Treatment Option Overview
Note: Some citations in the text of this section are followed by a level of
evidence. The PDQ editorial boards use a formal ranking system to help the
reader judge the strength of evidence linked to the reported results of a
therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more
information.)
The survival rate of patients with any stage of pancreatic exocrine cancer is
poor. Clinical trials are appropriate alternatives for treatment of patients
with any stage of disease and should be considered prior to selecting
palliative approaches. To provide optimal palliation, determination of
resectability must be made. Staging studies for resectability include helical
computed tomographic scan, magnetic resonance imaging scan, and endoscopic
ultrasound. The introduction of minimally invasive techniques, such as
laparoscopy and laparoscopic ultrasound, may decrease the use of
laparotomy.[1,2] Surgical resection remains the primary modality when feasible
since, on occasion, resection can lead to long-term survival and provides
effective palliation.[3-5] [Level of evidence: 3iA] Frequently, malabsorption
due to exocrine insufficiency contributes to malnutrition. Attention to
pancreatic enzyme replacement can help alleviate this problem. (Refer to the
PDQ summary on Nutrition in Cancer Care for more information.) Celiac axis (and intrapleural)
nerve blocks can provide highly effective and long-lasting control of pain for
some patients.
The designations in PDQ that treatments are “standard” or “under clinical
evaluation” are not to be used as a basis for reimbursement determinations.
References
- John TG, Greig JD, Carter DC, et al.: Carcinoma of the pancreatic head and periampullary region. Tumor staging with laparoscopy and laparoscopic ultrasonography. Ann Surg 221 (2): 156-64, 1995.
[PUBMED Abstract]
- Minnard EA, Conlon KC, Hoos A, et al.: Laparoscopic ultrasound enhances standard laparoscopy in the staging of pancreatic cancer. Ann Surg 228 (2): 182-7, 1998.
[PUBMED Abstract]
- Yeo CJ, Cameron JL, Lillemoe KD, et al.: Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 patients. Ann Surg 221 (6): 721-31; discussion 731-3, 1995.
[PUBMED Abstract]
- Conlon KC, Klimstra DS, Brennan MF: Long-term survival after curative resection for pancreatic ductal adenocarcinoma. Clinicopathologic analysis of 5-year survivors. Ann Surg 223 (3): 273-9, 1996.
[PUBMED Abstract]
- Yeo CJ, Abrams RA, Grochow LB, et al.: Pancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative adjuvant chemoradiation improves survival. A prospective, single-institution experience. Ann Surg 225 (5): 621-33; discussion 633-6, 1997.
[PUBMED Abstract]
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