Latest therapies for Pancreatic Tumors
Interview with Prof. Dr. Güralp Onur Ceyhan
Every day, approximately 1,200 people worldwide receive the pancreatic cancer diagnosis. Out of the total of 18 million cancer cases registered globally in 2018, nearly 450,000 were patients with malignant tumors located in one of the most important glands in the body: the pancreas.
Pancreas has two important roles in the body, besides other functions: it secretes insulin to maintain the optimum blood glucose level and secretes several enzymes required for digestion.
The pancreas can develop tumors, but unfortunately, until now, there are no screening tests that can highlight the cancer in an early stage. Risk factors for pancreatic cancer include smoking, obesity, chronic pancreatitis, and genetic inheritance.
There are two major types of tumors of the pancreas: some can affect the main pancreatic duct, others may affect smaller ducts. Those that affect the primary duct are associated with a higher risk of cancer than those located on smaller ducts.
In the case of tumors affecting the primary duct, the treatment is like that for the cancers, so we do a resection. The ones on the smaller ducts are not so aggressive, so there is still debate on this topic: monitoring or surgery. Besides these types of tumors, there are also the neuroendocrine ones, active or non-active. Another condition we diagnose is chronic pancreatitis, an inflammatory tumor mass that is not cancer and which we have to treat properly.
There is a tumor called insulinoma, responsible for insulin production in excess. There are times when diabetes can be a sign of pancreatic cancer: it’s the case of patients who had normal blood sugar constantly and suddenly they got diabetes. If we operate these patients and remove malignant tumor, diabetes disappears, too. Therefore, suddenly installed diabetes can be a symptom of pancreatic cancer.
Now we can diagnose these types of tumors more easily than they were 20 years ago when we could not see them with the imaging techniques available at the time. That’s why the number of cases with these types of tumors is increasing because we can diagnose them much easier. One of the top experts in the world who successfully tackles such cases is Professor Güralp Onur Ceyhan, who is currently part of physicians team at Acibadem Maslak Hospital in Istanbul Turkey. The modern therapy protocol includes neoadjuvant chemotherapy that reduces tumors and surgeries through state-of-the-art methods and technologies that reduce the risk of side effects.
What are the advances in early diagnosis of pancreatic tumors?
There is no routine checkup to detect the tumors of the pancreas. Pancreatic cancer can be detected only by chance: the patient goes to a checkup, the doctor sees something on the ultrasound and then the diagnosis is confirmed. There are also tumor markers, such as CA 19-9, an antigenic determinant associated with various types of tumors. Its value may be increased in pancreas cancer.
After the tumor removal operation, the value of this marker decreases. Increased CA19-9 values can also be associated with other problems in the body such as inflammatory processes so it can’t be used extensively to detect early stage pancreatic cancer, as is the PSA marker for prostate cancer.
Modern technology helps and assists you successfully in achieving successful operations?
If patients refer to a specialist center in pancreas or liver surgery, the success of the interventions is provided by a multidisciplinary team. The presence of an experienced surgeon in the team is important, but equally important is the presence of a specialist in interventional gastrointestinal surgery and an interventionist imaging specialist. They form a team that successfully intervenes in both chronic pancreatitis, pancreatic cancers and advanced hepatic tumors. Currently, in some cases of pancreatic cancer, we can use robotic surgery to remove tumors. That means fewer side effects, better recovery and less scarring.
What is the latest treatment protocol for pancreatic cancer?
This is an extremely exciting subject today, because things are changing in the approach to pancreatic cancer. First, let’s look at the patients: for 20 percent of them, the cancer is distinctively located at the head, body, or tail of the gland, there are no metastasis, infiltrations in the vessels. In these patients, we do resection, we apply chemotherapy, and the prognosis is good enough. Then, in another patient category, representing 20-25 percent of all patients, the cancer is advanced: there are vascular infiltrations in the portal or mesenteric veins or there are tumors around the arteries, the super mesenteric, in the celiac trunk. A few years ago, this second category of patients was similar to the third group, representing between 50 and 55 percent, with pancreatic cancer and metastasis. 15 years ago, these two categories were treated in the same way, with palliative chemotherapy. Now, things have changed: if the second group receives neoadjuvant chemotherapy with Folfirinox or Gemcitabine Abraxane, two substances that have proven to be effective, then cancer becomes resectable in more than 50 percent of patients, who were not candidates for resection and could not be saved before. With the help of these latest therapies, some tumors can decrease, and we can do surgery.