Pancreatic cancer is a malignancy that is characterized by poor prognosis and an aggressive course. Due to the latent current and, as a consequence, late diagnosis, the disease in most cases is diagnosed at stage IV, when the tumor metastases into distant organs, such as the liver or lungs. The standard approach for pancreatic cancer treatment is surgical removal of the tumor. But when it comes to a common, metastatic form of the disease, the tumor becomes inoperable. Today, there are already drugs that can increase the life expectancy of patients.
Today, pancreatic cancer is more often diagnosed in women. The risk of disease development increases with age. If we talk about the average age of patients, these are older people, about 60 years.
Stages of therapy
We can talk about two stages of treatment, surgical and chemotherapeutic. Their sequence can vary depending on the case. After examination, a patient with a cytologically or histologically confirmed diagnosis is shown to perform the operation in the volume of pancreatic resection, sometimes in combination with the duodenum, depending on the localization. After that, he is shown preventive chemotherapy for six months.
Sometimes, even in the absence of metastases, but with a large tumor size, the surgeon can not perform the operation at the first stage because of the involvement of vital vessels in the tumor process. Then the patient is given several courses of chemotherapy, sometimes radiation therapy, with subsequent decision on the operation.
If the tumor is not amenable to surgical intervention, the patient is prescribed chemotherapy. In remote metastases, the treatment protocol includes intensive modes of chemotherapy, the surgical treatment of this patient is out of the question. Chemotherapy is carried out for an unlimited time, while it helps the patient. If the patient does not have remote metastases, chemotherapy is carried out for 6 months.
If it is a non metastatic process, the aim of the therapy is recovery. Unfortunately, the statistics against us, and the disease, despite the radical surgery and an adequate amount of chemotherapy, in most cases progresses. Only in 20% of cases we can count on no relapse for 5 years, which roughly equates to the recovery of the patient.
If a patient has remote metastases, the treatment is aimed at achieving stabilization and absence of disease progression. In such patients, the average life expectancy does not exceed one year.
How have the approaches to treatment of a patient with pancreatic cancer changed in the last 15-20 years?
Approaches to therapy have changed fundamentally, and we can see it by its results – the average life expectancy of our patients has increased. If earlier we talked about several months, now we can talk about one year, and many patients live more than two years. For a long time until 2012 we had only one effective antitumor drug at our disposal. Now we use aggressive multicomponent chemotherapy, which includes four antitumor drugs, and we use other combinations associated with the use of modern drugs such as nanodisperse paclitaxel stabilized with albumin. In some cases, immunotherapy is successfully used, although this is a rare situation for pancreatic cancer – not every tumor is sensitive to it. The therapy of localized pancreatic cancer is fundamentally advanced. Previously, in the absence of effective therapeutic capabilities and tumor control, patients received palliative chemotherapy for several months, after which the prospects for further treatment were not seen for them. Now a significant cohort of these patients (from 20 to 30%) has a chance to be operated on in a radical volume after the preoperative therapy. And these patients theoretically have a chance to recover. There are statistics on 5-year survival rate of such patients. This is a significant breakthrough: a disease that used to be considered absolutely incurable is now beginning to be treatable, and every year we see more and more patients survive.