Pancreatic Cancer: Who Should Have Surgery?

Surgery is vital to the successful treatment but not everyone is a candidate

The most common form of pancreatic cancer is known as an adenocarcinoma. Other cancers that can involve the pancreas include neuroendocrine tumors and lymphoma. This article will specifically address surgery as it pertains to adenocarcinomas of the pancreas. 

Surgery for Pancreatic Cancer

Surgery is a standard part of the treatment plan of many cancer types. This is no exception in pancreatic cancer.

In fact, the only potential cure for pancreatic cancer includes surgery. 

Unfortunately, not everyone with pancreatic cancer is a surgical candidate upfront. This can be anxiety-provoking, to say the least. What makes someone eligible for surgery? Why would surgery not be recommended? To understand the answer, it is helpful to know a few basic facts about the anatomy and location of the pancreas.

The pancreas lies just behind the stomach and is next to several vital structures, most notably, several major blood vessels. Directly behind the pancreas, is a collection of major blood vessels. If a tumor is described as "locally advanced," it means that the tumor may be enveloping these major blood vessels, making the removal of all the tumor without damaging the vessels a near-impossibility. When this happens, the person is may not be a candidate for surgery.

Combined Treatments for Pancreatic Cancer

A certain number of people have what is known as borderline resectable disease.

Unfortunately, there are no standardized criteria for this diagnosis. In general, it refers a condition where  cancer envelopes 50 percent or less of the blood vessel.

Is this situation, there may be a benefit to administering chemotherapy with or without radiation before surgery with the intent to shrink the tumor.

If the treatment is successful, the tumor shrinks sufficiently to the point where it becomes possible to remove it surgically.

To add even more factors when looking at surgery, certain high-volume centers are potentially able to remove and reconstruct blood vessels to varying degrees. So what was previously thought to be inoperable is now potentially operable. 

When Pancreatic Cancer Has Metastasized

Another possible situation is the spread or metastasis of the cancer to more distant locations, such as the liver, other places within the abdomen, lungs or anywhere else. When this happens, there is no known advantage to surgically removing the primary (original) tumor. 

Why not surgically remove the cancer from both the pancreas and the liver? The problem is that the disease is microscopic. Single cancer cells are not visible to the naked eye and not visible with standard imaging tests such as CT scans or MRIs. Cancer only becomes barely visible when at least a million cells congregate to form roughly a 2mm tumor. This means millions of cells can be located in various locations such as the bloodstream, lymphatic channels, liver and other tissues without being detectable by any current means.

So how many people are typically candidates for surgery? The unfortunate truth about pancreatic cancer is that by the time someone has symptoms that lead to its discovery, it is often already advanced. Because of this, roughly 20 percent of people are considered to be surgical candidates at the time of diagnosis.

Pancreatic cancer is potentially curable when surgery is part of the treatment. When a question of surgery arises, it is certainly appropriate to get more than one medical expert opinion.