Surgical Oncology — Pancreatic Cancer
UC Davis Comprehensive Cancer Center offers comprehensive, multidisciplinary care for young and adult patients with pancreatic cancer of all stages. Treatment is aimed at preservation of critical functions, prevention of disease recurrence and optimization of quality of life. Your team of cancer specialists will include experts in surgical oncology, gastroenterology, radiation oncology, and medical oncology.
The UC Davis pancreatic cancer program utilizes a full team of professionals and revolutionary techniques to treat patients and relieve them of their symptoms.
Patients are carefully evaluated using advanced imaging methods to characterize their disease and facilitate optimal treatment planning. The surgical approach can be either laparoscopic, using several small incisions, or the traditional open approach. Surgical therapy is directed at removing all tumors when feasible, using approaches from enucleation (just the tumor is excised) to more radical surgery such as pancreaticoduodenectomy (i.e., “Whipple procedure”).
Patients may also benefit from participation in the Pancreatico-Biliary Disease Group, a multidisciplinary team focused on diseases of the pancreas and liver. Members of this group represent diverse clinical specialties including surgical oncology, gastrointestinal surgery, medical oncology, interventional radiology, gastroenterology, radiology and radiation oncology. This group performs three tasks: Discussion and treatment planning for complex patient cases; development and implementation of novel treatment protocols; and development and implementation of clinical databases.
Surgical removal of the tumor is the most common treatment for pancreatic cancer. Specific surgical techniques may include:
- Distal pancreatectomy: The body and the tail of the pancreas and usually the spleen are removed.
- Total pancreatectomy: This operation removes the whole pancreas, part of the stomach, part of the small intestine, the common bile duct, gallbladder, spleen and nearby lymph nodes.
- Tumor enucleation: The tumor is dissected from adjacent parenchyma. This approach is reserved for benign tumors.
- Whipple procedure: Also known as a pancreaticoduodenectomy, this procedure removes the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct. Enough of the pancreas is left to produce digestive juices and insulin.
If the cancer has spread and cannot be removed, the following types of palliative surgery may be done to relieve symptoms:
- Surgical biliary bypass: This bypass is performed if the cancer is blocking the small intestine and bile is building up in the gallbladder. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine to create a new pathway around the blocked area.
- Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin tube) to drain bile that has built up in the area. The doctor may place the stent through a catheter that drains to the outside of the body, or the stent may go around the blocked area and drain the bile into the small intestine.
- Gastric bypass: If the tumor is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally.
Radiation therapy: This treatment uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:
- External radiation therapy uses a machine outside the body to send radiation toward the cancer. One type of therapy, called fast neutron radiation therapy, aims neutrons (tiny, invisible particles) at the cancer cells to kill them. Using higher-energy radiation than X-ray radiation therapy allows the same amount of radiation to be given in fewer treatments.
- Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires or catheters, which are placed directly into or near the cancer.
Chemotherapy: This treatment uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).
UC Davis Comprehensive Cancer Center clinical trials can offer our gastrointestinal cancer patients access to the latest drugs and therapies, frequently unavailable elsewhere. We offer a number of pancreatic cancer clinical trials including:
Patients with metastatic or recurrent pancreatic cancer may enroll in a Phase II investigator-initiated study led by UC Davis oncologist Primo Lara. Drugs used in chemotherapy, such as gemcitabine, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Erlotinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. The trial is studying how well gemcitabine and erlotinib work together to potentially kill more tumor cells.
VIEW STUDY DETAILS
Vanderveen KA, Canter RJ, Yin D, Cress RD, Bold RJ. Factors affecting treatment delivery and outcomes of patients with early stage pancreas adenocarcinoma. Pancreas. 2011 Apr;40(3):480-2.
Coates JM, Galante JM, Bold RJ. Cancer therapy beyond apoptosis: autophagy and anoikis as mechanisms of cell death. The Journal of Surgical Research. 2010 Dec;164(2):301-8.
Muilenburg DJ, Coates JM, Virudachalam S, Bold RJ. Targeting Bcl-2-mediated cell death as a novel therapy in pancreatic cancer. The Journal of Surgical Research. 2010 Oct;163(2):276-81.
Parsons CM, Muilenburg D, Bowles TL, Virudachalam S, Bold RJ. The role of Akt activation in the response to chemotherapy in pancreatic cancer. Anticancer Research. 2010 Sep; 30(9):3279-89.
Coates JM, Beal SH, Russo JE, Vanderveen KA, Chen SL, Bold RJ, Canter RJ. Negligible effect of selective preoperative biliary drainage on perioperative resuscitation, morbidity, and mortality in patients undergoing pancreaticoduodenectomy. Archives of Surgery. 2009 Sep;1.
Vanderveen KA, Chen SL, Yin D, Cress RD, Bold RJ. Benefit of postoperative adjuvant therapy for pancreatic cancer: A population-based analysis. Cancer. 2009 June; 115(11):2420-9.
Parsons, C.M., J.L. Sutcliffe, R.J. Bold. Preoperative evaluation of pancreatic adenocarcinoma. Journal of Hepato-Biliary-Pancreatic Surgery. 2008; 15:429-435. 2008.
Cress, R.D., D. Yin, L. Clarke, R.J. Bold, E.A. Holly. Survival among patients with adenocarcinoma of the pancreas: A population-based study (United States). Cancer Causes and Control. 2006; 17:403-409, 2006.
Oncologists Specializing in Pancreatic Cancer
Richard J. Bold, M.D.
Professor and Chief of Surgical Oncology
Vijay Khatri, M.D.
Professor of Surgical Oncology
Director of Faculty Development and Mentoring
Robert J. Canter, M.D.
Assistant Professor of Surgical Oncology
John P. McGahan, M.D.
Professor of Radiology
Chief of Abdominal Imaging and Ultrasound
C. John Rosenquist, M.D.
Professor of Radiology
Chief of Gastrointestinal Radiology
Joseph W. Leung, M.D.
Professor of Medicine
Chief of Gastroenterology
Thomas Prindiville, M.D.
Professor of Medicine, Gastroenterology
Shiro Urayama, M.D.
Associate Professor of Medicine, Gastroenterology
Hematology and Oncology
I-Yeh Gong, M.D.
Assistant Professor of Medicine, Hematology and Oncology
Edward Kim, M.D., Ph.D.
Assistant Professor of Medicine, Hematology and Oncology
Jerry S. Powell, M.D.
Director, Hemophilia and Thrombosis Center
Professor of Internal Medicine, Hematology and Oncology
Michael Tanaka, Jr., M.D.
Associate Professor of Medicine, Hematology and Oncology
Jyoti Mayadev, M.D.
Arta Monjazeb, M.D., Ph.D.