Pancreatic cancer is a malignant tumor arising from the exocrine or endocrine pancreas cells. Depending on the localization and origin, pancreatic cancer reveals itself with various symptoms, including abdominal or back pain, jaundice, dyspepsia, and weight loss. The tumor does not cause any symptoms for a while, thus only 10% of patients are diagnosed at the early disease stage.
One should pay attention to the preventive examination in presence of risk factors, including family history of pancreatic cancer, hepatitis B infection, H. pylori infection, liver cirrhosis, chronic pancreatitis, exposure to benzene and pesticides, obesity.
Diagnosed early, pancreatic cancer is the potentially curable condition. Over 34% of patients demonstrate the 5-year survival rate. Advances in the sphere of oncology offer innovative options, like performing surgeries without skin incisions (stereotactic radiosurgery) and taking drugs that affect only the tumor (targeted therapy).
Stages of pancreatic cancer
Stage of the pancreatic cancer is a short and precise description of the tumor localization and the extent of its spreading. Determining the exact stage is possible after performing a number of the diagnostic tests, including the CT or PET-CT scan, biopsy and the molecular testing (only in well-equipped hospitals). The most common and understandable way of the pancreatic neoplasms classification divides all of them into 4 types:
- Resectable, which can be totally removed surgically.
- Borderline resectable, which can be totally removed surgically only after preliminary chemo- or radiation therapy (i.e. after the tumor shrinking).
- Locally advanced, which affect the nearby organs or blood vessels. The same time, the distant metastases are absent.
- Metastatic, which have spread to other organs and body parts.
The TNM staging system is another unified classification of all cancer types. TNM stages combine three components:
- T reflects the tumor size and localization.
- N reflects the state of lymphatic nodes.
- M reflects presence or absence of distant metastases.
Recurrent cancer (i.e. cancer that came back after the curative treatment) is classified as the separate disease form.
Types of treatment
Precise stage determining is a basis for choosing the most effective and safe treatment option. Basic types of treating malignant tumors of the pancreas are the following:
- Surgical treatment includes removing the whole pancreas or its part. Extent of the surgery depends on the size and localization of the tumor. This option is suitable for about 20% of patients, who do not have metastases at the moment of diagnosis confirmation.
- Chemotherapy includes use of drugs that destroy malignant cells. It may be the first-line treatment option for patients with metastatic or locally advanced cancer. Few chemotherapy cycles may also be recommended to consolidate the result of surgical treatment.
- Radiation therapy is using of high-energy rays or particles (e.g. protons, X-rays) for the tumor destruction. The external-beam radiotherapy includes the proton and conventional therapy. They differ in volume of the affected healthy tissues, number and duration of the procedures. Another radiotherapy type is the stereotactic radiation (known as Cyberknife). Cyberknife works similarly to the surgery, except for avoiding skin incision and the surrounding tissues damage. Directed by Cyberknife, beams are focused precisely on the tumor, physically destroying it.
- Targeted therapy is a type of drug therapy. Targeted drugs are able to recognize the tumor and affect only it, not killing the healthy tissues. This treatment mode has fewer side effects compared to the conventional chemotherapy.
- Taking part in the clinical trials is a unique opportunity to receive the innovative cancer therapy for free. Clinical trials are mainly held in the large specialized European hospitals. The investigators select patients with specific cancer stage, histological type of the tumor, etc.
Each treatment program is followed by the general therapeutic or oncological rehabilitation. Rehabilitation improves the general health condition and facilitates returning to the usual everyday life.
Treatment of pancreatic cancer in different age groups
Patient’s age and the general health condition are always taken into account when choosing the most beneficial treatment option. Pancreatic cancer is mainly diagnosed in people over 45 years old, and 70% of these patients are over 65 years old. The disease is virtually not diagnosed in young people.
The middle or elderly age is not the limiting factor in performing any type of treatment. Nevertheless, the concomitant pathologies can pose additional risks and require more careful treatment selection. For instance, surgical interventions may be contraindicated in patients with heart diseases (like stenocardia or myocardial infarction). Chemotherapy can be poor tolerated by patients with liver and kidneys pathology (like renal failure or acute hepatitis).
If risks of the active treatment significantly overweigh its possible benefits, then the person receives symptomatic or palliative therapy. This therapy mode is aimed at symptoms alleviation, improving the general state without tumor destruction or preventing the disease progression. Alternative therapy is another possible option. This includes acupuncture, diet, physical therapy, etc.
Cost of treatment in the specialized hospitals
Choosing pancreatic cancer treatment abroad, it will be useful to consider the approximate prices. Basically, treatment in the leading world’s hospitals is more expensive compared to one in the developing countries. Medical insurance, e.g. European Health Insurance Card (EHIC), may cover a part of expenses, but you should clarify this question with your insurance provider in advance. Approximate costs for the medical services in the specialized pancreatic cancer therapy centers are listed below:
- Diagnostic tests with elaboration of the individual treatment plan – from 2,350 €.
- Endoscopic retrograde cholangiopancreatography and biopsy under CT control – from 7,700 €.
- Surgical treatment with Whipple procedure (pancreaticoduodenectomy) – from 23,900 €.
- Surgical treatment with segmental pancreas resection – from 23,900 €.
- Chemotherapy – from 5,200 €.
- Chemotherapy and radiation therapy – from 19,600 €.
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