Treatment of pancreatic cancer stage 4

Posted by Master, Doctor Mai Vien Phuong - Department of Examination & Internal Medicine - Vinmec Central Park International General Hospital

Pancreatic cancer is difficult to diagnose early because the pancreas is not located in an easily recognizable area. Pancreatic cancer also often doesn't cause symptoms until the cancer has spread to other areas of the body. More than half of pancreatic cancer cases are first diagnosed at stage 4. So how is stage 4 pancreatic cancer treated?

Pancreatic cancer occurs in the tissues of the pancreas, which is an important endocrine organ located behind the stomach. The pancreas plays an essential role in digestion by producing enzymes that the body needs to digest fats, carbohydrates, and proteins.
The pancreas also produces two important hormones: Glucagon and insulin. These hormones are responsible for controlling glucose (sugar) metabolism.
Because of the location of the pancreas, pancreatic cancer can be difficult to detect and is often diagnosed at a more advanced stage of the disease.

When pancreatic cancer is found, doctors will likely perform additional tests to find out if the cancer has spread. Imaging tests, such as blood tests and PET scans, help your doctor determine the presence of cancerous masses.
With these tests, doctors will determine the stage of cancer, thereby helping to explain how advanced the cancer is and find the most suitable treatment.
Once the diagnosis is made, the doctor will assign a stage based on the test results:
Stage 1: The tumor exists only in the pancreas Stage 2: The tumor has spread to the tissues, muscles and organs. Intra-abdominal organs or nearby lymph nodes Stage 3: Tumor has spread to major blood vessels and lymph nodes Stage 4: Tumor has spread to other organs, such as liver By estimate of the American Cancer Society for 2019, about 57,000 people in the United States are diagnosed with pancreatic cancer, and 46,000 are expected to die from the disease.
The average survival rate for stage 4 pancreatic cancer is between two and six months. But keep in mind that the conclusion of an individual's disease depends on many factors, the doctor will base on the results and make the final conclusion.

Pancreatic cancer is difficult to diagnose early because the pancreas is not located in a shallow, easily perceptible area of ​​the body where growth can be felt on routine examination. It also usually doesn't cause symptoms until the cancer has spread to other areas of the body.
More than half of pancreatic cancer cases are first diagnosed in stage 4.
Stage 4 pancreatic cancer means the cancer has spread to other organs, typically the liver or lungs . The cancer cannot be cured at this point, but there are treatment options.
Treatment of stage 4 pancreatic cancer is mainly focused on prolonging life and improving the patient's quality of life.
Chemotherapy This treatment uses drugs that kill cancer cells or stop them from dividing. Chemotherapy is given by pill or given through a vein.
Gemcitabine (Gemzar) is the most commonly used drug for terminal pancreatic cancer. You can take this medicine alone or in combination with other medicines such as albumin-binding paclitaxel (Abraxane), erlotinib (Tarceva), or capecitabine (Xeloda).
Chemotherapy can also be done in combination with radiation, a procedure that kills cancer cells with high-energy rays. However, performing this procedure often leads to fatigue, hair loss, and an increased risk of infection.
Pain relief treatment
As the tumor grows, it can put pressure on nearby nerves and organs. This can cause pain and discomfort. Your doctor may inject you with pain medication or they may cut the nerves that cause pain.
This treatment does not cure cancer, but it can help you feel more comfortable.
Palliative surgery Surgery at this stage cannot remove the cancer because it has spread too far. However, it can release any blockages that the tumor has created. There are three types of surgery that can be done for stage 4 pancreatic cancer:
Bypass surgery (shortcut) of the bile ducts and intestines Bypass surgery is an option if the tumor is blocking the common bile duct .
The liver normally secretes a substance called bile, which helps with digestion. Bile is stored in the gallbladder. It then travels through the common bile duct to the intestines. From there, it is eliminated from the body in the stool.
When a tumor blocks the small intestine, bile can build up in the body and cause yellowing of the skin and eyes.
Bypass surgery directly connects the bile duct or gallbladder to the small intestine to resolve the obstruction. This procedure is called a biliary-intestinal surgery.
Stent A stent is a thin metal tube that is placed inside a blocked bile duct to open it up, allowing bile to escape. Bile can escape outside the body or into the small intestine. Stents can also be used to keep the small intestine open if cancer is stopping it.
You may need to have another surgery to place a new stent after a few months, as the tumor can eventually grow and block the stent.

Stomach-small-intestinal anastomosis Gastro-small-intestinal anastomosis (gastrojejunostomy) is surgery that attaches the stomach directly to the small intestine. It can be used to move food out of your stomach due to pancreatic invasion (known as gastric outlet obstruction) and into your intestines.
Cancer inherently does not spare anyone, it is estimated that every year in the world, a very large proportion of people die from cancer. In fact, if cancer can be detected at an early stage, the prognosis for treatment is very high, even if it is completely cured and not recurred. Therefore, screening for cancer is essential, especially for high-risk patients.
Currently, Vinmec International General Hospital has been implementing cancer screening packages. At Vinmec, there are fully modern diagnostic facilities such as: PET/CT, SPECT/CT, MRI..., blood marrow test, histopathology, immunohistochemistry test, gene test, lab test molecular biology, as well as a full range of targeted drugs, the most advanced immunotherapy drugs in cancer treatment. Multimodal cancer treatment from surgery, radiation therapy, chemotherapy, hematopoietic stem cell transplantation, targeted therapy, immunotherapy in cancer treatment, new treatments such as autoimmunotherapy body, heat therapy...
After having an accurate diagnosis of the disease and stage, the patient will be consulted to choose the most appropriate and effective treatment methods. The treatment process is always closely coordinated with many specialties: Diagnostic Imaging, Biochemistry, Immunology, Cardiology, Stem Cell and Gene Technology; Department of Obstetrics and Gynecology, Department of Endocrinology, Department of Rehabilitation, Department of Psychology, Department of Nutrition... to bring the highest efficiency and comfort to patients. After undergoing the treatment phase, the patient will also be monitored and re-examined to determine whether the cancer treatment is effective or not.
Thanks to modern facilities, a team of qualified doctors, perfect medical services, have brought confidence, health and good quality of life to patients who come to visit and treat diseases at the hospital. Vinmec.

References
About advanced cancer. (2017). Jacobson SD. (2001). Pancreatic cancer in the older patient.