Information about New Pancreatic Cancer Therapies Being Developed
Pancreatic cancer is one of the deadliest cancers, with a five-year survival rate of only about 4 to 5 percent. Tumors in the pancreas may grow rapidly without any symptoms at first and are often not detected until they have progressed to an advanced stage.
Even with standard treatments like radiation, chemotherapy, and surgery, the prognosis for pancreatic cancer is bleak, and survival is generally measured in months instead of years. For those in an early stage of the cancer who qualify for surgery, survival is only around 20 percent.
Fortunately, there are diagnostic tools that can help detect pancreatic cancer (especially for people with a family history), recent development in treatments, and new therapies on the horizon that may expand the available toolkit for dealing with this difficult disease.
Getting a Diagnosis of Pancreatic Cancer
Symptoms of pancreatic cancer may be vague or similar to other diseases; they include
- abdominal pain
- appetite and weight loss
- dark urine
- clay-colored stools
- nausea and vomiting
You should see your doctor right away if you experience any of these symptoms.
Because of the deep location of the pancreas, it is impossible for doctors to feel any tumors on a routine exam. Therefore, in addition to a biopsy, doctors rely on imaging technology such as computed tomography (CT) scans, magnetic resonance imaging (MRI), and ultrasound when making a diagnosis. Two tests used in tandem may be particularly helpful:
Endoscopic ultrasound (EUS). This test takes ultrasound images of your pancreas from inside your stomach. While you are under sedation, doctors will thread a tube into your stomach with an ultrasound device that captures images of your pancreas. The doctor may also perform a biopsy during EUS using fine needle aspiration (FNA).
Endoscopic retrograde cholangiopancreatography (ERCP). This test involves threading a tube into your stomach and injecting dye into your pancreatic and bile ducts to make them more visible on an x-ray. It is also possible to obtain a biopsy during this test.
A study in the Annals of Internal Medicine suggested that using EUS and ERCP together could effectively identify early cancerous changes in people with a family history of pancreatic cancer. Individuals showing early signs of cancer, then, could choose to have their pancreas removed. This measure is controversial, however, because removing the pancreas leaves a person unable to produce pancreatic enzymes for digestion as well as insulin to control blood glucose (sugar), thus causing diabetes.
Blood tests. Doctors may also use a blood test to either diagnose cancer or, more often, determine how advanced the cancer is or how well a treatment is working. One tumor marker is CA 19-9, which is elevated in 50 to 75 percent of people with pancreatic cancer.Another is the protein carcinoembryonic antigen (CEA).
Targeted Treatment for Cancer of the Pancreas
If pancreatic cancer is confined to the pancreas, surgery may be an option. If the tumor is in the head of the pancreas, a Whipple procedure may be performed to remove the head of the pancreas, the gallbladder, and portions of the small intestine and bile duct. The remaining parts of the pancreas, stomach, and intestines are reconnected so that a person can still digest food.
Tumors in the body or tail of the pancreas are removed through a distal pancreatectomy. For pancreatic cancers that have spread, radiation therapy and chemotherapy are mainstays of conventional treatment. The chemotherapy drug gemcitabine (Gemzar) has been considered the standard of care since the mid-1990s. More recently, Gemzar has started being used in combination with erlotinib (Tarceva) for people with advanced pancreatic cancer who have not had previous chemotherapy. Tarceva targets human epidermal growth factor receptor type 1 (EGFR), which is over-expressed in pancreatic tumors and is associated with a poorer prognosis.
In a 2009 trial of 539 individuals with advanced untreated pancreatic cancer, treatment with Tarceva plus Gemzar at a dosage of 100 mg per day resulted in a relative survival improvement of 22 percent.