Cancer is complex — there is no routine pancreatic cancer, nor is there a routine way to treat it.
The OSUCCC – James physicians are nationally and internationally renowned in research and patient care for their one particular cancer. Because of that expertise and understanding of cancer’s complexities and how it acts and reacts differently in each person, the very best outcomes — and the most effective means of treating cancer patients — come from a team approach.
At the OSUCCC – James, pancreatic cancer patients have a team of experts that includes medical oncologists, surgical oncologists, radiation oncologists, geneticists, gastroenterologists, hepatologists, nutritionists and more. Also on that team are pancreatic cancer researchers who help sequence tumors to identify key molecules that fuel each patient’s cancer and who then develop drugs that target only those particular molecules. Many of our experts also help write the national clinical guidelines for treatments.
As one of only a few cancer centers in the country funded by the National Cancer Institute to conduct both phase I and phase II clinical trials, the OSUCCC – James offers patients access to more clinical trials than nearly any other cancer hospital in the country and to more of the latest, most targeted, most effective treatment options — many that are available nowhere else but at the OSUCCC – James.
There are several types of treatment for pancreatic cancer. The OSUCCC – James team of subspecialists determine the best treatment for each patient based on his or her specific, individual pancreatic cancer.
Physicians determine the best approach for pancreatic cancer treatment based on the type and stage of the cancer as well as the molecular and genetic make up of your individual disease.
Pancreatic cancer is often diagnosed when it is in a more advanced stage and patients may require a combination of treatments.
Pancreatic cancer treatment may include:
Only a handful of hospitals in the country perform as many pancreatic surgeries as the OSUCCC – James specialists perform each year. A surgeon may perform one of following surgeries to remove pancreatic cancer:
Also called a pancreatoduodenectomy, a Whipple procedure is used to treat many types of exocrine pancreatic cancers and some neuroendocrine pancreatic cancers. The surgeon will remove a portion of the pancreas, the gallbladder, a part of the stomach and small intestine and the bile duct. A portion of the pancreas is left to product insulin and digestive juices.
A distal pancreatectomy most often is performed for patients who have pancreatic neuroendocrine cancer. The surgeon removes portions of the pancreas and often also the spleen.
In a total pancreatectomy, the surgeon removes the entire pancreas and portions of the small intestine and stomach. The gallbladder, common bile duct, spleen and nearby lymph nodes also are removed.
When pancreatic cancer is in advanced stages and has grown too large to be removed or has spread to distant organs, surgery may be performed to relieve a patient’s symptoms.
These procedures, also called palliative surgery, include:
Some pancreatic tumors block the flow of bile (a digestive fluid made by the liver) from the common bile duct to the small intestine, causing bile to build up in the gallbladder. The surgeon can bypass the blockage by cutting into the gallbladder or bile duct and routing a new path to the small intestine.
The surgeon might create a new route from the stomach to the small intestine at the same time as a biliary bypass to avoid a second surgery in case the tumor continues to grow. Other times, the tumor already is blocking the flow of food from the stomach, causing the need to sew a path directly from the stomach to the small intestine.
Endoscopic Stent Placement
A physician may be able to clear a blocked bile duct by placing a stent, a tiny flexible tube, into the blocked area. Endoscopy is a procedure that involves inserting a thin, flexible tube into the beginning of the small intestine while the patient is sedated.
Surgery for Pancreatic Neuroendocrine Tumors
Surgeries for pancreatic neuroendocrine tumors are performed to remove the tumor. In addition to the Whipple procedure and distal pancreatectomy surgery may include:
When an endocrine cancer occurs in only one location in the pancreas, the tumor alone can be removed by enucleation.
This surgery removes the patient’s stomach.
Parietal Cell Vagotomy
The surgeon cuts the nerve that causes acid to be made in the stomach.
The surgeon removes a portion of the liver or the entire liver.
Radiation therapy is a cancer treatment that uses high-energy X-rays to destroy cancer cells or stop their growth. Radiation therapy may be used before or after surgery to help shrink a pancreatic tumor or to destroy any cancer cells that remain following surgery to remove a tumor.
