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  • Q&A with Australian Health Practitioners

    What is the treatment for pancreatic cancer?

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    Mr Dean Spilias

    Upper GI Surgeon (Abdominal)

    Dean graduated from the University of Melbourne in 1997 and went on to surgical training at the Royal Melbourne Hospital. During his residency he had … View Profile

    The treatment of pancreatic cancer requires a team approach to maximise the chances of a good outcome. 

    The first step is staging of the cancer, using a number of tests to determine the tissue type of the cancer and how advanced the cancer is. The staging tests usually consist of 

    1. Blood tests, which may include tumour markers and hormone levels;
    2. CT scanning (“CAT scan”)
    3. Endoscopic ultrasound - a test similar to a gastroscopy, performed under sedation or a light anaesthetic, where a flexible telescope is passed down the mouth to ultrasound and biopsy the pancreas.  

    If the staging investigations show no spread of cancer outside the pancreas, and if the blood vessels around the pancreas are not affected by the cancer, then an operation to remove the cancerous part of the pancreas is often the best option. 

    When the cancer involves the “head” of the pancreas, the operation performed is a Whipple's procedure, or pancreaticoduodenectomy. The operation usually removes about half of the pancreas, along with the part of the intestine the pancreas is surrounded by (the duodenum) and the gall bladder and bile ducts. Both the removal of the cancer and the reconstruction (rejoining) of the organs require meticulous surgery and the operation is often performed by a two-surgeon team. 

    When the “tail” of the pancreas is affected surgical removal is often more straightforward and can often be performed laparoscopically (keyhole surgery). The spleen is often removed along with the tail of the pancreas, in order to decrease the chance of leaving any cancer cells around the blood vessels that join the spleen and the pancreas. 

    Chemotherapy can decrease the chance of an early recurrence of pancreatic cancer and is often offered after surgery. Clinical trials of different chemotherapy options may be available for consideration. 

    Radiotherapy is sometimes used when there is a risk of cancer cells having been left behind after surgery, for example if the cancer is large or invading the fat around the pancreas.

    Cancer Council Australia's resource page on pancreatic cancer is here: http://www.cancer.org.au/about-cancer/types-of-cancer/pancreatic-cancer.html

    Dean Spilias
    http://www.uppergi.net

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