is used . This involves a highly complex surgery to cut out the head of the pancreas together with part of the stomach as well as the small bowel and the bile duct . Since these organs are all connected , surgeons then have to rejoin all their loose ends back together .
“ Whipple resection is a major undertaking that can last up to ten hours , probably one of the biggest operations humans can take , � stressed Dr Liau .
Given its invasive nature , the risk of complications from a Whipple procedure is high . In about 15 percent of cases , for instance , the pancreas tends to leak enzymes , or chemicals , needed for digestion , which can damage surrounding tissues causing them to bleed . Drains then have to be inserted to draw off the enzymes .
Post-surgery problems can include difficulty emptying the stomach or digesting some foods , but these usually settle with time .
A much simpler surgery , known as distal or subtotal pancreatectomy , is required for cancers in the neck , body , or tail of the pancreas . In this case , the pancreatic body with the tumour is removed , but not the head , together with the spleen , an organ to which the cancer is likely to spread through lymph nodes . �That ’ s a far less complex operation where there ’ s no reconstruction involved , � said Dr Liau . As a key function of the spleen is to prevent infections , patients who undergo a splenectomy ( removal of the spleen ) will have to get several vaccines and be on antibiotics for life .
Despite going through these massive operations , most patients aren ’ t cured , with 50 to 80 percent suffering a recurrence of cancer , usually in tissues far away from the pancreas .
�The relapse rate is high , probably higher than any other type of cancer , � acknowledged Dr Liau .
It ’ s unknown why so many surgeries end up being unsuccessful , but one hypothesis is that pancreatic cancer sheds tiny malignant growths ( called micrometastases ) away from the primary cancer site that our diagnostic tools can ’ t pick up but that develop and gain strength over time . In order to kill off any remaining cancer cells , most patients need to undergo additional ( or adjuvant ) chemotherapy after they have recovered from surgery . If chemotherapy is given immediately post-operation , outcomes are much improved .
�With surgery alone , the survival at five years is about 10 to 25 percent depending on whether any disease has been left behind ( the surgical margin status ), but you can get up to 40 percent survival with chemotherapy , � said Dr Liau .
Though it ’ s an arbitrary mark , the five-year survival is considered a strong sign the malignancy has been kept at bay . �There ’ s a small number of patients for whom cancer may recur after five years , but if it doesn ’ t , the chances of a patient being cured would be deemed to be good , � explained Dr �ee .
Pancreatic cancers can grow to a large size without causing noticeable signs and symptoms
Medications are still not up to the task When surgery is too risky or not an option , chemotherapeutic drugs are the standard treatment for patients with inoperable pancreatic cancers and are sometimes combined with radiotherapy to increase their potency . �ut they are palliative rather than curative .
�If patients cannot have surgery , the next step is chemotherapy and maybe radiation . �ut you have to tell them it is not a cure , it is not going to make the cancer totally disappear . It may alleviate some symptoms such as back pain , and in some it may shrink the tumour making surgery an option ,” said Dr Sharmila .
When cancers have spread outside the pancreas , there are combinations of drugs that can offer a median survival of 12 to 19 months after diagnosis , but they carry some side effects , including increased risk of infections , nausea , vomiting , mouth ulcers , and rashes . Some patients can also experience mild to moderate diarrhoea , constipation , and bloating , as well as subtle changes to their memory . A small number might suffer from long-term memory problems .
�iven these side effects , patients are first thoroughly evaluated to ensure they can withstand them before starting the treatment . �Older patients who are less fit may not receive treatment at all , or others who receive treatment end up with a less rigorous regimen , for example a single-drug chemotherapy , so they ’ re treated but perhaps less optimally so , � said Dr �ee .
GlobalHealthAsiaPacific . com AUGUST 2021
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