Diagnosis and Surgery
"Diagnosis" is what your healthcare team does to recognize whether or not you have pancreatic cancer, based on its outward signs, symptoms, and diagnostic tests. The diagnosis of pancreatic cancer is a multistep process that is required in order for you and your healthcare team to make decisions about treatment.
Diagnostic Tests
Your Healthcare Team
Treatment Options
Diagnostic Tests
The process begins with your healthcare team learning about your health history. They will also conduct a physical exam to check for any pancreatic cancer risk factors, along with questions about any pain you may be experiencing. Symptoms such as appetite, weight loss, tiredness, and others are checked.1
A thorough physical exam checks for any masses or fluid buildup in the abdomen. Skin and eyes are checked for jaundice (yellow color). Cancers that block the bile duct may also cause an enlarged gallbladder, which can sometimes be felt.1
Pancreatic cancer can also spread to the liver and lymph nodes and other locations. These areas are looked at carefully for swelling that might indicate that the cancer has spread there.1
Your healthcare team may then order one or more of the following diagnostic tests.
- CT and MRI scans
These tests are conducted by two different machines that show three-dimensional images of your body. Computerized tomography (also called "CT") and magnetic resonance imaging ("MRI") images, or "scans," produce highly detailed pictures that are like slices of your body. These can help determine the size, shape, and location of a cancerous tumor.1
- PET scans
A newer technology called "positron emission tomography" (also known by its initials, "PET") can make scans of your body that distinguish between normal cells and quickly growing cancer cells. These PET scans are often used as a follow-up to other tests to see if a tumor is "malignant" (cancerous) or "benign" (non-cancerous), or if the cancer has spread outside the lungs and into the chest cavity.1
- Endoscopic Retrograde Cholangiopancreatography (also called "ERCP")
A thin, lighted, flexible tube is passed into the small intestine. A small amount of dye is then injected helping to outline the bile duct and pancreatic duct in x-ray images that can show narrowing or blockage due to cancer. Some cells are removed and viewed under a microscope to check for cancer.1
- Angiography
A small amount of contrast material is injected into an artery to outline the blood vessels, and x-rays are taken. Angiography can show whether blood flow in a particular area is blocked or compressed by a tumor and can show any abnormal blood vessels in the area. The test can also find out if any cancer may have grown through the walls of blood vessels.1
- Blood tests
Measures levels of different kinds of bilirubin (a chemical made by the liver) to determine whether a patient's jaundice is due to liver disease or to a blockage possibly caused by cancer. High levels of these "tumor marker" chemicals may also suggest cancer. Additional blood tests can help determine a patient's ability to undergo surgery.1
- Biopsy
A biopsy is the examination of a small sample of the tumor through a microscope. It usually is done to confirm a cancer diagnosis, and to identify the type of cancer you may have and how far it has spread (its "stage").1
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Your Healthcare Team
Pancreatic cancer is a serious disease that is usually treated by a team of healthcare professionals with different specialties. Members of a healthcare team might include a surgeon, radiation oncologist, medical oncologist, radiologist, pathologist, oncology nurse, and social worker, among others. Not everyone with pancreatic cancer should receive the same treatment. Your particular medical situation will determine the type of treatment you receive.
Each person's journey with cancer is different. Your own experience will depend on the stage of the cancer and other factors such your general state of health and your treatment goals. You should talk openly with your healthcare team about your cancer stage and prognosis, and how they affect your treatment options.
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Treatment Options
Treatment depends on the extent of the disease and your general health. Your test results will help your healthcare team plan a treatment program that is best suited for you.
There are generally three forms of treatment for pancreatic cancer. One or a combination of these treatments may be used:
- Surgery
Physical removal of the tumor.2
- Chemotherapy and biologic agents
Uses intravenous drugs or other substances to kill cancer cells, and is often used with radiation therapy to make the tumor cells more sensitive. The schedule for receiving these drugs depends on the particular drug you are given.2
- Radiation therapy (also called radiotherapy)
Uses x-rays or other high-energy rays to kill cancer cells and prevent tumors from growing.2
Surgery
If a tumor can be removed, the first course of action is generally surgery, along with chemotherapy and radiation therapy. Pancreatic cancer surgery is a very difficult operation, however, and can be especially difficult for patients to undergo. Complications are common, and recovery may take several weeks. When choosing therapeutic options, patients should weigh the benefits and risks carefully.2
Should the tumor be diagnosed by a needle biopsy, you may receive chemotherapy and radiation therapy before surgery. In the instances when the surgery is done first, these treatments usually begin about four to eight weeks after surgery. Surgery alone as the only treatment for pancreatic cancer is uncommon.
