Treatment Options For Stage 2 Pancreatic Cancer

What is stage II pancreatic cancer?

Pancreatic cancer is staged primarily using the TNM method of staging cancers, T stands for Tumour, N stands for node and M for Metastasis. Tumour shows the size of the primary tumour, Node shows the presence of cancer in the lymph nodes and Metastasis is the spreading of cancer from the primary tissue to the other tissues and organs.
The second stage of pancreatic cancer is resectable or borderline resectable cancer, where the cancer has just spread to the blood vessels, but there is a chance that it could be removed by surgery.

Picture of a patient in pain from pancreatic cancer

Treatment options:

The type treatment that is to be given to the patient depends on the stage of cancer, the spreading of the tumour, location of the tumour, patient’s tolerance level and general health.
For stage II of pancreatic cancer, surgical removal of tumours for resectable cancer and surgery along with other therapies for borderline resectable cancer are considered. These treatments aim in diminishing the cancer or move it away from the blood cells, in order to make surgical removal easier.

Surgery:

Surgical procedures are used in removing the tumour and the surrounding lymph nodes if the cancer has not spread beyond the pancreas. Surgeries can be complicated though for treating pancreatic tumours because of the location of the pancreas.

In most cases, the bile duct is relocated to the middle part of the small intestine, and in very few, the bile duct is left open with a stent. The most common surgery used to treat stage II pancreatic cancer is pancreaticoduodenectomy (Whipple procedure) includes removing the last part of the stomach, and connecting it to the middle of the small intestine, redirecting the bile duct into the jejunum.

Only 20% of stage II pancreatic cancer patients get treated only by surgical because the patients are often diagnosed after the cancer has spread.

Neoadjuvant therapy or pre-operative therapy:

This treatment is given to patients with borderline resectable pancreatic cancer before surgery. It aims at shrinking the tumour, facilitating the surgical removal of the tumour with clear margins. The treatment generally includes chemotherapy, with or without radiation.

  • Chemotherapy: This treatment includes the usage of drugs in order to kill the cancer cells and shrink the tumour.
  • Radiotherapy: The procedure includes giving high doses of x-rays to reduce the size of the tumour.
  • Chemoradiation: This treatment is a combination of chemotherapy and radiotherapy. It is given before surgeries to shrink the cancer and reduce it’s recurrence.

Adjuvant therapy or post-operative therapy:

This therapy is given post surgical procedures. Depending on the recurrence of the cancer and recovery of the patient, the treatment usually starts within 8-12 weeks after surgery.
Again, this treatment might include chemotherapy and Radiotherapy.

  • Chemotherapy: Chemotherapeutic drugs are given for around 6 months post surgery. For most effective results, a combination of gemcitabine and capecitabine is given.
  • Radiotherapy: Depending upon the recovery of the patient, radiotherapy is given when there are no clear margins post surgery.

Survival rates:

The overall 5-year survival rate of stage II pancreatic cancer is about 5 to 7% while for those resectable is about 52%.

Resectable pancreatic cancers have a high survival rate because the removal of tumours eliminates cancer and there are very less chances of recurrence. The 5-year survival rate of stage II pancreatic cancer with surgery alone is 10-35%.

The survival rate of borderline resectable cancers completely depends on the treatment given, spreading of the cancer and the tolerance of the patient. Higher dosage of chemotherapy and/or radiation helps surgical procedures easier, increasing the survival rates.

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