Pancreatic Cancer
with John Flowers, MD
What are the different stages of pancreatic cancer?
Each year in the United States, more than 30,000 people are diagnosed with pancreatic cancer. Sadly, the survival statistics are grim, with only about four percent of patients reaching the five-year survival rate. According to John Flowers, MD, Surgeon at GBMC, pancreatic cancer is so lethal primarily because it is usually not found until it has progressed to an advanced stage.
“The most common symptoms of pancreatic cancer are usually weight loss and abdominal pain,” says Dr. Flowers. “Other symptoms may include decreased appetite, bloating or belching. Usually by the time the person gets the symptoms checked out, the disease is already beyond the point where it can be cured.”
Older age is the main risk factor for pancreatic cancer. “It’s rare before age 45 and becomes increasingly common after age 60,” says Dr. Flowers. “Other risks include cigarette smoking and a family history of the disease.”
The disease is usually diagnosed through a CT scan of the abdomen, which can reveal a mass in the pancreas. When diagnosed, the cancer is categorized into four stages. During Stage 1, the tumor is confined to the pancreas. Stage 2 is when the tumor is still confined to the pancreas, but is larger and has a greater chance of spreading. Stage 3 is characterized by the tumor spreading from the pancreas to nearby organs or lymph nodes. During Stage 4, the tumor has metastasized and spread to distant organs. The majority of pancreatic cancer cases are discovered during this stage.
Although a multidisciplinary approach is the preferred method to treat pancreatic cancer, the only way to completely cure it is with surgery. Unfortunately only about one in five patients have a potentially curable tumor. Patients who do not have a curable tumor may still have surgery to relieve symptoms.
A common surgical approach for pancreatic cancer is the Whipple procedure. “The Whipple operation is used on pancreatic tumors that are located in the head of the pancreas,” says Dr. Flowers. During the procedure, surgeons remove the head of the pancreas, as well as the patient’s duodenum, gallbladder, the end of the bile duct and in some cases, part of the stomach. Additional surgical procedures for treating pancreatic cancer include removing the tail end of the pancreas or scooping a tumor out of the pancreas.
Although chemotherapy and radiation therapy are almost always administered in the treatment of other types of cancer, this is not always the case with pancreatic cancer. “With pancreatic cancer there is no real consensus as to what drugs should be used,” says Dr. Flowers. “We almost always recommend chemotherapy, but if a surgeon goes in to operate and finds the tumor cannot be removed, then we often recommend chemotherapy plus radiation therapy.”
According to Dr. Flowers, studying the development of the disease is the best opportunity physicians have for learning how to treat it. “We need more research into how pancreatic cancer develops in early diagnosis and that is where the real progress is going to be made,” he says. “It won’t happen in the operating room or with a better CT scan – it will be learning more about the fundamental genetic association and development of the disease process.”
Communication between physicians can help patients receive the best possible care and outcome. “The quality and interaction of the multidisciplinary oncology team at GBMC is very impressive,” says Dr. Flowers. “Everyone is very dedicated and knowledgeable and there is excellent communication between physicians.”
