Radiation Therapy for Pancreatic Cancer

Pancreatic cancer includes malignant or cancerous tumors originating in the cells of the pancreas.

The pancreas is a gland located in the right side of the abdomen near the stomach, liver, spleen, and gallbladder. The gland is about six inches in length and serves two primary functions: to generate enzymes that move into the small intestine to help with the digestion of food, and to produce two important hormones, insulin and glucagon, which work together to maintain the proper levels of sugar in the blood stream.

Facts about Pancreatic Cancer

Adenocarcinoma is the name for the most common type of pancreatic cancer, accounting for the vast majority of cases. Adenocarcinoma develops in the parts of the pancreas responsible for aiding in digestion.

Much rarer are neuroendocrine tumors, which develop in the parts of the pancreas that produce hormones.

Pancreatic cancer is the fourth most common cause of cancer deaths in the US and eighth worldwide.

Men are 30% more likely to develop pancreatic cancer than women.

General Risk Factors for Pancreatic Cancer

Smoking is believed to cause about 20-30% of all cases of pancreatic cancer and people who smoke are twice as like to develop pancreatic cancer.

Most individuals with pancreatic cancer are over the age of 60 at the time of diagnosis.

An individual with a family history of pancreatic cancer is at higher risk to develop the disease.

Those who suffer from chronic pancreatitis are at higher risk of pancreatic cancer. Long-term alcohol abuse, mumps, and some autoimmune disorders can cause pancreatitis.

People with diabetes are at higher risk to develop pancreatic cancer. Up to 85% of people diagnosed with pancreatic cancer have diabetes or hyperglycemia.

Screening for Pancreatic Cancer

Screening is testing to detect cancer in people with no existing symptoms. While there is no standard diagnostic tool for screening or early detection of pancreatic cancer, individuals who are at a higher risk of developing pancreatic cancer should discuss possible screening methods with their doctors.

Signs of Pancreatic Cancer

The symptoms of pancreatic cancer are often vague and difficult to identify until the cancer has reached advanced stages. The onset of the following symptoms often leads to a diagnosis of pancreatic cancer:

  • Jaundice
  • Weight loss
  • Pain
  • Digestive problems
  • Changes in bowel movements
  • Blood clots
  • Diabetes
  • Ascites, or the accumulation of fluid in the abdomen causing swelling or distention around the belly.

Diagnosing Pancreatic Cancer

Endoscopic retrograde cholangiopancreatography — ERCP is a procedure used to create images of the digestive tract. During an ERCP procedure, doctors insert a thin, lighted tube into the mouth and down through the stomach to produce an image of the surrounding organs and glands.

Magnetic resonance cholangiopancreatography — MRCP is similar to an MRI, except that is uses specialized software to target the pancreas and bile ducts and create detailed images.

X-ray, CT, MR and PET scans are often needed to show the location and extent of the cancer.

To confirm a diagnosis, doctors will need to remove a small piece of tissue from a tumor for testing. Often, a biopsy sample can be collected during an ERCP procedure, if one is performed.

Treating Pancreatic Cancer

Treatment for pancreatic cancer depends on several factors, including the type of cancer, the size and stage, its location, and your overall health.

Surgery may be possible for pancreatic cancers and offers the best chance for long term control of the cancer. Typically, surgery is only considered if the pancreatic cancer has not spread beyond the pancreas and does not involve any major arteries.

Chemotherapy is often used in combination with radiation therapy, although the doses of radiation given might be lower for patients concurrently taking chemotherapy. Gemcitabine, fluorouracil, and, most recently, albumin-bound paclitaxel have been approved by the FDA in the US for treatment of pancreatic cancer.

Targeted therapy is available for pancreatic cancer. Targeted therapy refers to drugs that target certain aspects of cancer cells, thereby killing the cancer cells while causing little harm to healthy cells.

Understanding Radiation Therapy

Radiation therapy, sometimes called radiotherapy, is the careful use of radiation to safely and effectively treat cancer.

  • Cancer doctors called radiation oncologists use radiation therapy to try to cure cancer, to control cancer growth or to relieve symptoms, such as pain.
  • Radiation therapy works within cancer cells by damaging their ability to multiply. When these cells die, the body naturally eliminates them.
  • Healthy cells are also affected by radiation, but they are able to repair themselves in a way cancer cells cannot.
  • After a diagnosis of pancreatic cancer has been established, it’s important to talk about your treatment options with a radiation oncologist.

External Beam Radiation

External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the area at risk.

  • Before beginning treatment, you will be scheduled for a simulation to map out the area being treated. This will involve having X-rays and/or a CT scan. You will also receive tiny tattoo marks on your skin to help the therapists precisely position you for daily treatment.
  • Treatment is given once a day, Monday through Friday, for about six weeks.
  • Newer technologies like 3-dimensional conformal radiotherapy (3D-CRT) and intensity modulated radiation therapy (IMRT) are being evaluated for use in treating pancreatic cancers. Ask your radiation oncologist for more information on these treatments.

Possible Side Effects

Common side effects of radiation therapy for patients with pancreatic cancer include loss of appetite, nausea, diarrhea, and fatigue.  Side effects tend to accumulate over the course of treatment and subside within weeks or months of the final treatment.