The latest advances in radiation therapy offer new hope to patients with pancreatic cancer.
Your pancreas, which is located below your stomach, is about six inches long by two inches wide. It contains two different types of glands: exocrine glands and endocrine glands. Exocrine glands manufacture enzymes that break down fats and proteins in food so your body can absorb them. Endocrine glands make hormones likes insulin that helps maintain the blood sugar level.
The majority of pancreatic cancer cases originate in the exocrine glands. Less common are tumors that form in the endocrine glands. A rarer type is a form of ampullary cancer that starts where the bile duct from the liver and the pancreatic duct flow into the small intestine. In 2012 nearly 44,000 Americans will be diagnosed with pancreatic cancer.
Smoking, diabetes and obesity have been associated with a higher risk of pancreatic cancer. Extended pancreatitis, a painful inflammation of the pancreas, is also a risk factor. Later stage symptoms may include dark urine, yellow skin and eyes from jaundice, pain in the upper abdomen or middle back, pale or floating stool and nausea and vomiting.
Several different treatments can effectively manage pancreatic cancer, prolong life and help minimize discomfort and pain. These include surgery, ablation, embolization, chemotherapy, targeted therapy and radiation therapy. Determining the most appropriate treatment for your situation depends on the type of pancreatic cancer you have, its stage and location.
When diagnosed early, surgical removal of the tumor can slow growth and control the disease and, in very early cases, potentially cure it. One of several different surgical techniques may be chosen, ranging from partial to full removal of the pancreas. The most common is the Whipple procedure where the tumor is removed in the head of the pancreas. Your surgeon typically also removes parts of the duodenum, gallbladder, common bile duct and part of the stomach. The lymph nodes and spleen may also be removed.
If the pancreatic cancer has spread to other sites, ablation of the tumors may be an option. With image-guided ablation therapy, the clinician uses an imaging technology such as a CT scan or MRI to guide the ablation technology to the tumor site. Ablation technology includes Cryotherapy (using extreme cold to freeze and destroy the tumor), Radiofrequency (using high-energy radio waves to heat and destroy the tumor) and laser or microwave therapy (to heat and destroy the tumor).
Arterial embolization can be used for patients who are not candidates for surgery or ablation. Embolization therapy uses tiny particles to block the flow of blood to tumors through the artery feeding them. This destroys the cancer cells by starving them of oxygen and nutrients. In some cases, the particles may be radioactive or infused with chemotherapy, providing the added power of a dual–acting therapy.
Your Medical Oncologist may recommend one of three different forms of chemotherapy. Neo-adjuvant or primary systemic chemotherapy is used before radiation or surgery. Adjuvant chemotherapy is used after radiation or surgery to destroy any remaining cancer cells. Systemic chemotherapy circulates throughout the body via the bloodstream when the cancer is metastatic.
Tumors need new blood vessels to keep nourished. Targeted therapy uses biological agents to interfere with the blood supply, ensuring the pancreatic cancer cells do not get the nutrition they need and can no longer grow.
Radiation therapy has been found helpful in treating exocrine pancreatic cancer but not pancreatic neuroendocrine tumors. External Beam Radiation Therapy or ERBT delivers high-powered x-rays from outside the body; precisely targeting and shrinking or destroying tumors. Radiation therapy may be recommended after surgery to destroy any remaining cancer cells and to help prevent a recurrence or slow the growth of the disease.
3D-Conformal Radiation Therapy and Intensity-Modulated Radiation Therapy (IMRT) are two forms of External Beam Radiation Therapy. During 3D-Conformal treatments, a device called a “multi-leaf collimator” will shape the individual radiation beams to “conform” to the shape of your tumor according to the data and instructions it receives from the system computer. IMRT uses thousands of radiation “beamlets” from many different angles to deliver a single dose of radiation. The intensity of the “beamlets” can change during the treatment session to modulate the dose, so that the tumor receives a very precise high dose of radiation, while minimizing damage to surrounding, normal tissue.
Before each session, a Radiation Therapist will carefully position you on the treatment table using a body immobilizer for precise body placement. Image guidance will be used to confirm the location of the tumor before the therapy begins. During your treatment sessions, the radiation delivery system will revolve around you, delivering the radiation according to the plan set by your Radiation Oncologist. Each treatment session lasts from 10 to 30 minutes. Typically, you will be scheduled for five sessions a week for several weeks. The sessions are pain-free and require no sedation so you can return to your normal activities right away.