What are Pancreas?
The pancreas is a glandular organ located in the abdomen, behind the stomach. It plays a crucial role in digestion and the regulation of blood sugar levels. The pancreas has two main functions –
- Exocrine function: The pancreas secretes digestive enzymes and bicarbonate into the small intestine to help break down and absorb nutrients from food.
- Endocrine function: The pancreas also secretes hormones, such as insulin and glucagon, directly into the bloodstream to regulate blood sugar levels. Insulin helps lower blood sugar levels, while glucagon helps raise them.
The pancreas is a vital organ in the body and any dysfunction or disease of the pancreas can lead to serious health problems, such as diabetes, pancreatitis, and pancreatic cancer.
What is Pancreatic Cancer?
Pancreatic cancer is a disease in which healthy cells in the pancreas stop working correctly and grow out of control. These cancerous cells can build up and form a mass called a tumour. A cancerous tumour is malignant, meaning it can grow and spread to other parts of the body. As it grows, a pancreatic tumour can affect the function of the pancreas, grow into nearby blood vessels and organs, and eventually spread to other parts of the body through a process called metastasis.
Types of Pancreatic Cancer
Pancreatic cancer can be classified into several types based on the type of cell where cancer originates. The main types of pancreatic cancer are –
1. Exocrine Pancreatic Cancer
This type of pancreatic cancer includes –
- Adenocarcinoma: This is the most common type of pancreatic cancer, accounting for about 90% of all cases. It originates in the cells that line the ducts of the pancreas.
- Acinar cell carcinoma: This is a rare type of pancreatic cancer that originates in the cells that produce digestive enzymes in the pancreas.
- Adenosquamous carcinoma: This is a rare type of pancreatic cancer that contains both glandular (adenocarcinoma) and squamous (squamous cell carcinoma) cell components. Adenosquamous carcinoma is an aggressive form of pancreatic cancer that is often diagnosed at an advanced stage.
- Squamous cell carcinoma: This is a rare and aggressive type of pancreatic cancer that originates in the cells that line the ducts of the pancreas.
- Colloid carcinoma: This is a rare subtype of pancreatic cancer which accounts for 1-3 per cent of exocrine cancer. It is characterized by the presence of large amounts of mucin, a jelly-like substance, within the tumour cells. This mucin production gives the tumour a gelatinous or colloid-like appearance under the microscope.
2. Endocrine Pancreatic Cancer
This type of pancreatic cancer is also known as neuroendocrine tumour (NET). Neuroendocrine tumours (NETs) can develop in various organs throughout the body, including the pancreas. Pancreatic NETs are a rare type of pancreatic tumour that arises from the hormone-producing cells in the pancreas.
Pancreatic NETs can be classified into two main types based on their size and the hormones they produce: functioning and non-functioning tumours. Functioning tumours produce hormones that cause specific symptoms, while non-functioning tumours do not produce hormones and may not cause any symptoms until they grow large enough to press on surrounding tissues or organs.
The treatment and prognosis for each type of pancreatic cancer can vary widely. Therefore, an accurate diagnosis is essential to determine the most appropriate treatment plan for an individual patient.
Risk Factors of Pancreatic Cancer
The exact cause of thyroid cancer is not known, but there are several factors that may increase a person’s risk of developing the disease. Some of these risk factors include –
Cigarette smoking
is a consistently noted risk factor for pancreatic cancer, with a relative risk of at least 1.5. The risk increases with increasing duration and amount of cigarette smoking. The risk is ascribed to tobacco-specific nitrosamines.
Diet
A high intake of fat, meat, or both is associated with increased risk, whereas the intake of fresh fruits and vegetables appears to have a protective effect.
Partial gastrectomy
Partial gastrectomy appears to correlate with a 2 to 5 times higher than expected incidence of pancreatic cancer 15 to 20 years later. The increased formation of N-nitroso compounds by bacteria that produce nitrate reductase and proliferate in the hypoacidic stomach has been proposed to account for the increased occurrence of gastric and pancreatic cancer after partial gastrectomy.
