic tumor with dysplasia.Pseudopapillary solid tumor.References: Sanchez JA, Newman KD, Eichelberger MR, et al.: The papillary-cystic neoplasm of the pancreas. An increasingly recognized clinicopathologic entity. Arch Surg 125 (11): 1502-5, 1990. Warshaw AL,
Cellular Classification of Pancreatic Neuroendocrine Tumors (Islet Cell Tumors)
Table 1. Endocrine Tumors of the PancreasIslet CellsSecreted Active AgentTumor and SyndromeACTH = adrenocorticotropin; MSH = melanocyte-stimulating hormone; VIP = vasoactive intestinal peptide; WDHA = watery diarrhea, hypokalemia, and achlorhydria; 5-HT = serotonin.AlphaGlucagonGlucagonoma (diabetes, dermatitis)BetaInsulinInsulinoma (hypoglycemia)DeltaSomatostatinSomatostatinoma (mild diabetes); diarrhea/steatorrhea; gallstonesDGastrinGastrinoma (peptic ulcer disease)A -> DVIP and/or other undefined mediatorsWDHA5-HTACTHMSHCarcinoidCushing syndromeHyperpigmentationInteracinar CellsSecreted Active AgentTumor and SyndromeFPancreatic polypeptideMultiple hormonal syndromesEC5-HTCarcinoid
Changes to This Summary (06 / 29 / 2012)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.Editorial changes were made to this summary.This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.
Recurrent Pancreatic Cancer
Recurrent pancreatic cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the pancreas or in other parts of the body.
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