If the tumor is in the head of your pancreas, the right half of your pancreas and part of your stomach and small intestine generally are removed in a procedure called a "pancreaticoduodenectomy."
After surgery, you generally stay in the Surgical Intensive Care Unit (also called "SICU") for one to two days, and remain in the hospital for about two weeks. You may need one to two months of recovery at home before you can return to your everyday activities.
Chemotherapy
If a tumor has spread beyond the pancreas, surgery will not be helpful. The most common treatment for pancreatic cancer that has spread (metastasized) beyond the pancreas is 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. It can be given through a vein, injected into a body cavity, or delivered orally in the form of a pill. Chemotherapy is different from surgery in that the cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread; it can kill or eliminate cancer cells at sites far from the original cancer.3
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Let's see how GEMZAR can help.
Indications and Important Safety Information for GEMZAR
GEMZAR is approved by the FDA in combination with carboplatin (another type of chemotherapy) for the patient with advanced ovarian cancer that has returned at least 6 months after the patient had finished platinum-based therapy.
GEMZAR is approved by the FDA in combination with cisplatin (another type of chemotherapy) for the first-line treatment of patients (for whom surgery is not possible) with locally advanced (stage IIIA or stage IIIB) or metastatic (stage IV or cancer that has spread) non-small cell lung cancer.
GEMZAR is approved by the FDA in combination with paclitaxel for the first-line treatment of patients with metastatic breast cancer after they have received another type of chemotherapy called an anthracycline, unless their medical condition did not allow them to receive an anthracycline.
GEMZAR is approved by the FDA as a single agent (given alone) as the first-line treatment for patients with locally advanced (stage II or stage III when surgery is not an option) or metastatic (stage IV) adenocarcinoma of the pancreas. GEMZAR is also indicated for patients previously treated with 5-FU (another type of chemotherapy).
GEMZAR can suppress bone marrow function, which may cause low blood cell counts.
GEMZAR may not be appropriate for some patients.
If you are allergic to GEMZAR, tell your doctor because you should not receive it.
GEMZAR given for longer than 60 minutes or more than once a week has caused increased side effects.
You should call your doctor right away if you have any symptoms of infection, such as a fever or chills. If you notice bleeding, unexplained bruising, or symptoms of anemia, contact your healthcare team, as these can be symptoms of low blood cell counts.
Serious lung problems, sometimes fatal, have been reported with GEMZAR. Tell your healthcare team if you develop breathing problems.
There have been reports of serious kidney or liver damage including failure with GEMZAR treatment, sometimes fatal. If you have had kidney or liver problems or impairment, please tell your healthcare team. GEMZAR may not be right for you.
You will have regular blood tests before and during your treatment with GEMZAR. Your doctor may adjust your dose of GEMZAR or delay your treatment based on the results of your blood tests and on your general condition.
If you think you are pregnant, are planning to become pregnant, or are nursing, please tell your healthcare team.
Patients who receive radiation therapy before, during, or after receiving GEMZAR may sometimes experience more side effects, especially at the site of the radiation.
Tell your doctor if you are taking other medicines, including prescription and nonprescription medicines, vitamins, or herbal supplements.
There is a risk of side effects associated with GEMZAR therapy. The most common side effects are low blood cell counts (red blood cells, white blood cells, and platelets); fever; infection; hair loss; tiredness; nausea; vomiting; constipation; diarrhea; rash; shortness of breath; muscle aches; blood in urine; hearing changes and numbness or tingling in your toes or fingers. These are not all of the side effects of GEMZAR. Lab work may identify additional side effects. If you have any side effect that bothers you or that does not go away, be sure to talk with your doctor. Call your healthcare team right away if you have fever or chills. These symptoms could mean you have an infection.
If you are pregnant, GEMZAR may cause fetal harm to your unborn baby. It is not known if GEMZAR passes into breast milk; because of the potential for serious side effects in nursing infants, discuss breast feeding and GEMZAR with your doctor. The safety and effectiveness of GEMZAR in children has not been established.
For more information about all of the side effects of GEMZAR, please talk with your healthcare team, see the full Prescribing Information, or call 1-800-545-5979.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit , or call 1-800-FDA-1088.
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