Dr. Michael Pishvaian discusses treatment options for localized pancreatic cancer, or pancreatic cancer that hasn’t yet spread to any other part of the body. Because of the placement of the pancreas within the abdomen, pancreatic tumors can make surgery difficult or impossible. Chemotherapy treatment can result in an inoperable tumor becoming operable, however, to determine if surgery will become part of a treatment plan requires the work of multiple specialists.
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Transcript:
If a patient is then diagnosed with a localized pancreatic cancer, one that hasn't spread to other parts of the body, we know that the reaction is to try and have that cancer cut out. But unfortunately, the pancreas sits in a very critical part of the abdomen and involves some very important blood vessels. Pancreatic tumors can very quickly wrap around those blood vessels, ultimately making surgery impossible, because the surgeon can't compromise those blood vessels. But at the same time, it's not worth the surgeon doing surgery and leaving any tumor behind. These are the kinds of tumors that we consider localized, sometimes localized and unresectable.

It's really important that your physician engage with a team that involves a specialized pancreatic cancer surgeon, as well as potentially a radiation oncologist and a good radiologist who knows how to read imaging for pancreatic cancer to try and decide whether the tumor is operable, or whether it's called borderline resectable, or whether it's called locally advanced unresectable, because it can be critical in deciding whether surgery will ultimately be part of the treatment plan.

Nevertheless, we know that the chemotherapy regimens that we use for these patients with localized disease are pretty consistent with what we use for patients with more advanced disease, such as FOLFIRINOX and gemcitabine nab-paclitaxel. The way that we give the chemotherapy is not tremendously different, just that we hope that the tumor can be rendered operable with giving chemotherapy.

I will caution that that does not happen very often, unfortunately. The reality is that patients with localized pancreatic cancer, more often than not, their tumors do not become rendered operable and ultimately decision is to just continue the chemotherapy until the cancer eventually starts to grow and spread.

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