Cholecystokinin
Cholecystokinin is the primary hormone that causes growth of exocrine pancreatic cells; others include epidermal growth factor 392 and insulin-like growth factors. Pancreatic cancer has been induced experimentally by long-term duodenogastric reflux, which is associated with increased cholecystokinin levels. Some clinical evidence suggests that cholecystectomy, which also increases the circulating cholecystokinin, may increase the risk for pancreatic cancer.
Chronic and hereditary pancreatitis
Chronic and hereditary pancreatitis is associated with pancreatic cancer. Chronic pancreatitis is associated with a 15-fold increase in the risk for pancreatic cancer.
Diabetes mellitus
This maybe an early manifestation of pancreatic cancer or a predisposing factor. It is found in 13% of patients with pancreatic cancer and in only 2% of controls. Diabetes mellitus that occurs in patients with pancreatic cancer may be characterized by marked insulin resistance, which moderates after tumor resection. Islet amyloid polypeptide, a hormonal factor secreted by pancreatic B cells, reduces insulin sensitivity in vivo and glycogen synthesis in vitro and may be present in elevated concentrations in patients with pancreatic cancer who have diabetes.
Having one or more of these risk factors does not necessarily mean that an individual will develop pancreatic cancer. However, it’s important to be aware of these risk factors and to speak with a healthcare professional about ways to reduce the risk of developing pancreatic cancer.
Symptoms of Pancreatic Cancer
Pancreatic cancer often does not cause symptoms in its early stages, and by the time symptoms appear, cancer may have already spread to other parts of the body. However, some of the common symptoms of pancreatic cancer include –
- Abdominal pain
- Anorexia
- Weight loss
- Early satiety
- Xerostomia and sleep problems
- Jaundice
- Easy fatigability
- Weakness, nausea, or constipation
It’s important to note that these symptoms can also be caused by other conditions, and having one or more of these symptoms does not necessarily mean that an individual has pancreatic cancer. However, if these symptoms persist or worsen over time, it’s important to speak with a healthcare professional. Early detection of pancreatic cancer can improve the chances of successful treatment.
Diagnoses of Pancreatic Cancer
The diagnosis of pancreatic cancer typically involves several tests and procedures to confirm the presence of cancer and determine the stage of cancer. These may include –
Ultrasonography:
Abdominal ultrasound is technically adequate in 60% to 90% of patients and is noninvasive, safe, and inexpensive. Ultrasound can detect pancreatic masses as small as 2 cm, dilation of the pancreatic and bile ducts, hepatic metastases, and extrapancreatic spread. Intraoperative ultrasound facilitates surgical biopsy and may detect unsuspected liver metastases in 50% of patients.
CT:
is less operator dependent than ultrasound and is not limited by air-containing abdominal organs, as is ultrasound. CT is favored over ultrasound because of its superior ability to demonstrate retroperitoneal invasion and lymphadenopathy. A pancreatic tumor must be at least 2 cm in diameter to become visible. Dynamic CT 395 with continuous infusion of IV contrast (pancreas protocol) is the best test for assessing the size of the tumor and its extension. At least 20% of pancreatic tumors believed to be resectable may not be detectable by CT.
MRI:
has no demonstrated advantage over CT in the diagnosis and staging of pancreatic cancer.
Endoscopic retrograde cholangiopancreatography (ERCP):
is the mainstay in the differential diagnosis of the tumors of the pancreatobiliary junction, 85% of which originate in the pancreas (about 5% each in the distal common bile duct, ampulla, and duodenum). Ampullary and duodenal carcinomas can usually be visualized and biopsy performed with ERCP. The pancreatogram typically shows the pancreatic duct to be encased or obstructed by carcinoma in 97% of cases.
