What is pancreatic cancer?
The pancreas is the second largest gland in the body. It is located in the upper abdomen, between the small intestine and the spleen, just behind the stomach, and plays an essential role in the digestion of fats and the regulation of blood glucose levels.
Pancreatic cancer develops when an initially healthy pancreatic cell changes (e.g. due to a mutation) and then multiplies uncontrollably, forming a cluster of cancerous cells known as a tumour. Most tumours are located in the head of the pancreas – the part of the organ that is close to the intestine.
- In 90% of cases, pancreatic cancer manifests as pancreatic ductal adenocarcinoma. This type of cancer develops from the cells that produce pancreatic juice, which is necessary for the digestion of food.
- In 10% of cases, another type of tumour is involved, namely a neuroendocrine tumour that develops in the pancreas.
Based on 2018 figures, an estimated 14,184 new cases of pancreatic cancer have been diagnosed each year in France*. This pathology affects men and women to equal extent.
Diagnosis of pancreatic cancer
Gustave Roussy is involved in the diagnosis and treatment of pancreatic cancer, but also manages patients whose diagnosis has already been confirmed.
More than 50% of patients already have metastases at diagnosis, partly because the symptoms of pancreatic ductal adenocarcinoma are not that specific. A series of examinations is therefore essential to assess the condition of the pancreas and disease spread in order to make an accurate diagnosis.
Various tests are used to diagnose pancreatic cancer. An ultrasound scan is initially performed to view the organs within the abdomen and highlight any suspicious mass on the pancreas. This examination is supplemented by a CT scan which provides a closer view of the tumour detected. The CT scan also provides information about the size of the tumour, its location, the distance between the tumour and the major vessels surrounding the pancreas and whether the disease has spread beyond the pancreas.
In the case of a localised tumour or prior to any non-surgical treatment, an echo-endoscopy is performed in order to confirm that the disease has not spread to the vessels. This examination also identifies the precise type of tumour by collecting a sample internally.
Hepatic MRI plays an important role in assessing pancreatic ductal adenocarcinoma. The examination is carried out to look for liver metastases in resectable or borderline tumours.
Treatment pathway decisions are taken at multidisciplinary meetings. These meetings involve several doctors from different disciplines including gastrointestinal oncologists, liver surgeons, radiotherapists and interventional radiologists who have access to the latest technical equipment. A meeting report is compiled for each patient.
Pancreatic Cancer Treatments
The prognosis of pancreatic ductal adenocarcinoma is largely related to the extent of the tumour. Depending on the treatment of this condition and the stage of vascular infiltration, a distinction is made between three types of tumour: resectable (which can be removed by surgery), borderline and non-resectable. Various types of treatment are available at Gustave Roussy:
In case of resectable tumour
Surgery is the primary treatment for resectable pancreatic ductal adenocarcinoma. It involves the removal of part of the pancreas where the tumour has formed. The procedure involving the head of the pancreas is known as cephalic duodenopancreatectomy (CDP). The term left splenopancreatectomy refers to surgery performed on the tail of the pancreas. Part of the intestine, stomach, gallbladder and spleen may also be removed during surgery to prevent the growth of cancer cells on these organs.
When the tumour has been surgically removed, the patient is prescribed adjuvant chemotherapy. The aim of this treatment is to destroy the cancer cells that remain following surgical excision of the tumour. Various molecules are used, either alone or in combination (gemcitabine, 5-fluorouracil, folinic acid, oxaliplatin and irinotecan, etc.).
In case of borderline tumours
Chemotherapy is often the first treatment given for borderline pancreatic ductal adenocarcinoma. It is used in an attempt to shrink the size of the tumour before administering other treatments or prior to surgery. In such cases it is known as "preoperative" or "neoadjuvant" therapy.
Radiation and chemotherapy known as chemoradiotherapy can be prescribed. It can be given following neoadjuvant chemotherapy if the latter has reduced the size of the tumour in order to complete pre-surgical treatment. If the tumour grows during chemotherapy, radiotherapy is excluded as it is unlikely that the tumour will regress.
Following these treatments, the doctor will perform a CT scan to reassess the tumour.
If the CT scan shows that the tumour has regressed and if the multidisciplinary medical team is considering surgical removal of the entire tumour following neoadjuvant treatment, a surgical resection can be performed.
In case of non-resectable tumour
Chemotherapy is generally recommended for locally advanced and metastatic pancreatic ductal adenocarcinoma. Indeed, cases of narrowing, infiltration of the portal trunk (one of the main vessels in the liver) or arterial extension preclude any tumour-related surgical procedure. The purpose of chemotherapy is to slow down or even halt disease progression, reduce pain and improve the patient's quality of life.
Radiotherapy may be performed following a period of chemotherapy to increase the response to medical treatment and the time taken to control the disease. It can also be prescribed to control cancer-related pain. In this instance, treatment is palliative and does not offer a cure.
Clinical trials and advanced therapy medicinal products
Depending on the characteristics and stage of the cancer, Gustave Roussy can invite patients to participate in clinical trials. The advanced therapy medicinal products arising from these protocols give patients access to new molecules and precision medicine based on the molecular characteristics of each tumour. If appropriate, patients will be referred to a therapeutic trial during treatment by the referring oncologist, giving them access to innovative treatments.
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