The first step in controlling pancreas cancer is confirming if the disease is local or has spread.
Our fundamental objective at iTAcC is to administer an individualized treatment in order to obtain the highest percentage of success in each patient.
Surgery is the most efficient therapeutic option in cases in which the tumor can be removed.
The radiosurgery or stereotactic body radiation therapy (SBRT) with Truebeam-STX offers an elevated percentage of local control of the disease
The pancreas is a gland located in the abdomen with a dual function; firstly as an endocrine function producing hormones that regulate the metabolism of carbohydrates (insulin and glucagon) and secondly, as a producer of a number of very important enzymes in food digestion.
There are various types of tumors of the pancreas. The most common is adenocarcinoma, a fast-growing tumor that rarely is diagnosed in its early stages and with an unknown cause. Tumors that arise from cells that produce hormones are much less common and they are called endocrine tumors.
As mentioned previously, the cause is unknown. Some factors have been described which may increase the risk of pancreas cancer. It is a tumor that occurs most often in the sixties, has a higher incidence in overweight people, diabetics, smokers and people who have suffered from pancreatitis. There are cases of family history of pancreatic cancer that could be detected in a mutation of the BRCA-2 gene and associated with hereditary diseases such as Peutz-Jeghers or Lynch syndrome.
The first diagnostic step is related to the clinical symptoms that can cause disease. Initially the tumor is asymptomatic but as the disease progresses it can lead to:
- Jaundice (yellowing of the skin) usually as well as dark urine and light colored stools.
- Pain occurs if the tumor is compressed or infiltrates nerves near the pancreas.
- Nausea, vomiting, loss of weight and appetite occur if the tumor affects the stomach wall.
- Abrupt onset of diabetes due to the death of insulin producing cells.
The first step in controlling pancreatic cancer is to determine whether the disease is localized or has spread to lymph nodes, arteries, veins or nearby organs. Imaging tests is best way to know the real situation of the disease during a suspected diagnosis. iTAcC has the latest technology to carry out an exhaustive, quick evaluation of the disease with a high level of accuracy.
The imaging techniques used in the evaluation of a pancreatic tumor in at iTAcC are:
- Ultrasound. Although not specific, it usually provides an initial overview of the disease. On occasion, when this test is being done for other reasons, may detect a pancreatic lesion which is suspicious of a pancreatic carcinoma.
- CT (Computed Tomography) permits a thorough study. With the state of the art multislice system it is possible to perform extremely detailed studies of the pancreas and adjacent organs, arteries, veins and nearby lymph nodes. A three-dimensional reconstruction is done using a computerized system. This allows the surgeon or radiation therapist to know the true spread of the disease and tailor the treatment plan to the patient.
- MRI (Magnetic Resonance Imaging) and cholangioresonance have a high diagnostic specificity for determining the type of lesion in the pancreas as well as a study of the bile duct in order to determine, noninvasively, where and whether if an obstruction has occurred.
- Endoscopic ultrasound (EUS).- A specialist introduces a gastroduodenoendoscopioto in order to visualize the area and take samples for cytology or biopsy as well as distinguish between the inflammation of the pancreas (pancreatitis) and a malignant tumor.
- Endoscopic retrograde cholangiopancreatography (ERCP). Contrast is introduced into the common bile or pancreatic duct through an endoscope. If this cannot be performed then an alternative test, the percutaneous trans-hepatic cholangiography (PTC), can be done introducing the contrast through a puncture.
- Positron Emission Tomography (PET) associated with computed tomography (PET-CT) can be useful for determining the spread of a previously diagnosed disease.
The speed and aggressiveness of the spread of pancreatic cancer to nearby tissues, its resistance to standard chemotherapy and tendency to reoccur makes it one of the most difficult cancers to treat. ITAcC’s medical team maintains direct contact with all the specialists involved in making the best treatment decision for patients diagnosed with pancreatic carcinoma. This includes surgeons, gastrointestinal specialists, radiologists, pathologists, radiation oncologists, and medical oncologists. As an open institution, our specialists count on the opinions of the patients’ trusted physicians.
