Treatment of Stage III Pancreatic Cancer
Medically reviewed by Dr. C.H. Weaver M.D. 10/2018
Pancreatic cancer is referred to as Stage III cancer if the final pathology report shows that the cancer has spread to local lymph nodes and major blood vessels. A patient may be diagnosed with Stage III cancer following surgical removal of the pancreas and surrounding lymph nodes or after surgical sampling of the lymph nodes. Pancreatic cancer diagnosed at this stage is often difficult to cure. To help improve a patient’s outcome, a combination of anti-cancer drugs, radiation therapy or participation in a clinical trial is often recommended following surgery. If the cancer cannot be removed by surgery, a combination of anticancer drugs and/or radiation therapy may be given instead.
When complete surgical removal of the cancer is possible, Stage III pancreatic cancer is best managed by 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.
While up to 20% of patients survive without evidence of cancer five years after surgery, the majority of patients with Stage III pancreatic cancer will develop recurrence of their cancer after surgery. 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 III 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 III 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 is treatment directed at destroying cancer cells throughout the body. Many patients with Stage III 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.
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). 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 to patients who received 5-FU.
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. Patients should clearly understand the risks and benefits of being treated with radiation and discuss them with their physician.
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