Expert Health Articles

Pancreatic Cancer

Sharon Cole, MDSharon Cole, MD

Oncology & Hematology

Orion Cancer Care 

Pancreatic cancer is a common malignancy that has proven difficult to treat. It is often diagnosed after the cancer has spread to other organs or is no longer receptive due to involvement with nearby blood vessels. In some cases, the cancer is found when surgery for a cure is still an option. This is particularly true when it starts at the head of the pancreas where the pancreas joins with the gallbladder and the patient becomes jaundiced (yellow skin), therefore seeking medical attention.

Until now resectable pancreatic cancer has been treated with an aggressive removal of the pancreas and spleen and rerouting of the bowel. This is called a "Whipple procedure” and is a difficult surgery for a patient to undergo. After the surgery, if the entire tumor has been successfully removed, the patient then gets six months of chemotherapy to help prevent regrowth. Chemotherapy has been proven to increase the chance of being cured. The problem with this approach is that patients often take a long time to recover from the Whipple surgery. Therefore, there has been a recent trend to give the chemotherapy first than operate. We call this neoadjuvant treatment. This formula works well for patients with rectal cancer, breast cancer and other cancers. It is now being tried in patients with pancreatic cancer and is an area for clinical research.

The most common chemotherapy given for pancreatic cancer is gemcitabine/nab-paclitaxel. A new emerging combination is called mFOLFIRINOX, which is a combination of various medications. Currently, we are working on a national study that compares two options. First, if a patient is diagnosed with pancreatic cancer, CT scans and surgical opinions must be given if surgery is feasible. Then the patient is evaluated by a research nurse, doctor and study protocol chairperson to determine if their health is strong enough to be on the study. Next, the patient is randomized to one of the two treatment groups. All patients receive therapy and know which treatment they are receiving. After three months, scans and surgical evaluations are done again. If there has been no progression anywhere of the cancer, then the patient goes on to surgery for the Whipple. After recovery from surgery, three more months of chemo is given then the treatment is over. The patients are watched carefully for side effects. Sometimes the chemotherapy dose has to be reduced, but rarely does the patient need to be removed from the study.

There are multiple advantages to treating this way. One can get to the chemotherapy right away and prevent spread to other organs, and/or the tumor could shrink and make surgery easier. In addition, more cycles are generally delivered with this method, meaning more patients get clear to the sixth month. We just opened this protocol here in Findlay and our first patient was registered recently. I feel he is getting top quality care by being involved in this study. This patient is helping himself and many who will come after him because this study will likely set the new standard of how we treat cancer of the pancreas.