Our fundamental objective at iTAcC is to administer a customized treatment to the patient in order to obtain the highest rate of success.
Surgery is the most effective therapeutic option in cases where it is possible to remove the tumor. This means when there is no evidence that it has spread to the major blood vessels located near the liver, abdominal cavity or the lungs (there are no metastases). Only 20% of patients can be surgically treated with a complete resection of the tumor. Pancreatic surgery remains one of the most challenging and requires surgeons with proper training and experience.
The surgical Interventions for pancreatic cancer performed by iTAcC surgeons are:
- Cephalic pancreaticoduodenectomy: This is the most common pancreatic cancer surgery. It involves the removal of the “head” of the pancreas, duodenum, gall bladder and the first part of the small intestine as well as, on occasion, a portion of the stomach.
- Central pancreatectomy. Surgeons perform a procedure that involves removal of the central portion or body of the pancreas in selected cases, retaining both ends (head and tail). The risk of diabetes and severe gastric disturbances is reduced by retaining more pancreatic tissue with cells that produce insulin and digestive enzymes.
- Left pancreatectomy. Includes the removal of the body and tail of the pancreas, often together with the spleen.
- Total pancreatectomy: involves the removal of the entire pancreas along with the gallbladder, a portion of the stomach and small intestine, bile duct, spleen and regional lymph nodes. It is carried out in the case of multifocal tumors.
- Simple enucleation. This is done in the case of benign tumors of small dimensions such as insulinomas.
In the treatment of pancreatic cancer and other diseases iTAcC surgeons propose to employ minimally invasive surgery techniques whenever possible. It is possible to perform procedures with a laparoscope in selected cases. These techniques offer patients significant benefits such as a shorter hospital stay, faster return to normal activity and reduced risk of complications.
This is done in patients in whom surgery is not an option or on occasion, they are treated with radiation as a complement.
ITAcC Specialists have extensive experience in the treatment of pancreatic tumors using image guided radiosurgery or SBRT in one or two parts. These techniques offer a high rate of local control of the disease significantly improving patients’ symptoms. With the Truebeam system fortunately there is no longer the need to place gold markers in the patient, eliminating the typical complications of this type of technique used by others systems.
A treatment regimen is required when there is local spread of the tumor to adjacent organs. This regimen is associated with chemotherapy using intensity modulated radiotherapy (IMRT), image-guided radiotherapy (IGRT) techniques which have proven to be those with the lowest incidence of side effects.
Remote techniques using radiosurgery or SBRT are done in cases in which the disease has spread in order to control symptoms and decrease the tumor burden of the patient. This results in better quality of life for the patient.
The gemcitabine drug is the most important in the treatment of pancreatic cancer. It can be administered alone or in combination with other drugs.
Chemotherapy may be used after surgery to decrease the risk of distant recurrence or to prevent local recurrence along with radiation therapy.
Chemotherapy is used in conjunction with radiation therapy to reduce the size or extent of the tumor making it operable in locally advanced conditions in which surgery is not possible.
Chemotherapy is used to slow its progression in the more advanced stages of the disease.
The introduction in recent years of biological therapies and active drugs that fight against some of the tumor growth factors has opened once-in-a-lifetime perspectives for patients affected by this type of cancer. Specialists in medical oncology iTAcC have extensive experience in the use of these drugs.
The multidisciplinary team establishes a customized control plan after treatment according to the needs of each patient and the biology of the disease. This is done in order to rule out or detect any recurrence early on. A follow-up based on a comprehensive control of the tumor control by imaging tests is carried out.
Follow up is done as in the case of all oncological activity at iTAcC, in a personalized manner in cooperation with the doctors who have been involved in the diagnosis and treatment of each case. iTAcC is an open institution and works closely them.