Pancreatic Cancer Treatment

The pancreas is a small organ in the upper area of the abdomen. It is about six inches long and two inches wide, with a large “head,” narrow body and pointed tail. It has two different kinds of functions. The exocrine glands in the pancreas produce the enzymes that digest protein, fats and carbohydrates. The enzymes are released into the small intestine through the pancreatic duct. The pancreas is also lined with endocrine cells, which are grouped in small clusters, called islets. The islet cells produce the hormones, insulin and glucagons, which are released into the blood. These hormones regulate the body’s use of glucose (sugar) as a form of fuel for the cells.

This year, the American Cancer Society estimates 37,680 cases of pancreatic cancer will be diagnosed in the U.S. Most of the cancers develop within the exocrine ducts. It’s the fourth leading cause of cancer death in this country and will kill about 34,290 Americans this year.

Risk for pancreatic cancer increases with age. 90 percent of patients are over 55 at the time of diagnosis. It’s more common in African Americans than in whites. Smokers are two to three times more likely to develop the cancer than non-smokers. Risk is also higher in those with a family history of pancreatic cancer, people who are obese or get little physical activity, diabetics and patients with a history of chronic pancreatitis (inflammation of the pancreas).

If pancreatic cancer is diagnosed in early stages, surgery may be done to remove the cancer. However, researchers estimate about two-thirds of patients with pancreatic cancer have advanced disease at the time of diagnosis. That’s because symptoms are often vague (like jaundice, stomach or back pain, weight loss and digestive problems) and associated with other conditions. Therefore, surgery is often not an option for later-stage diagnosis. Patients may be given a combination of radiation therapy and chemotherapy to shrink the tumor and alleviate symptoms. But treatments are usually limited in their ability to fight the cancer. Currently, five-year survival rates are less than five percent.

Gemcitabine (GEMZAR®) is a drug that disrupts the ability of cancer cells to divide and repair damage. It’s given intravenously once a week and has already been approved for patients with locally-advanced or metastatic pancreatic cancer.

Researchers wanted to find out if adding gemcitabine to chemoradiation therapy could improve outcome or survival for patients with early stage pancreatic cancer. Nearly half the patients received standard chemoradiation, or combined low-dose abdominal radiation and another anti-cancer drug, fluorouracil, or 5-FU. The other half received the chemoradiation plus infusions of gemcitabine.

The researchers found patients with tumors of the pancreatic head had improved survival rates (31 percent survival at three years) compared to those receiving only chemoradiation (22 percent survival at three years). Common side effects of gemcitabine include appetite loss, thinning or brittle hair, diarrhea, constipation, nausea and vomiting. The results of the study were published in the March 5, 2008 issue of the Journal of the American Medical Association.

William Regine, M.D., a Radiation Oncologist with the University of Maryland School of Medicine, says investigators eventually hope to add an additional chemotherapy agent that specifically targets cancer cells. For information about the ongoing study: University of Maryland, Greenebaum Cancer Center, http://data.umms.org/scripts/trials/trial.cfm?ID=GCC%200319. Information is also available from http://www.clinicaltrials.gov. Type the trial ID number in the search box: NCT00003546.

For information about the study: University of Maryland, Greenebaum Cancer Center, http://data.umms.org/scripts/trials/trial.cfm?ID=GCC%200319. Information is also available from http://www.clinicaltrials.gov. Type the trial ID number in the search box:
NCT00003546.

For general information on pancreatic cancer:
American Cancer Society, http://www.cancer.org, or contact your local chapter
The National Cancer Institute, http://www.cancer.gov
The National Pancreas Foundation, http://www.pancreasfoundation.org