Cancer Education Slides

Pancreatic Cancer2010

What is Cancer?

• A group of 100 different diseases

• The uncontrolled, abnormal growth of cells

• Cancer may spread to other parts of the body

What is Pancreatic Cancer?

• Fourth leading cause of cancer death in men and women

• An estimated 43,140 people diagnosed in the United States in 2010

• A disease in which normal cells in the pancreas grow uncontrollably

• Most cases aren’t detected until the cancer has metastasized (spread) beyond the pancreas to other areas of the body

What is the Function of the Pancreas?

• Pear-shaped gland located in the abdomen between the stomach and spine

• Comprised of the head (where pancreatic cancer is most commonly diagnosed), the body, and the tail

• Helps the body digest food and produces hormones, such as insulin

• The most common type of pancreatic cancer is ductal adenocarcinoma, which occurs in cells lining pancreatic ducts

What are the Risk Factors for Pancreatic Cancer?

• Age • Gender: Men at higher risk than women • Race: Black people at increased risk• Smoking• Obesity and diet• Diabetes• Family history• Chronic pancreatitis (inflammation of the pancreas)

• Exposure to pesticides, benzene, certain dyes, and petrochemicals

Pancreatic Cancer and Early Detection

• No tests are recommended for screening the general population

• Often called the “silent disease” because it usually doesn’t cause symptoms in early stages

What are the Symptoms of Pancreatic Cancer?

• Jaundice (yellow skin and eyes, darkened urine, clay-colored stool)

• Pain in upper abdomen or upper back

• Burning feeling in the stomach

• Floating stools with an especially bad odor

• Weakness

• Loss of appetite

• Nausea and vomiting

• Weight loss with no known explanation

How is Pancreatic Cancer Diagnosed?

• Physical examination; laboratory tests

• Diagnosis is confirmed with a biopsy

• Endoscopic retrograde cholangiopancreatography (ERCP), a test that checks the bile ducts and pancreatic ducts for blockage

• Endoscopic ultrasound (EUS), a test using a thin, lighted tube to get images of the pancreas using sound waves

• Other imaging tests, such as computerized tomography (CT) scans

Pancreatic Cancer Staging• Staging is a way of describing a cancer, such as

the size of a tumor and if or where it has spread• Staging is the most important tool doctors have to

determine a patient’s prognosis• Pancreas cancer is most commonly classified as:

• Resectable (able to be surgically removed)• Locally advanced (cancer confined to the area around the pancreas, but not resectable because of extension/invasion into surrounding vessels and organs)

• Metastatic (cancer has spread to other organs)• Treatment depends on the stage of the cancer• Recurrent cancer is cancer that comes back after

treatment

How is Pancreatic Cancer Treated?

• Treatment depends on the stage of cancer; more than one treatment may be used

• Surgery, radiation therapy, and chemotherapy may be used at any stage of the disease

• Has a much higher chance of being successfully treated if detected at an early stage

• People with pancreatic cancer may consider enrolling in a clinical trial

Cancer Treatment: Surgery

• May involve removing all or part of the pancreas– Cancer at the pancreatic head: Whipple resection (pancreatoduodenectomy)

– Cancer at the pancreatic body or tail: distal pancreatectomy

• Surgeons sometimes start with a diagnostic laparoscopy, a less invasive surgical procedure to get a more accurate sense of the disease stage

• Surgery may be combined with radiation therapy or chemotherapy before or after surgery (adjuvant therapy)

• Prescription hormones and enzymes can be given to replace those lost by pancreas removal

Cancer Treatment: Radiation Therapy

• The use of high-energy x-rays to destroy cancer cells

• Most common type is external-beam: outside the body

• May be used before, during, or, after surgery; is often given at the same time as chemotherapy

• Also used to relieve pain associated with pancreatic cancer

• Newer techniques, such as stereotactic radiosurgery (Cyberknife), are still considered experimental

Cancer Treatment: Chemotherapy

• Use of drugs to kill cancer cells

• Most common treatment drug for pancreatic cancer is gemcitabine (Gemzar)

• Two large clinical trials have shown a survival advantage using a combination of gemcitabine and another drug for advanced pancreatic cancer:• Gemcitabine combined with erlotinib (Tarceva) • Gemcitabine combined with capecitabine (Xeloda)

• One recently reported study showed that the combination of fluorouracil (5-FU) and oxaliplatin (Eloxatin) is effective in some patients as a second-line treatment if the tumor continues to grow.

• Patients well enough to consider more aggressive therapy may consider enrolling in a clinical trial

Cancer Treatment: Advanced Pancreatic Cancer

• Treatments can help patients with advanced pancreatic cancer live longer

• Treatment options include palliative (symptom relief) surgery, radiation therapy, and chemotherapy

• In rare cases, chemotherapy and radiation therapy may shrink the tumor enough in patients with locally advanced cancer so it can be surgically removed (downstaging)

• Patients with advanced pancreatic cancer may consider enrolling in a clinical trial

Current Research

• New tools for early detection

• Studies of pancreatic cancer genes

• Other chemotherapy agents: new formulations of paclitaxel (Taxol)

• Biologic therapy

• Targeted therapy

• Multidrug therapy

The Role of Clinical Trials for the Treatment of Pancreatic Cancer

• Clinical trials are research studies involving people

• They test new treatment and prevention methods to determine whether they are safe, effective, and better than the standard treatment

• The purpose of a clinical trial is to answer a specific medical question in a highly structured, controlled process

• Clinical trials can evaluate methods of cancer prevention, screening, diagnosis, treatment, and/or quality of life

Clinical Trials: Patient Safety

• Informed consent: participants should understand why they are being offered entry into a clinical trial and the potential benefits and risks; informed consent is an ongoing process

• Participation is always voluntary, and patients can leave the trial at any time

• Other safeguards exist to ensure ongoing patient safety

Clinical Trials: Phases

• Phase I trials determine the safety and dose of a new treatment in a small group of people

• Phase II trials provide more detail about the safety of the new treatment and determine how well it works for treating a specific type of cancer

• Phase III trials take a new treatment that has shown promising results when used to treat a small number of patients with cancer and compare it with the standard treatment for that disease; phase III trials involve a large number of patients

Clinical Trials Resources

• Coalition of Cancer Cooperative Groups (www.CancerTrialsHelp.org)

• CenterWatch (www.centerwatch.com)

• National Cancer Institute (www.cancer.gov/clinical_trials)

• EmergingMed (www.emergingmed.com)

Coping with Side Effects

• Side effects are treatable; talk with the doctor or nurse

• Fatigue is a common, treatable side effect

• Pain is treatable; non-narcotic pain-relievers are available

• Antiemetic drugs can reduce or prevent nausea and vomiting

• For more information, visit www.cancer.net/sideeffects

After Treatment

• Talk with the doctor about developing a follow-up care plan

• For patients who have had surgery, doctor’s visits every three to six months

• Blood tests

• In some cases, a CT scan may be appropriate

Where to Find More InformationCancer.Net Guide to Pancreatic Cancer

(www.cancer.net/pancreatic)

• Overview• Medical

Illustrations• Risk Factors• Symptoms• Diagnosis• Staging• Treatment

• Clinical Trials• Side Effects• After Treatment• Current Research• Questions to Ask the

Doctor• Patient Information

Resources

Cancer.Net

• The expertise of ASCO, the voice of the world’s cancer physicians

• Guides to more than 120 types of cancer and cancer-related syndromes

• Clinical trials information• Weekly feature articles• Videos and podcasts• Information in Spanish• The latest cancer news• Learn more at www.cancer.net or 888-651-3038