As with other cancer types, pancreatic cancer happens when cells in your pancreas mutate and multiply, becoming a tumor. Most pancreatic tumors are found in the ducts of the pancreas and do not appear on imaging tests like CT scans or ultrasounds. Because of this, pancreatic cancer is often diagnosed in later stages, after the cancer has spread.

What are the types of pancreatic cancer?

There are two main pancreatic cancer types, endocrine tumors, and neuroendocrine tumors.

  • Endocrine tumors account for most pancreatic cancer diagnoses. The most common pancreatic endocrine tumor is adenocarcinoma, a tumor that forms in the cells lining your pancreas.
  • Neuroendocrine tumors, also called islet tumors, are much rarer. These tumors form in the endocrine gland of the pancreas and only account for about five percent of all pancreatic cancer cases.

Pancreatic Cancer Stages

When pancreatic cancer is diagnosed, your physician will assign a numerical stage. This describes how much the cancer has progressed or spread. The stages of pancreatic cancer include:

Stage 0

Abnormal cells, which have the potential to become cancerous, have been found in the lining of the pancreas.

Stage I

Cancer has been found but is only in the pancreas. Tumors smaller than two centimeters are called Stage IA and tumors larger than two centimeters are Stage IB.

Stage II

With Stage IIA pancreatic cancer, the cancer cells are still isolated to the pancreas. If you have Stage IIB, the cancer has spread to nearby lymph nodes and potentially organs but is not affecting blood vessels.

Stage III

In Stage III, the cancer has spread to nearby blood vessels and lymph nodes but has not reached more distant areas of the body.

Stage IV

At this point in the progression of pancreatic cancer, tumors can be any size and may have metastasized (or spread) to more distant parts of the body, like the lungs or brain.

The difficulty in achieving an early diagnosis means pancreatic cancer is often diagnosed in the later stages.

Pancreatic cancer treatment may include surgery alone, a combination of surgery and proton therapy, or proton therapy alone, as well as chemotherapy. The choice of pancreatic cancer treatment depends on several factors, such as the location of the tumor and the health of the patient.

The nature of pancreatic cancer, combined with the location of the pancreas and its proximity to other sensitive tissues, can make the disease challenging to treat. In most cases, surgery is the first method of treatment of pancreatic cancer to be considered. However, in many cases surgery cannot be performed or is insufficient to control the disease. In such patients, proton therapy for pancreatic cancer treatment can be helpful as well as chemotherapy.

When Pancreatic Cancer Surgery is Recommended

Surgery for pancreatic cancer treatment, called a pancreatectomy, is often recommended when imaging scans show the tumor is confined to just the pancreas. However, cancer cells can often be found in the lymph nodes and tissue surrounding the pancreas after surgery is completed. 

In these cases, performing radiation therapy prior to pancreatic cancer surgery would be ideal to better confine the cancer to the pancreas and ensure surgery is more effective.

Even when it is possible to completely remove the adenocarcinoma with surgery, there is still a chance of cancer recurring after surgery. Proton therapy for pancreatic cancer could offer the hope of more options for people affected by the disease.

For many patients, proton therapy for pancreatic cancer can be used after surgery to improve disease control, before surgery to shrink the pancreatic tumor leading to more effective surgery, or in lieu of surgery. In most cases, chemotherapy is also considered.

The Difference Proton Therapy for Pancreatic Cancer Can Make

While some pancreatic cancers can be successfully treated with a combination of surgery, chemotherapy and radiation, traditional forms of radiation can sometimes prove problematic. That’s because the organs that surround the pancreas – including the small intestine, kidneys, spinal cord and stomach – cannot withstand high doses of radiation. 

Thanks to the highly precise nature of proton therapy for pancreatic cancer, however, the radiation dose is concentrated at the site of the pancreatic cancer, sparing other healthy organs exposure to radiation, and decreasing the risk of side effects.

And, since higher doses of radiation can be delivered to the pancreas with a lower risk of damage to other organs, the chance of destroying the pancreatic cancer is potentially greater. 

Physicians at the University of Florida Health Proton Therapy Institute are using proton therapy to treat both operable and inoperable pancreatic cancers in an effort to improve the cure rate for this difficult disease. They have already proven the advantages over conventional radiation therapy in terms of radiation dose distribution1 and demonstrated minimal side effects2,3 with proton therapy. Ongoing trials at the UF Health Proton Therapy Institute include postoperative proton therapy in resected pancreatic cancers, preoperative proton therapy in borderline resectable pancreatic cancer, and proton therapy in unresectable pancreatic cancer. If you are interested in pancreatic cancer treatment with proton therapy, and would like to know if you are eligible, contact the UF Health Proton Therapy Institute today.

1 Hitchcock KE, Nichols RC, Morris CG, Bose D, Hughes SJ, Stauffer JA, Celinski SA, Johnson EA, Zaiden RA, Mendenhall NP, Rutenberg MS. Feasibility of pancreatectomy following high-dose proton therapy for unresectable pancreatic cancer. World J Gastrointest Surg. 2017 Apr 27;9(4):103-108. doi: 10.4240/wjgs.v9.i4.103. PMID: 28503258.

2 Nichols RC Jr, George TJ, Zaiden RA Jr, Awad ZT, Asbun HJ, Huh S, Ho MW, Mendenhall NP, Morris CG, Hoppe BS. Proton therapy with concomitant capecitabine for pancreatic and ampullary cancers is associated with a low incidence of gastrointestinal toxicity. Acta Oncol. 2013 Apr;52(3):498-505.

3 Nichols RC Jr, Huh SN, Prado KL, Yi BY, Sharma NK, Ho MW, Hoppe BS, Mendenhall NP, Li Z, Regine WF. Protons offer reduced normal-tissue exposure for patients receiving postoperative radiotherapy for resected pancreatic head cancer. Int J Radiat Oncol Biol Phys. 2012 May 1;83(1):158-63. doi: 10.1016/j.ijrobp.2011.05.045. Epub 2012 Jan 13. PubMed PMID: 22245197.

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