Pancreatic and Biliary Cancer Program

Pancreatic Cancer

Pancreatic cancer impacts the digestive system and starts when cells in the pancreas grow without the normal controls. These cancers are typically divided into two subtypes:

• Exocrine tumors are by far the most common type of pancreatic cancer and about 95% of them are adenocarcinomas. These cancers begin in the ducts of the pancreas and interfere with normal digestion.
• Endocrine tumors develop in the hormone-producing, or endocrine, cells of the pancreas. These are far less common and can have a more favorable prognosis.

Biliary Cancer

These relatively rare cancers involve the gall bladder or the ducts that carry bile from the liver to the intestines. They are located very close to the pancreas and are often treated like pancreatic cancer. However, we’ve learned more about these cancer in the last several years and now see several genetic distinctions from cancer of the pancreas and use targeted therapies for them.

Symptoms

Pancreatic cancer is difficult to detect early. When symptoms appear, they can be vague and hard to notice as they could also be caused by other problems that are more common than pancreatic cancer. Some people notice the following symptoms as pancreatic cancer evolves:

• Jaundice – yellowing of the skin and whites of the eyes
• Pain developing in upper abdomen and back
• Weight loss
• Loss of appetite
• Digestive problems including changes in bowel habits, pain after eating, or bloating

Screenings

For some cancers, routine screenings help to detect the disease early. For people who have an average risk of pancreatic cancer, there is currently no routine screening test recommended to detect pancreatic cancer. Screening is recommended for anyone with a high risk, including those ages 40 or older with two or more first-degree relatives with pancreatic cancer along with having inherited genes that increase the risk of pancreatic cancer. Screening is also offered to those with three or more family members with pancreatic cancer, even without a documented genetic alteration.

Diagnosis

In addition to completing a comprehensive physical examination and lab work, our physicians may utilize any of the following diagnostic procedures to identify pancreatic and biliary cancers:

Ultrasound
Ultrasound uses sound waves to create detailed images of the organs in your abdomen. During this test, the technician will place an ultrasound device on your abdomen to capture the images.

CT Scan
Computed tomography (CT) uses a series of X-ray images and computer processing to create cross-sectional images of the bones, blood vessels and soft tissue in your body. CT scans are much more detailed than general X-rays. During the test, you lie on a table that moves into a circular-shaped scanner.

MRI
Magnetic resonance imaging (MRI) uses magnetic field and computer-generated radio waves to create detailed images of organs and tissues in your body. During the test, you lie on a table that moves into a long narrow tube-shaped scanner.

Endoscopic Ultrasound
Endoscopic ultrasound is used to examine the gastrointestinal tract and nearby organs, including the liver and pancreas. During this procedure, a long flexible tube with an ultrasound probe on the end is passed through the mouth and into the stomach and small intestine. If abnormalities are detected, the doctor may collect a sample of tissue for a biopsy. Endoscopic ultrasound requires sedation.

PET Scan
Positron emission tomography (PET) uses nuclear imaging technology to measure blood flow, oxygen use, and metabolism to evaluate how organs and tissues are functioning. Prior to the test, a radioactive drug (tracer) will be injected into your arm or hand to show your metabolic activity. During this test, you will lie on a table that slides into a circular-shaped scanner, similar to a CT scan.

Endoscopic Retrograde Cholangiopancreatography (ERCP)
ERCP is a procedure to diagnose and treat problems in the pancreas, liver, gallbladder and bile ducts. It combines x-ray and the use of an endoscope. During this procedure, your provider will pass a long flexible, lighted tube through your mouth, throat, esophagus, stomach and small intestine to view the inside of these organs. Next, they will pass a tube through the scope and inject a dye that highlights the organs on x-ray. This procedure is used to help diagnose cancer and even start the drainage of bile that is blocked by the pancreatic cancer.

Biopsy
A biopsy removes a sample of pancreatic tissue for examination under a microscope to determine whether or not it is cancerous, and if so, what kind of pancreatic cancer. There are different kinds of biopsies including fine needle aspiration biopsy, brush biopsy and laparoscopy. After verifying the diagnosis, we’ll do additional testing on the biopsy, more specifically, on the proteins and on the genetic mutations.

Staging
Once pancreatic or biliary cancer is diagnosed, your physicians will use imaging techniques to clarify the extent of the cancer and determine the stage. The type of pancreatic cancer and the stage of pancreatic cancer help your doctor determine the most effective treatment plan for your condition.

Treatment

Treatment for patient with pancreatic or biliary cancer may include surgery, chemotherapy, radiation therapy or a combination of these.

Surgery
Depending on size and location of the tumor, your doctor may recommend surgery, such as the Whipple procedure to remove the tumor. Our fellowship-trained surgical oncologist performs all manner of pancreatic resection, including the Whipple procedure, and those requiring vascular resection and reconstruction. Some patients can even be offered minimally invasive, robotic surgery for pancreatic tumors. Our center qualifies as a high-volume Pancreatic Surgery Program based on the Leapfrog Groups guidelines.

Chemotherapy
Our Medical Oncology department delivers chemotherapy, targeted therapies, immunotherapy and supportive treatments for cancer patients. Chemotherapy may be used as part of a treatment plan to shrink pancreatic tumors before surgery, or used after surgery to help prevent recurrence. We’ve learned that even advanced pancreatic and biliary cancers can be treated with chemotherapy and targeted therapies, often with impressive results. Our medical oncologists are all board certified in oncology and come from some of the most prestigious training programs in the country.

Radiation Therapy
As the premier provider of Radiation Oncology in Santa Barbara County, Ridley-Tree Cancer Center provides the latest radiation therapy treatments available. In pancreatic cancer, radiation may be used before surgery to shrink the tumor, or after surgery to help prevent recurrence. Radiation treatment is prescribed by our radiation oncologists who are all board certified and have received extensive training to ensure precise treatment outcomes.

Clinical Trials
For some people with pancreatic cancer, a clinical trial might be the best treatment option available. A clinical trial is a research study in which patients participate to help determine the effectiveness of a new medical treatment, procedure or technology. Those who participate in clinical trials are often the first people to access new therapies that are not yet readily available.

Ridley-Tree Cancer Center offers clinical trials through our partnerships with US Oncology Research Network, Tempus, NRG Oncology Network and leading pharmaceutical and biotech companies. Our medical and radiation oncologists together with the Clinical Research Department review records and identify those who may benefit from the promising new therapies offered in clinical trials.

We have many clinical trials for cancers of the gastrointestinal tract and several in pancreatic and biliary cancers.  We are frequently opening new trials and the list of open trials changes frequently. To review the most updated list of clinical trials available at Ridley-Tree Cancer Center, please visit our Clinical Trials online search tool.

Palliative Care
Palliative care is designed to relieve suffering and improve the quality of your life by treating physical and emotional symptoms caused by your cancer or its treatment. Palliative care may be provided at any time during a person’s illness, even from the time of diagnosis. Surprising many, palliative care can even be given along with curative treatments.