USC TREATMENT PROTOCOL FOR PANCREATIC CANCER

pancreatic cancer: (i) home page (ii) staging (iii) treatment
(iv) surgical treatment (v) whipple operation (vi) palliation
(viii) USC treatment protocol (ix) genetics (x) questions for your doctor

Initial evaluation

If you desire to have your care at USC then we would evaluate you according to an established protocol at our institution based on our experience in many patients with pancreatic cancer. Your doctor at USC will obtain a detailed physical history and physical examination and will review any x-rays that may have been performed on you prior to your consultation at USC. It is important as part of your consultation that you obtain all prior your records and also collect your original x-rays, including all CT scans that have been performed on you.

What are the steps in the work up and treatment of the tumor in the pancreas at USC

The following questions are sequentially addressed when a patient is seen at USC with a pancreas mass

After the initial evaluation has been performed we will stage your tumor to determine whether the tumor is surgically removable. Click on this link for information on studies performed at USC for staging pancreatic cancer. Relationship of the tumor to the surrounding blood vessels is a critically important determination for evaluating whether the tumor is surgically removable.

Summary of initial evaluation

Initial visit: bring your outside records and all your CT X-rays
Additional studies that may be recommended: CT at USC, endoscopic ultrasound, CA19-9
Medical Evaluation: Depending on your age a medical clearance to determine your fitness for surgery will be important. We would request that all patients over the age of 70 years obtain a cardiac evaluation to rule out any heart disorders that may have an impact on surgical outcome.
Recommendations: If the patient is medically fit and if the tumor is surgically removable resectable then surgery will be recommended

Surgical treatment

Treatment of adenocarcinoma of the pancreas

Adenocarcinoma of the pancreas is an aggressive form of cancer. For this cancer complete removal of the cancer with an an envelope of normal tissue is surrounding the cancer is important. If complete removal is not possible then surgery should not be performed since the survival after surgery is not improved unless the cancer is completely removed.

At surgery it is important to exclude possible spread of the tumor, since in about 10 to 20% of patients spread of the cancer would have occurred in the abdomen when all the staging studies suggest that the disease is localized to the pancreas. We perform a diagnostic laparoscopic examination of the abdomen prior to open surgery in all cases where the suspected diagnosis is an adenocarcinoma of the pancreas. The diagnostic laparoscopy is performed to detect spread of the cancer and to avoid unnecessary surgical exploration. If the diagnostic laparoscopic examination suggests that there is no spread of the tumor then we will proceed to remove the tumor.

The type of operation for pancreatic cancer will depend on the location of the cancer.For cancer of the pancreatic head, a whipple operation is performed. For cancers of the body and tail of the pancreas, a distal pancreatectomy is performed.

Most patients require 4 to 6 weeks of recovery period after their surgery. Following recovery from the surgery your surgeon will arrange for you to see an oncologist who will evaluate you for chemotherapy and radiation therapy for your tumor.

Periampullary tumors

Cancer of the pancreas, ampullary cancer and bile duct cancer of the bottom end of the bile duct cancer present with similar signs and symptoms. The outcome the each of these tumors is different, for example compare to pancreatic cancer, patients with ampullary cancer can often undergo curative surgery, therefore distinguishing between these tumors is very important.

Other tumors of the pancreas

The majority of these tumors are benign (non cancerous), however even when cancer is found in these tumors, the five year survival rates are excellent and in the order of 40 to 80% depending on the tumor type. In view of the excellent outcome, complete surgical therapy is indicated for these tumors, and the part of the pancreas that is affected by the tumor is removed.

At USC our emphasis has been to preserve as much of the pancreas as possible when removing benign and precancerous tumors to minimize the consequences of removal of large amounts of the pancreas such as diabetes and malabsorption (inability to digest food).

Specialized pancreatic procedures that are performed only in few centers in the United States such as a pancreatic head resection where only the head of the pancreas is removed preserving the duodenum and the bile duct that would otherwise be removed in a Whipple operation, central pancreatectomy where only the central portion of the pancreas is removed for tumors in this location preserving the head and body and tail of the pancreas and laparoscopic procedures that emphasize minimal access surgical technique for more rapid recovery are offered to patients at USC with benign tumors of the pancreas.



Contact information: USC Center for Pancreatic and Biliary Diseases
1510 San Pablo Street, Los Angeles, CA
Phone:
1-855-724-7874 dde-mail:
PancreasDiseases@surgery.usc.edu
Programs: pancreatic cancer, pancreatitis, laparoscopic surgery, endocrine surgery,
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biliary surgery

This web site provides select information about pancreatic and biliary disorders and is updated twice monthly. This information is not intended as a substitute for professional medical consultation with your physician.It is important that you consult with your physician for detailed information about your medical condition and treatment.The center will make every effort to update the site, however, past performance is no guarantee of future medical outcomes.
Copyright © 2002 USC Center for pancreatic and biliary diseases. All rights reserved.