Changes to This Summary (08 / 08 / 2013)
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.
Stages of Pancreatic Cancer
Tests and procedures to stage pancreatic cancer are usually done at the same time as diagnosis. The process used to find out if cancer has spread within the pancreas or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage of the disease in order to plan treatment. The results of some of the tests used to diagnose pancreatic cancer are often also used to stage the disease. See the General Information section for more information.There are three ways that cancer spreads in the body.The three ways that cancer spreads in the body are:Through tissue. Cancer invades the surrounding normal tissue.Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.When cancer cells break away from the primary
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
Miscellaneous Islet Cell Tumors
VIPomaImmediate fluid resuscitation is often necessary to correct the electrolyte and fluid problems that occur as a result of the watery diarrhea, hypokalemia, and achlorhydria that patients experience. Somatostatin analogs are also used to ameliorate the large fluid and electrolyte losses. Once patients are stabilized, excision of the primary tumor and regional nodes is the first line of therapy for clinically localized disease. In the case of locally advanced or metastatic disease, where curative resection is not possible, debulking and removal of gross disease, including metastases, should be considered to alleviate the characteristic manifestations of VIP overproduction. (Refer to the Treatment Option Overview section of this summary for information about the remaining principles of therapy.)SomatostatinomaComplete excision is the therapy of choice, if technically possible. However, metastases often preclude curative resection, and palliative debulking can be considered to
Stage III Pancreatic Cancer Treatment
Treatment Options for Stage III Pancreatic CancerWhile stage III and stage IV pancreatic cancer are both incurable, the natural history of stage III (locally advanced) disease may be different than it is for stage IV disease. An autopsy series demonstrated that 30% of patients presenting with stage III disease died without evidence of distant metastases.[Level of evidence: 1iiA] Therefore, investigators have struggled with the question of whether chemoradiation for patients presenting with stage III disease is warranted.Treatment options for stage III pancreatic cancer include the following:Palliative surgery: palliative surgical biliary and/or gastric bypass, percutaneous radiologic biliary stent placement, or endoscopic biliary stent placement.[2,3]Chemoradiation therapy:Chemoradiation followed by chemotherapy.Chemotherapy followed by chemoradiation, for patients without metastatic disease.Chemotherapy: gemcitabine; gemcitabine and
General Information About Pancreatic Cancer
Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas. The pancreas is a gland about 6 inches long that is shaped like a thin pear lying on its side. The wider end of the pancreas is called the head,the middle section is called the body,and the narrow end is called the tail. The pancreas lies behind the stomach and in front of the spine. The ...
The approach to treatment often depends on the results of preoperative localization studies and findings at exploratory laparotomy. At exploration, 85% of these tumors are found in the gastrinoma triangle with 40% on the surface of the pancreas and 40% outside of the pancreas. Only 15% are found within the substance of the pancreas. Percutaneous transhepatic venous sampling may occasionally provide accurate localization of single sporadic gastrinomas. Resection (enucleation of individual tumors, if technically feasible), and even excision of liver metastases, is associated with long-term cure or disease control.Standard treatment options: Single lesion in head of the pancreas:[2,3,4,5]Enucleation.Parietal cell vagotomy and cimetidine.Total gastrectomy (rarely used with the advent of current therapies).Single or multiple lesions in the duodenum:[2,3,4,5]Pancreatoduodenectomy.Single lesion in body/tail of the pancreas:[2,3,4,5]Resection of body/tail.Multiple lesions in
Stage Information for Pancreatic Neuroendocrine Tumors (Islet Cell Tumors)
Note: The American Joint Committee on Cancer has published the 7th edition of the AJCC Cancer Staging Manual, which for the first time incorporates pancreatic neuroendocrine tumors in the same staging system as pancreatic exocrine tumors. The classification of these tumors as benign versus malignant is not always consistent, so the AJCC recommends that all pancreatic neuroendocrine tumors be staged using this system and reported to cancer registries. It also recommends that the protocol developed by the College of American Pathologists for endocrine pancreatic tumors be used to examine and stage specimens.Definitions of TNMThe American Joint Committee on Cancer has designated staging by TNM classification to define pancreatic neuroendocrine tumors (islet cell tumors).Table 2. Primary Tumor (T)aa Reprinted with permission from AJCC: Exocrine and endocrine pancreas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer,
Stage Information for Pancreatic Cancer
The staging system for pancreatic exocrine cancer continues to evolve. The importance of staging beyond establishing whether a tumor is resectable is uncertain since state-of-the-art treatment has demonstrated little impact on survival. However, knowledge of the extent of the disease is necessary to communicate a uniform definition of disease. AJCC Stage Groupings and TNM DefinitionsThe American Joint Committee on Cancer (AJCC) has designated staging by TNM classification.Table 1. Definitions of TNM Stage 0aStageTNMDescriptiona Reprinted with permission from AJCC: Exocrine and endocrine pancreas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 241-9.b This also includes the pancreatic intraepithelial neoplasia (PanIN)-3 classification.0Tis, N0, M0Tis = Carcinomain situ.bN0 = No regional lymph node metastasis.M0 = No distant metastasis.Table 2. Definitions of TNM Stages IA and
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.