Radiation is not effective for most pancreatic neuroendocrine cancers.
Ablative therapies are used to treat pancreatic neuroendocrine cancer that has spread to the liver or other organs and sometimes to treat metastases from exocrine pancreatic cancer.
Cryoablation, or cryosurgery, freezes cancer cells and the tissue immediately around them with a probe that is inserted into the tissue and filled with liquid nitrogen or liquid carbon dioxide. A physician may perform the ablation during surgery or laparoscopy.
A probe is inserted into cancerous tissue in radiofrequency ablation. The probe delivers high-frequency radio waves to heat the tumor and destroy it. Microwave thermotherapy is a similar technique using microwaves instead of radiofrequency waves.
Embolization is a technique used to destroy cancer growth by stopping the blood supply to the tumor. The physician guides a thin tube called a catheter through the artery near the cancer and injects a dye to highlight the blood vessels and arteries if necessary. Next, the physician injects a special material into the vessel to stop blood flow just to that area. Transarterial embolization injects tiny microspheres that deliver radiation. The physician also can inject specific chemotherapy drugs.
Hepatic arterial occlusion is embolization that delivers tiny particles or special drugs to the liver through the blood vessel that supplies blood to the liver, called the hepatic artery. Blocking blood flow can stop oxygen and nutrients from reaching the tumor to stop the tumor’s growth. Delivering chemotherapy drugs to a tumor in the liver through embolization concentrates most of the drugs in the tumor.
Chemotherapy uses drugs to destroy cancer cells or stop their growth. Patients may receive the drugs orally or by injection. These drugs enter the bloodstream and reach cancer cells throughout the patient’s body. Other drugs are placed directly into an organ or region of the body, such as the abdominal cavity. Combination chemotherapy uses more than one drug to treat a patient’s cancer.
Patients with pancreatic neuroendocrine cancer may receive hormone therapy to block or remove hormones that are controlling the growth of cancer cells.
Targeted therapies are drugs that attack cancer cells without destroying healthy surrounding cells. An example is tyrosine kinase inhibitors, which block the signals of certain enzymes that cancer cells use to rapidly divide and grow. Erlotinib is a type of tyrosine kinase inhibitor that attacks pancreatic cancer cells. Other targeted drugs are designed specifically to attack pancreatic neuroendocrine cancer cells. Examples are sunitinib and everolimus.
Immunotherapy uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct or restore the body's natural defenses against cancer. This type of cancer treatment is also called biologic therapy.
Many types of pancreatic cancer affect your digestive system. In addition, surgery and other treatments for pancreatic cancer affect normal production of enzymes that help you digest food. Many patients need help with nutrition and maintaining a healthy weight.
(Source: National Cancer Institute)
For cancer patients, clinical trials mean hope. Hope for a cancer-free world and for better, more targeted ways to prevent, detect, treat and cure individual cancers. Patients can enter clinical trials before, during or after starting their cancer treatment.
The OSUCCC – James has more than 500 open clinical trials at any given time, with some of the world’s latest discoveries available to clinical trial patients right here in Columbus, Ohio. In fact, patients have access to more cancer clinical trials here than at nearly any other hospital in the region as well as access to some of the most advanced, targeted treatments and drugs available.
The OSUCCC – James is one of only four U.S. cancer centers funded by the National Cancer Institute (NCI) to conduct phase I and phase II clinical trials on novel anticancer drugs. These trials go only to centers that demonstrate an exemplary capacity for research and clinical care, the expertise to deliver the latest in treatments and the infrastructure to interpret and track treatment results.
Additionally, Ohio State has nearly 300 cancer researchers dedicated to understanding what makes each patient’s cancer grow, move, metastasize or reoccur. Because of the OSUCCC – James’ NCI phase I and phase II approvals, these experts can move research discoveries into clinical trials and make them available to patients sooner.
If you have received a pancreatic cancer diagnosis, or if you want a second opinion or just want to speak to a pancreatic cancer specialist, we are here to help you. Call 800-293-5066 or 614-293-5066 to make an appointment.