The pancreas is a pear-shaped gland located between the stomach and the spine. It is made up of 2 major components:

The exocrine component is made up of ducts and small sacs and makes enzymes that are released into the small intestine to help the body digest food, particularly fats.

The endocrine component is made up of islets of Langerhans and makes specific hormones like insulinoma, glucagonoma, somatostatin, pancreatic polypeptide (PP), and vasoactive intestinal peptide (VIP).


Pancreatic Cancer Treatment In Malaysia



Types of pancreatic cancer

There are several types of pancreatic cancer, depending on whether the cancer began in the exocrine or endocrine component. Rarely, other types of cancer can begin in the pancreas, such as lymphoma and sarcoma.

Exocrine tumors

Adenocarcinoma is the most common type of exocrine tumor. Rare types of exocrine pancreatic tumors include acinar cell carcinoma, adenosquamous carcinoma, colloid carcinoma, giant cell tumor, serous cyst adenoma, signetring cell carcinoma, squamous cell carcinoma and undifferentiated carcinoma.

Endocrine tumors

These are also called pancreatic neuroendocrine tumors (PNETs) and make up 1% of pancreatic cancers. A PNET can be functioning or non-functioning. A functioning PNET is named based on the hormone produced such as insulinoma, glucagonoma and VIPomas.

 

Risk factors

Gender
More men are diagnosed with pancreatic cancer than women.
Age
The risk of developing pancreatic cancer increases with age. 90% of people who develop pancreatic cancer are older than 55.
Race/ethnicity
Black people and those of Ashkenazi Jewish heritage are more likely than Asian, Hispanic, or white people to develop pancreatic cancer.
Smoking
People who smoke are 2 to 3 times more likely to develop pancreatic cancer.
Obesity, diet, and alcohol
Research has shown that obese men and women have a higher risk of dying from pancreatic cancer. Chronic, heavy alcohol use can also increase the risk of pancreatic cancer, most likely through causing recurrent pancreatitis.
Family history
Pancreatic cancer may run in the family, called familial pancreatic cancer, if at least 2 family members with pancreatic cancer are first-degree relatives.
Genetics
Members of families with certain uncommon inherited conditions such as Hereditary Breast and Ovarian Cancer syndrome, Lynch syndrome and Familial Adenomatous Polyposis have a significantly increased risk of pancreatic cancer, as well as other types of cancer.
Chemicals
Exposure to certain chemicals such as pesticides, benzene, certain dyes, and petrochemicals may increase the risk of developing pancreatic cancer.

 

Treatment overview

In order to tailor your treatment plan, our oncologists at Onco Life Centre will review factors such as your pre-existing medical conditions, your overall health and nutritional status, as well as potential treatment side effects. When detected at an early stage, pancreatic cancer has a much higher chance of being successfully treated. However, there are also treatments that can help control the disease for patients with later stage pancreatic cancer to help them live longer.

Surgery

Surgery for pancreatic cancer includes removing all or part of the pancreas,depending on the location and size of the tumor in the pancreas. A key goal of surgery is to have clear margins. Only about 20% of patients with pancreatic cancer are able to have surgery because most pancreatic cancers are first diagnosed when the disease has already spread. Surgery for pancreatic cancer may be combined with radiation therapy and/or chemotherapy, called adjuvant therapy. These treatments may sometimes be used before surgery to shrink a tumor. This is called neoadjuvant therapy.

Radiation therapy

External-beam radiation therapy is the type of radiation therapy used most often for pancreatic cancer. Chemotherapy may be given at the same time as radiation therapy because it can enhance the effects of the radiation therapy, which is called radio sensitization. Combining chemotherapy and radiation therapy may occasionally help shrink the tumor enough so it can be removed by surgery.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells ability to grow and divide. A chemotherapy regimen usually consists of a specific number of cycles given over a set period of time. There is usually a rest period in between cycles. There are generally more side effects when 2 or more drugs are used together.

Combination treatments are usually best for patients who are able to carry out their usual activities of daily living without help.

For pancreatic cancer, chemotherapy may be described by when and how it is given. First-line chemotherapy is generally the first treatment used for patients with either locally advanced or metastatic pancreatic cancer. Second-line chemotherapy is used when treatment does not work or stops working to control cancer growth.

Sometimes, first-line treatment does not work at all, which is called primary resistance. Or, treatment may work well for a while and then stop being effective later, which is sometimes called secondary or acquired resistance.

Targeted therapy

Targeted therapy is a treatment that targets the cancers specific genes, proteins or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

To match your pancreatic cancer disease with the most effective treatment, our oncologist at Onco Life Centre may run tests to identify the genes, proteins, and other factors in your tumor. EGFR tyrosine kinase inhibitor blocks the effect of the epidermal growth factor receptor in patients with advanced pancreatic cancer, and this helps to block cancer growth and spread.

 

Treatment options by stage

Potentially curable pancreatic cancer (resectable and borderline resectable pancreatic cancer)

 

Surgery

Removal of the tumor and nearby lymph nodes if there are no signs that the disease has grown beyond the pancreas or spread to other parts of the body.

Neoadjuvant therapy before surgery

Chemotherapy, with or without radiation, to try to shrink the tumor and increase the chance of curative surgery.

Treatment after surgery or adjuvant therapy

Adjuvant chemotherapy usually starts within 8 weeks after surgery, based on how quickly a patient recovers. The option to use radiation therapy after surgery.

 

Locally advanced pancreatic cancer

 

First-line therapy

Chemotherapy with a combination of drugs can be used depending on each patients situation and overall health. Radiation therapy may be used, most often after chemotherapy if the cancer has not spread beyond the pancreas.

Second-line therapy

If the disease worsens during or after first-line treatment, options may include a different line of chemotherapy.

 

Metastatic pancreatic cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. Your treatment plan may include a combination of the treatments discussed above. Talk to our oncologists about your first and second line treatment options, which can heavily depend on your overall health and preferences.

Palliative care will also be important to help relieve symptoms and side effects. For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families have opportunities to talk about the way they are feeling with our oncologists, nurses, counselors, or join our psychosocial program and support group.

Patients and their families have opportunities to talk about the way they are feeling with our oncologists, nurses, counselors, or join our psychosocial program and support group at Onco Life Centre.

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