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Pancreatic cancer treatment: Why is it so difficult?

Pancreatic cancer, also called pancreatic adenocarcinoma, is one of the deadliest cancers. Even with aggressive treatment, the prognosis is poor.

Why is pancreatic cancer so difficult to treat?

Various factors make the chances of successful treatment of pancreatic cancer are very low:

1 Early detection is rare

Few pancreatic cancers pancreases are discovered in the early stages of the disease, when cancerous cells can be surgically removed. Signs and symptoms of pancreatic cancer, such as pain in the upper abdomen, yellowing of the skin and eyes, and weight loss, usually don’t show up until late in the disease .

There are no effective screening tests for pancreatic cancer. If you or your family have a strong history of pancreatic cancer or other cancers, talk to your doctor about whether you should have genetic testing or routine checkups.

2 Pancreatic cancer tends to spread quickly

The pancreas sits at the junction of several very important structures in your abdomen, making it easier for cancer to spread to these structures and other organs. Pancreatic cancer often spreads to nearby organs, including the liver, gallbladder and intestines, early in the disease.

3 Recurrence is likely

Even after surgical removal, pancreatic cancer often recur. Most people with pancreatic cancer undergo chemotherapy as part of their treatment. Several new combinations of treatments show promise for increasing the response rate to pancreatic cancer treatment.

Treatments for pancreatic cancer

The treatment Pancreatic cancer depends on the stage and location of the cancer, as well as your general health. For most people, the first goal of treatment for pancreatic cancer is to eliminate the cancer, if possible. When this is not possible, the focus may be on improving your quality of life and limiting the growth of the cancer or its consequences.

Treatment may include surgery, radiotherapy, chemotherapy or a combination of these methods. When pancreatic cancer is at an advanced stage and these treatments are not likely to provide benefit, your doctor will focus on symptom relief (palliative care) to keep you as comfortable as possible for as long as possible.

Several types of surgery for pancreatic cancer

Advanced surgical interventions for pancreatic cancer bring hope. Operations used in people with pancreatic cancer include:

– Surgery for pancreatic head tumors

If your cancer is located in the head of the pancreas, you may consider an operation called a Whipple’s procedure (pancreaticoduodenectomy).

The Whipple’s procedure is a technically difficult operation that involves removing the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder, part of the bile duct and nearby lymph nodes. In some situations, part of the stomach and colon may also be removed. Your surgeon reconnects the remaining parts of your pancreas, stomach, and intestines to allow you to digest food.

– Surgery for tumors in the body and tail of the pancreas

Surgery to remove the left side (body and tail) of the pancreas is called distal pancreatectomy. Your surgeon may also need to remove your spleen.

– Surgery to remove the entire pancreas

In some people, the pancreas whole may need to be removed. This is called total pancreatectomy. You can live relatively normally without a pancreas, but you need lifelong insulin and enzyme replacement.

– Surgery for tumors affecting nearby blood vessels

Many people with advanced pancreatic cancer are not considered eligible for the Whipple procedure or other pancreatic surgeries if their tumors involve nearby blood vessels. At highly specialized and experienced medical centers, surgeons can offer pancreatic surgery operations that include the removal and reconstruction of affected blood vessels.

Each of these operations carries a risk of bleeding and of infection. After the operation, some people have nausea and vomiting if the stomach has trouble emptying (delayed gastric emptying). Expect a long recovery after one of these procedures. You will spend several days in the hospital and then recover for several weeks at home.

Extensive research shows that pancreatic cancer surgery tends to have fewer complications when performed by highly experienced surgeons in centers that perform many of these operations. Be sure to ask about your surgeon’s and hospital’s experience with pancreatic cancer surgery. If you have any doubts, ask for a second opinion.

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