pancreatic cancer (Pancreatic ductal adenocarcinoma)

What is Pancreatic Cancer?

Most people with pancreatic cancer have a type called Pancreatic Ductal Adenocarcinoma (PDAC). It is one of the deadliest cancers because it often spreads before it's found and grows aggressively.

Only about 10–15% of people are diagnosed early enough for surgery, which is the only chance of a cure, many sadly have cancer that is too advanced or has already spread.

How is Pancreatic Cancer Treated?

🏥 Surgery

• If the cancer is caught early and is in a location that can be safely operated on, surgery may be offered.
• The most common operation is the Whipple procedure, which removes part of the pancreas, the bile duct, and parts of the digestive tract.
• Surgery today is much safer than in the past, with much lower death rates, especially in expert centers.
• Minimally invasive (keyhole or robotic) surgeries are also being done in experienced hospitals like Royal Stoke Hospital.

🩻 Staging

There are four main stages:

1. Resectable – can be removed with surgery
2. Borderline Resectable – may need chemotherapy to shrink before surgery depending on which vessels are involved
3. Locally Advanced – not operable but may still respond to chemo
4. Metastatic – cancer has spread, usually not curable

Doctors also look at tumour biology (blood markers like CA 19-9) and the patient’s overall health.

💊 Chemotherapy

• Chemotherapy uses drugs to kill cancer cells or stop them from growing.
• Two common drug combinations are:
  • FOLFIRINOX – used in younger, fitter patients
  • Gemcitabine + Nab-Paclitaxel – used in patients who may be older or less fit
• Chemotherapy can be given:
  • Before surgery (neoadjuvant) – to shrink the tumour and catch hidden cancer cells early
  • After surgery (adjuvant) – to reduce the chance of the cancer returning

🔬 Radiation Therapy

• Radiation may be used before or after surgery in some patients.
• It can help shrink tumours or control pain.
• The evidence for its benefit varies and is still being studied.

What If Surgery Is Not an Option?

For many patients, surgery is not possible because the cancer has spread or is in a location that makes it dangerous to operate. In these cases, treatment focuses on improving quality of life and extending survival using:

• Chemotherapy
• Targeted therapies (newer drugs aimed at specific weaknesses in cancer cells)
• Clinical trials of experimental treatments
• Palliative care for symptoms like pain or digestive problems

Newer Treatments and Hope for the Future

🧬 Targeted Therapy

• Some patients have special gene mutations like BRCA. These can be treated with drugs called PARP inhibitors (e.g., Olaparib), which are already helping people with breast and ovarian cancer.
• Researchers are also developing treatments for people with changes in the KRAS gene, which is common in pancreatic cancer.

🛡️ Immunotherapy

• This helps the body’s immune system fight cancer.
• It works well in some other cancers but hasn’t been very effective in most pancreatic cancer patients—except in a small group with rare DNA repair problems.
• Scientists are working on ways to make pancreatic cancer more responsive to immunotherapy.

🧪 Clinical Trials

• Many promising treatments are being studied in clinical trials.
• Patients are encouraged to consider participating in trials when appropriate, especially when standard treatments are not effective.

Outlook and Support

While pancreatic cancer remains a very serious disease, treatment options have improved in recent years. The best care often comes from specialist centers like ours at Royal Stoke Hospital where experts from different fields work together.

Patients and families should always feel comfortable asking about:

• Second opinions
• Support services
• New or experimental treatments
• Genetic testing to guide therapy