It may be difficult to distinguish between pancreatic cancer and chronic pancreatitis because both diseases share clinical and radiologic characteristics. Pancreatic duct stricture usually does not exceed 5 mm in chronic pancreatitis; strictures longer than 10 mm (especially if irregular) indicate pancreatic cancer. Cytologic examination of cells in samples of pancreatic juice obtained during ERCP with secretin stimulation has been reported to be highly specific for the diagnosis of carcinoma and 85% sensitive. Brush biopsy of the pancreatic stricture (when possible) increases the diagnostic yield.
Percutaneous fine needle aspiration cytology:
is safe and reliable, with a reported sensitivity of 55% to 95% and no false-positive results for the diagnosis of pancreatic cancer. This procedure should be performed for histologic confirmation on all patients with unresectable or metastatic disease unless a palliative surgical procedure is planned. Needle aspiration cytology distinguishes adenocarcinoma from islet cell tumors, lymphomas, and cystic neoplasms of the pancreas, permitting therapy to be tailored to the specific diagnosis in each case.
The drawbacks to percutaneous aspiration biopsy include potential tumor seeding along the needle tract, potential to enhance intraperitoneal spread, and negative biopsy results that do not exclude the diagnosis of malignancy. Furthermore, the diagnosis of early and smaller tumors is most likely to be missed by this technique.
Laparoscopy:
This is a surgical procedure in which a small incision is made in the abdomen and a camera is inserted to look for signs of cancer. It can demonstrate extrapancreatic involvement in 40% of patients without demonstrable lesions on CT.
Preventions and Treatments for Pancreatic Cancer
Preventions to be considered are as follows
Pancreatic cancer prevention is challenging, as there is no guaranteed way to prevent the disease. However, some steps may help reduce your risk –
- Quit smoking: Smoking is a significant risk factor for pancreatic cancer. Quitting smoking or avoiding tobacco products altogether can help reduce your risk.
- Manage diabetes: If you have diabetes, work with your doctor to manage your blood sugar levels. High blood sugar levels over time can increase your risk of developing pancreatic cancer.
- Eat a balanced diet: Eating a diet rich in fruits, vegetables, and whole grains may help reduce your risk of pancreatic cancer. Avoiding processed and red meat, and limiting your intake of saturated fats, may also be helpful.
- Limit alcohol consumption: Heavy alcohol consumption has been linked to an increased risk of pancreatic cancer. It is advisable to stop the consumption of alcohol for health benefits.
- Exercise regularly: Regular physical activity may help lower your risk of many types of cancer, including pancreatic cancer.
- Get screened: If you have a family history of pancreatic cancer or genetic mutations associated with the disease, your doctor may recommend screening tests to check for early signs of the disease.
Treatments required for Pancreatic Cancer
The treatment options for pancreatic cancer depend on several factors, including the stage and location of cancer, as well as the overall health of the patient. Here are some common treatments used for pancreatic cancer –
Only 5% to 20% of patients with pancreatic cancer have resectable tumors at the time of presentation.
Surgical procedures are as follws:
- Pancreaticoduodenal resection (Whipple procedure or a modification) is the standard operation. This implies that only cancer involving the head of the pancreas is resectable
- A pylorus-preserving variation of Whipple procedure is a commonly used operation in the United States, in part because it has resulted in a significant reduction of postgastrectomy syndrome with no decrease in survival.
- An extended Whipple procedure, with a more extensive lymph node dissection, is used commonly in Japan but has not been widely accepted in the United States because of higher morbidity and lack of data from randomized trials to suggest that the procedure results in better survival.
- Regional pancreatectomy confers no survival advantage over conventional Whipple procedure.
- Total pancreatectomy produces exocrine insufficiency and brittle diabetes mellitus and should be performed only when necessary to achieve clear surgical margins.
