Stage II Pancreatic Cancer

Overview

A pancreatic cancer is considered to be Stage II if, following surgical removal of cancer in the pancreas, the final pathology report shows that the cancer has only spread locally. This means the cancer may extend to the duodenum, bile ducts, or fat surrounding the pancreas, but does not invade any local lymph nodes and cannot be detected in other locations in the body. Most early pancreatic cancers can be removed by surgery. Unfortunately, early pancreatic cancer only accounts for a minority of newly diagnosed cases.

Currently, Stage II adenocarcinoma of the pancreas is best managed by surgical removal of the cancer. Depending on the features of the cancer, approximately 10-35% of patients will be alive and without evidence of cancer five years after surgery. The most common surgical procedure is a pancreaticoduodenectomy, or Whipple procedure, which involves removal of a portion of the pancreas, small intestine (duodenum), stomach, and the entire gallbladder. The exact surgical procedure may differ based on the location and extent of the cancer within the pancreas. To learn more, go to Surgery for Pancreatic Cancer.

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Despite undergoing surgical removal of all visible cancer, approximately 60-70% of patients with Stage II pancreatic cancer will experience recurrence of their cancer. The cause of relapse following surgical removal of the caner is micrometastases, which are small amounts of cancer that have spread outside the pancreas and could not be removed by surgery. The majority of patients with Stage II disease have micrometastases that cannot be detected with currently available tests and cannot be removed with surgery. The presence of micrometastases causes the relapses that follow treatment with surgery alone.  In order to increase the chance of cure with surgery, an effective treatment is needed to cleanse the body of micrometastases.

The following is a general overview of treatment for Stage II pancreatic cancer. Treatment may consist of surgery, radiation, chemotherapy, biological therapy, or a combination of these treatment techniques. Multi-modality treatment is treatment using two or more techniques, and is increasingly recognized as an important approach for improving a patient’s chance of cure or prolonging survival. In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment. Circumstances unique to each patient’s situation may influence how these general treatment principles are applied and whether the patient decides to receive treatment. The potential benefits of multi-modality care, participation in a clinical trial, or standard treatment must be carefully balanced with the potential risks. The information on this Web site is intended to help educate patients about their treatment options and to facilitate a mutual or shared decision-making process with their treating cancer physician.

Systemic Therapy

Systemic therapy is treatment directed at destroying cancer cells throughout the body.  Many patients with Stage II pancreatic cancer already have small amounts of cancer that have spread outside the pancreas (micrometastases). An effective systemic treatment is needed to cleanse the body of micrometastases in order to improve a patient’s duration of survival and potential for cure. Systemic treatment administered after surgery is called adjuvant therapy and treatment before surgery is called neoadjuvant therapy. Currently, adjuvant therapy is the recommended systemic therapy for patients with Stage II pancreatic cancer; neoadjuvant therapy, however, is increasingly being evaluated.  Adjuvant therapy may include chemotherapy, radiation therapy, biologic therapy, or a combination of therapies.

Chemotherapy: Chemotherapy is any treatment involving the use of drugs to kill cancer cells.  Cancer chemotherapy may consist of single drugs or combinations of drugs and can be administered through a vein or delivered orally in the form of a pill.  Gemzar® (gemcitabine) is FDA-approved for the treatment of pancreatic cancer and is now considered the standard initial chemotherapy drug for early-stage and advanced disease. Gemzar has been shown to improve response to treatment, time to cancer progression, and survival duration when compared with the older chemotherapy drug 5-fluorouracil (5-FU).[1] In a clinical trial involving patients with advanced pancreatic cancer, patients who received Gemzar experienced a significant improvement in disease-related symptoms as well as prolonged survival compared with patients who received 5-FU.

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Radiation Therapy

Radiation therapy, or radiotherapy, uses high-energy rays to damage or kill cancer cells by preventing them from growing and dividing. Similar to surgery, radiation therapy is a local treatment used to eliminate or eradicate visible cancers. Radiation therapy is not typically useful in eradicating cancer cells that have already spread to other parts of the body. It is particularly effective as an adjuvant therapy (therapy given in addition to the primary treatment) to surgery by helping to eliminate any microscopic cancer cells leftover after surgery.  Clinical studies that have evaluated adjuvant radiation therapy have yielded conflicting results and there currently remains no consensus whether radiation should be used as adjuvant therapy or combined with chemotherapy for the treatment of pancreatic cancer, although it is offered to many patients.[2][3] Patients should clearly understand the risks and benefits of being treated with radiation and discuss them with their physician.

Strategies to Improve Treatment of Stage II Pancreatic Cancer

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References


[1] Burris HA III, Moore MJ, Andersen J, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: A randomized trial. J Clin Oncol 1997;15:2403-2413.

[2] Oettle H, Neuhaus P. Adjuvant therapy in pancreatic cancer: a critical appraisal. Drugs. 2007;67:2293-310.

[3] Hazard L, Tward JD, Szabo A, Shrieve DC. Radiation therapy is associated with improved survival in patients with pancreatic adenocarcinoma: results of a study from the Surveillance, Epidemiology, and End Results (SEER) registry data. Cancer. 2007;110:2191-201.

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