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Pancreatic Cancer Treatment

pancreatic cancerIdeal objective for the treatment of exocrine pancreatic cancer has two components:

– Oncologic – tumor disappearance and the absence of recurrence and / or metastasis after 5 years of treatment with radical intent;

– Functional – solving complications caused by expansive tumor in evolution: biliary retention, pancreatic retention, duodenal stenosis.

This can be fully realized only surgical with wide excision of the segment that contains the pancreatic tumor (or sometimes entirely pancreas) and locoregional lymph stations, according to the general principles of oncologic surgery.

In most statistics, at the time when a surgical indication is established the proportion of cases with resectable tumors is between 10 and 20%. After the surgery the surviving rate is about 4% at 5 years. Recent statistics highlight improve of these parameters, especially for intraductal papillary tumors with mucus secretion.

Palliative – the only achievable goal for most patients.

Evolution (relatively) is long without significant clinical manifestations. When the diagnosis is established the indication for surgery with the intention to exterminate is usually impossible. This situation can be caused by:

a. The advanced local evolution of the tumor with invasion of surrounding structures (especially large vessels);

b. Advanced evolution through lymphatic dissemination with regional and / or distant neoplastic lymph nodes, or metastatic dissemination (liver, peritoneum, extra-abdominal);

c. advanced age and associated diseases (biologically status does not allow a laborious and lengthy surgical intervention).

In these conditions, the fundamental component, oncology, of the ideal objective is impossible to realise. Therefore, treatment aims only improvement of the patient’s condition by solving the complications caused by expansive tumor evolution:

• biliary retention;
• pancreatic retention;
• duodenal stenosis;
Pancreatic pain syndrome.

Palliative objective can be performed surgically (conventional or laparoscopic) or by imaging and / or endoscopic intervention.

Symptomatic treatment usually analgesic, is the only tentative to relief patient suffering when local and regional evolution and lymph nodes invasion or metastatic dissemination makes any gesture impossible or ineffective palliative and life expectancy is minimal.

Therapeutic means that can be put into practice to achieve therapeutic goals in relation to the particular situation of each patient are:

• open or laparoscopic surgery;
• interventional endoscopy;
• interventional imaging;
• Chemotherapy;
• radiotherapy;
• immunotherapy;
• hormone therapy.

These can be used alone, associated or in complex therapeutic protocols as needed.

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