External-beam radiation therapy is the type of radiation therapy used most often for pancreatic cancer. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period. There are different ways that radiation therapy can be given:
- Traditional radiation therapy: This is also called conventional or standard fraction radiation therapy. It is made up of daily treatments of lower doses of radiation per fraction or day.
- Stereotactic body radiation (SBRT) or cyberknife: These are shorter treatments of higher doses of radiation therapy given over as few as 5 days. This is a newer type of radiation therapy that can provide more localized treatment in fewer treatment sessions.
- Proton beam therapy: This is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells. This type of therapy also lessens the amount of healthy tissue that receives radiation.
Prior trials assessing the potential benefit of adjuvant chemotherapy have shown mixed results. However, in a phase III trial, 368 patients were randomized to either observation alone or six cycles of gemcitabine following gross complete resection. Significant improvement was noted in DFS, but only a trend toward benefit in overall survival.
Immunotherapy works by boosting the immune system’s ability to fight cancer. It may be used in combination with chemotherapy or as a standalone treatment for advanced pancreatic cancer.
Immune checkpoint inhibitors, which include anti-PD-1 antibodies such as pembrolizumab (Keytruda) and dostarlimab (Jemperli), are an option for treating pancreatic cancers that have high microsatellite instability (MSI-H) or mismatch repair deficiency (dMMR). Approximately 1% to 1.5% of pancreatic cancers are associated with high MSI-H.
- Denvax Immunotherapy:
Denvax is a treatment known as cancer immunotherapy. It boosts the immune system to fight against cancer, mostly solid tumours. Denvax is targeted therapy and comes under the 4th modality of cancer treatment called cancer Immunotherapy.
Dendritic cells are cells of the immune system that help in the fight against cancer. Denvax treatment is customized dendritic cell-based cancer immunotherapy. Denvax shows the most promise at preventing a recurrence of cancer after surgery, chemotherapy or radiation because the immune system will need to recognize and attack a smaller number of cancer cells.
References:
- Manual of Clinical Oncology by Bartosz Chmeilowski and Mary Territo
- cancer.net
What are Pancreas?
The pancreas is a glandular organ located in the abdomen, behind the stomach. It plays a crucial role in digestion and the regulation of blood sugar levels. The pancreas has two main functions –
- Exocrine function: The pancreas secretes digestive enzymes and bicarbonate into the small intestine to help break down and absorb nutrients from food.
- Endocrine function: The pancreas also secretes hormones, such as insulin and glucagon, directly into the bloodstream to regulate blood sugar levels. Insulin helps lower blood sugar levels, while glucagon helps raise them.
The pancreas is a vital organ in the body and any dysfunction or disease of the pancreas can lead to serious health problems, such as diabetes, pancreatitis, and pancreatic cancer.
What is Pancreatic Cancer?
Pancreatic cancer is a disease in which healthy cells in the pancreas stop working correctly and grow out of control. These cancerous cells can build up and form a mass called a tumour. A cancerous tumour is malignant, meaning it can grow and spread to other parts of the body. As it grows, a pancreatic tumour can affect the function of the pancreas, grow into nearby blood vessels and organs, and eventually spread to other parts of the body through a process called metastasis.
Types of Pancreatic Cancer
Pancreatic cancer can be classified into several types based on the type of cell where cancer originates. The main types of pancreatic cancer are –
1. Exocrine Pancreatic Cancer
This type of pancreatic cancer includes –
- Adenocarcinoma: This is the most common type of pancreatic cancer, accounting for about 90% of all cases. It originates in the cells that line the ducts of the pancreas.
- Acinar cell carcinoma: This is a rare type of pancreatic cancer that originates in the cells that produce digestive enzymes in the pancreas.
- Adenosquamous carcinoma: This is a rare type of pancreatic cancer that contains both glandular (adenocarcinoma) and squamous (squamous cell carcinoma) cell components. Adenosquamous carcinoma is an aggressive form of pancreatic cancer that is often diagnosed at an advanced stage.
