Pancreatic cancer develops when cells in the pancreas, a gland located behind the stomach, begin to grow uncontrollably, forming a tumor. The pancreas plays a dual role in the body, producing enzymes for digestion and hormones like insulin to regulate blood sugar. When pancreatic cancer is described as “resectable,” it means the tumor is localized and can be completely removed through surgery, offering the best chance for long-term survival. This classification indicates that the cancer has not spread to distant parts of the body or extensively invaded nearby major blood vessels.
Determining Resectability
Determining whether pancreatic cancer is resectable involves a thorough evaluation of the tumor’s characteristics, including its size, precise location, and relationship to surrounding major blood vessels. Physicians commonly utilize advanced imaging techniques such as multiphase computed tomography (CT) scans, often referred to as pancreatic protocol CT scans, to visualize the pancreas and detect any spread to nearby organs or lymph nodes. Magnetic resonance imaging (MRI) and positron emission tomography (PET) scans also play a role in this assessment, particularly for identifying smaller metastatic spots in the liver or when CT scans are contraindicated.
The assessment goes beyond just imaging, as doctors also consider the patient’s overall health and ability to tolerate a major surgical procedure. Tumor markers, such as carbohydrate antigen 19-9 (CA19-9), can provide additional information, with elevated levels sometimes suggesting a higher likelihood of unresectable disease, even if not immediately apparent on imaging. A staging laparoscopy, a minimally invasive surgical procedure, may be performed to visually inspect the abdominal cavity and obtain biopsy samples to confirm the extent of the cancer and determine if complete removal is feasible.
Treatment for Resectable Cases
For individuals with resectable pancreatic cancer, surgical removal of the tumor is the primary treatment approach. The specific surgical procedure depends on the tumor’s location within the pancreas. When the tumor is located in the head of the pancreas, near the small intestine, a Whipple procedure, also known as a pancreaticoduodenectomy, is performed. This complex operation involves removing the head of the pancreas, the duodenum (the first part of the small intestine), the gallbladder, a portion of the bile duct, and often nearby lymph nodes.
If the tumor is situated in the body or tail of the pancreas, a distal pancreatectomy is the surgical intervention. This procedure involves removing the affected portion of the pancreas, and often the spleen is also removed due to its close proximity and shared blood supply. In rare cases where the cancer has spread throughout the entire pancreas but is still considered removable, a total pancreatectomy may be considered.
Following surgery, adjuvant chemotherapy is often administered to target any remaining cancer cells and reduce the risk of recurrence. Chemotherapy regimens such as modified FOLFIRINOX or combinations of gemcitabine and capecitabine have shown promise in improving long-term survival after resection. Sometimes, neoadjuvant therapy, involving chemotherapy and/or radiation, is used before surgery to shrink the tumor, making it easier to remove and potentially increasing the chances of a complete resection.
Recovery and Follow-Up
Recovery after pancreatic cancer surgery is a gradual process that can take several months to a year. Immediately following the operation, patients often spend time in an intensive care unit for close monitoring. During this initial period, individuals may have various tubes and drains. Pain management is a focus, with medications used for comfort.
Eating and drinking are gradually reintroduced as the digestive system slowly resumes normal function. Many patients will require pancreatic enzyme supplements to aid in digestion, as the removal of part or all of the pancreas can affect enzyme production. Regular physical activity, such as walking, is encouraged soon after surgery to aid recovery. Long-term follow-up care is structured to monitor for any signs of recurrence and manage ongoing side effects, typically involving physical examinations, blood tests, including CA19-9 levels, and imaging scans like CT scans, usually every 3 to 6 months for the first few years, then less frequently.
Understanding the Prognosis
The long-term outlook for individuals with resectable pancreatic cancer is more favorable compared to those with advanced or unresectable disease. While pancreatic cancer historically has a challenging prognosis, with a combined five-year survival rate for all stages around 12%, early detection and successful surgical removal improve these statistics. For patients whose tumors are resected, the five-year survival rate can be around 27% to 50%, especially when coupled with adjuvant chemotherapy.
Several factors influence the prognosis, including the stage of the cancer at diagnosis, whether lymph nodes are involved, the completeness of the surgical removal (achieving a negative surgical margin, or R0 resection), and the patient’s response to adjuvant therapies. Tumor size also impacts survival, with smaller tumors associated with better outcomes. Ongoing research continues to explore new therapeutic strategies, including personalized treatments and targeted therapies, aiming to improve survival rates and quality of life for patients with pancreatic cancer.