- Squamous cell carcinoma: This is a rare and aggressive type of pancreatic cancer that originates in the cells that line the ducts of the pancreas.
- Colloid carcinoma: This is a rare subtype of pancreatic cancer which accounts for 1-3 per cent of exocrine cancer. It is characterized by the presence of large amounts of mucin, a jelly-like substance, within the tumour cells. This mucin production gives the tumour a gelatinous or colloid-like appearance under the microscope.
2. Endocrine Pancreatic Cancer
This type of pancreatic cancer is also known as neuroendocrine tumour (NET). Neuroendocrine tumours (NETs) can develop in various organs throughout the body, including the pancreas. Pancreatic NETs are a rare type of pancreatic tumour that arises from the hormone-producing cells in the pancreas.
Pancreatic NETs can be classified into two main types based on their size and the hormones they produce: functioning and non-functioning tumours. Functioning tumours produce hormones that cause specific symptoms, while non-functioning tumours do not produce hormones and may not cause any symptoms until they grow large enough to press on surrounding tissues or organs.
The treatment and prognosis for each type of pancreatic cancer can vary widely. Therefore, an accurate diagnosis is essential to determine the most appropriate treatment plan for an individual patient.
Risk Factors of Pancreatic Cancer
The exact cause of thyroid cancer is not known, but there are several factors that may increase a person’s risk of developing the disease. Some of these risk factors include –
Cigarette smoking
is a consistently noted risk factor for pancreatic cancer, with a relative risk of at least 1.5. The risk increases with increasing duration and amount of cigarette smoking. The risk is ascribed to tobacco-specific nitrosamines.
Diet
A high intake of fat, meat, or both is associated with increased risk, whereas the intake of fresh fruits and vegetables appears to have a protective effect.
Partial gastrectomy
Partial gastrectomy appears to correlate with a 2 to 5 times higher than expected incidence of pancreatic cancer 15 to 20 years later. The increased formation of N-nitroso compounds by bacteria that produce nitrate reductase and proliferate in the hypoacidic stomach has been proposed to account for the increased occurrence of gastric and pancreatic cancer after partial gastrectomy.
Cholecystokinin
Cholecystokinin is the primary hormone that causes growth of exocrine pancreatic cells; others include epidermal growth factor 392 and insulin-like growth factors. Pancreatic cancer has been induced experimentally by long-term duodenogastric reflux, which is associated with increased cholecystokinin levels. Some clinical evidence suggests that cholecystectomy, which also increases the circulating cholecystokinin, may increase the risk for pancreatic cancer.
Chronic and hereditary pancreatitis
Chronic and hereditary pancreatitis is associated with pancreatic cancer. Chronic pancreatitis is associated with a 15-fold increase in the risk for pancreatic cancer.
Diabetes mellitus
This maybe an early manifestation of pancreatic cancer or a predisposing factor. It is found in 13% of patients with pancreatic cancer and in only 2% of controls. Diabetes mellitus that occurs in patients with pancreatic cancer may be characterized by marked insulin resistance, which moderates after tumor resection. Islet amyloid polypeptide, a hormonal factor secreted by pancreatic B cells, reduces insulin sensitivity in vivo and glycogen synthesis in vitro and may be present in elevated concentrations in patients with pancreatic cancer who have diabetes.
Having one or more of these risk factors does not necessarily mean that an individual will develop pancreatic cancer. However, it’s important to be aware of these risk factors and to speak with a healthcare professional about ways to reduce the risk of developing pancreatic cancer.
Symptoms of Pancreatic Cancer
Pancreatic cancer often does not cause symptoms in its early stages, and by the time symptoms appear, cancer may have already spread to other parts of the body. However, some of the common symptoms of pancreatic cancer include –
- Abdominal pain
- Anorexia
- Weight loss
- Early satiety
- Xerostomia and sleep problems
- Jaundice
- Easy fatigability
- Weakness, nausea, or constipation
It’s important to note that these symptoms can also be caused by other conditions, and having one or more of these symptoms does not necessarily mean that an individual has pancreatic cancer. However, if these symptoms persist or worsen over time, it’s important to speak with a healthcare professional. Early detection of pancreatic cancer can improve the chances of successful treatment.
Diagnoses of Pancreatic Cancer
The diagnosis of pancreatic cancer typically involves several tests and procedures to confirm the presence of cancer and determine the stage of cancer. These may include –
Ultrasonography:
Abdominal ultrasound is technically adequate in 60% to 90% of patients and is noninvasive, safe, and inexpensive. Ultrasound can detect pancreatic masses as small as 2 cm, dilation of the pancreatic and bile ducts, hepatic metastases, and extrapancreatic spread. Intraoperative ultrasound facilitates surgical biopsy and may detect unsuspected liver metastases in 50% of patients.
CT:
is less operator dependent than ultrasound and is not limited by air-containing abdominal organs, as is ultrasound. CT is favored over ultrasound because of its superior ability to demonstrate retroperitoneal invasion and lymphadenopathy. A pancreatic tumor must be at least 2 cm in diameter to become visible. Dynamic CT 395 with continuous infusion of IV contrast (pancreas protocol) is the best test for assessing the size of the tumor and its extension. At least 20% of pancreatic tumors believed to be resectable may not be detectable by CT.
MRI:
has no demonstrated advantage over CT in the diagnosis and staging of pancreatic cancer.
Endoscopic retrograde cholangiopancreatography (ERCP):
is the mainstay in the differential diagnosis of the tumors of the pancreatobiliary junction, 85% of which originate in the pancreas (about 5% each in the distal common bile duct, ampulla, and duodenum). Ampullary and duodenal carcinomas can usually be visualized and biopsy performed with ERCP. The pancreatogram typically shows the pancreatic duct to be encased or obstructed by carcinoma in 97% of cases.
It may be difficult to distinguish between pancreatic cancer and chronic pancreatitis because both diseases share clinical and radiologic characteristics. Pancreatic duct stricture usually does not exceed 5 mm in chronic pancreatitis; strictures longer than 10 mm (especially if irregular) indicate pancreatic cancer. Cytologic examination of cells in samples of pancreatic juice obtained during ERCP with secretin stimulation has been reported to be highly specific for the diagnosis of carcinoma and 85% sensitive. Brush biopsy of the pancreatic stricture (when possible) increases the diagnostic yield.
Percutaneous fine needle aspiration cytology:
is safe and reliable, with a reported sensitivity of 55% to 95% and no false-positive results for the diagnosis of pancreatic cancer. This procedure should be performed for histologic confirmation on all patients with unresectable or metastatic disease unless a palliative surgical procedure is planned. Needle aspiration cytology distinguishes adenocarcinoma from islet cell tumors, lymphomas, and cystic neoplasms of the pancreas, permitting therapy to be tailored to the specific diagnosis in each case.
The drawbacks to percutaneous aspiration biopsy include potential tumor seeding along the needle tract, potential to enhance intraperitoneal spread, and negative biopsy results that do not exclude the diagnosis of malignancy. Furthermore, the diagnosis of early and smaller tumors is most likely to be missed by this technique.
Laparoscopy:
This is a surgical procedure in which a small incision is made in the abdomen and a camera is inserted to look for signs of cancer. It can demonstrate extrapancreatic involvement in 40% of patients without demonstrable lesions on CT.
Preventions and Treatments for Pancreatic Cancer
Preventions to be considered are as follows
Pancreatic cancer prevention is challenging, as there is no guaranteed way to prevent the disease. However, some steps may help reduce your risk –
- Quit smoking: Smoking is a significant risk factor for pancreatic cancer. Quitting smoking or avoiding tobacco products altogether can help reduce your risk.
- Manage diabetes: If you have diabetes, work with your doctor to manage your blood sugar levels. High blood sugar levels over time can increase your risk of developing pancreatic cancer.
- Eat a balanced diet: Eating a diet rich in fruits, vegetables, and whole grains may help reduce your risk of pancreatic cancer. Avoiding processed and red meat, and limiting your intake of saturated fats, may also be helpful.
- Limit alcohol consumption: Heavy alcohol consumption has been linked to an increased risk of pancreatic cancer. It is advisable to stop the consumption of alcohol for health benefits.
- Exercise regularly: Regular physical activity may help lower your risk of many types of cancer, including pancreatic cancer.
- Get screened: If you have a family history of pancreatic cancer or genetic mutations associated with the disease, your doctor may recommend screening tests to check for early signs of the disease.
Treatments required for Pancreatic Cancer
The treatment options for pancreatic cancer depend on several factors, including the stage and location of cancer, as well as the overall health of the patient. Here are some common treatments used for pancreatic cancer –
Only 5% to 20% of patients with pancreatic cancer have resectable tumors at the time of presentation.
Surgical procedures are as follws:
- Pancreaticoduodenal resection (Whipple procedure or a modification) is the standard operation. This implies that only cancer involving the head of the pancreas is resectable
- A pylorus-preserving variation of Whipple procedure is a commonly used operation in the United States, in part because it has resulted in a significant reduction of postgastrectomy syndrome with no decrease in survival.
- An extended Whipple procedure, with a more extensive lymph node dissection, is used commonly in Japan but has not been widely accepted in the United States because of higher morbidity and lack of data from randomized trials to suggest that the procedure results in better survival.
- Regional pancreatectomy confers no survival advantage over conventional Whipple procedure.
- Total pancreatectomy produces exocrine insufficiency and brittle diabetes mellitus and should be performed only when necessary to achieve clear surgical margins.
External-beam radiation therapy is the type of radiation therapy used most often for pancreatic cancer. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period. There are different ways that radiation therapy can be given:
- Traditional radiation therapy: This is also called conventional or standard fraction radiation therapy. It is made up of daily treatments of lower doses of radiation per fraction or day.
- Stereotactic body radiation (SBRT) or cyberknife: These are shorter treatments of higher doses of radiation therapy given over as few as 5 days. This is a newer type of radiation therapy that can provide more localized treatment in fewer treatment sessions.
- Proton beam therapy: This is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells. This type of therapy also lessens the amount of healthy tissue that receives radiation.
Prior trials assessing the potential benefit of adjuvant chemotherapy have shown mixed results. However, in a phase III trial, 368 patients were randomized to either observation alone or six cycles of gemcitabine following gross complete resection. Significant improvement was noted in DFS, but only a trend toward benefit in overall survival.
Immunotherapy works by boosting the immune system’s ability to fight cancer. It may be used in combination with chemotherapy or as a standalone treatment for advanced pancreatic cancer.
Immune checkpoint inhibitors, which include anti-PD-1 antibodies such as pembrolizumab (Keytruda) and dostarlimab (Jemperli), are an option for treating pancreatic cancers that have high microsatellite instability (MSI-H) or mismatch repair deficiency (dMMR). Approximately 1% to 1.5% of pancreatic cancers are associated with high MSI-H.
- Denvax Immunotherapy:
Denvax is a treatment known as cancer immunotherapy. It boosts the immune system to fight against cancer, mostly solid tumours. Denvax is targeted therapy and comes under the 4th modality of cancer treatment called cancer Immunotherapy.
Dendritic cells are cells of the immune system that help in the fight against cancer. Denvax treatment is customized dendritic cell-based cancer immunotherapy. Denvax shows the most promise at preventing a recurrence of cancer after surgery, chemotherapy or radiation because the immune system will need to recognize and attack a smaller number of cancer cells.
References:
- Manual of Clinical Oncology by Bartosz Chmeilowski and Mary Territo
- cancer.net
