Pancreatic and Liver Cancers
Both organs are found in the upper abdomen and perform vital functions. In the early stages, cancers arising in these organs may not exhibit any noticeable symptoms. Because of this, both diseases are typically in late stages of development before they are discovered, making treatment difficult and prognosis poor.
In April 2010, Steve Lockwood was diagnosed with Stage IV pancreatic cancer. Before he and his wife, Joannie, made a decision about treatment, they decided to seek several options. They met with a local oncologist, as well as experts at UCLA and City of Hope. All spoke of conventional treatments and advised Steve to get his affairs in order. Then they met with Dr. Nagourney..
The pancreas is responsible for the production of enzymes and hormones that assist in the digestion of food and the regulation of metabolism. Tumors can form in either the exocrine cells, or the endocrine cells. Cancer in this organ typically grows rapidly, which makes providing the right treatment upon diagnosis critical.
More than 90 percent of all pancreatic tumors are adenocarcinoma. More rare forms are the neuroendocrine tumors that include insulinomas, glucagonomas and other islet cell tumors.
Common Treatments for Pancreatic Cancer
Surgery is the most effective way to manage pancreatic cancers if the disease remains confined to the pancreas (Stage I). If the disease has progressed, then radiation or combinations of radiation plus chemotherapy are typically employed. Unfortunately, pancreatic cancers are often advanced when first diagnosed and the only option left is chemotherapy. Despite years of study, there are no curative therapies for metastatic pancreatic cancer. Nonetheless, some patients have dramatic and durable benefit from chemotherapy.
Currently, medical oncologists base their treatment strategy on standard chemotherapy protocols for specific types of cancer. For pancreatic cancer, most treatment regimens apply the drug gemcitabine alone or in combination. Additional agents with activity include 5FU, streptozotocin, Mitomycin-C, doxorubicin, the taxanes, platin and select molecularly targeted agents like Tarceva.
Gemcitabine has also been used successfully to prevent recurrence as an adjuvant therapy. Numerous clinical trials have compared gemcitabine to gemcitabine-based combinations. While no single trial has established clear benefit, there are individual patients who have demonstrably better and longer responses to drug combinations when they are laboratory selected.
One such patient had a dramatic response to the combination of Cisplatin plus Gemcitabine, leading to an 11-year survival with metastatic disease. His story was the subject of a report in Scientific American in July 1998.
From this story, and others, the fact that all patients with pancreatic cancer will have an equal likelihood of response to a drug does not mean they will respond equally. Patients unfortunate enough to find themselves on the wrong side of that probability curve will be getting, what is for them, the wrong treatment. This is why functional profiling of your tumor to determine which drug or combination of drugs will most likely kill your specific cancer is so important.
The liver has many functions without which we cannot survive, including glycogen storage, the metabolism of foodstuffs and detoxification of chemicals, as well as the production of bile and its secretion into the intestines to assist in the absorption of nutrients. The liver is vital, both in its metabolic and synthetic roles producing the most common protein in the blood, albumin, as well as the clotting factors necessary to stop bleeding from injury.
Not all tumors of the liver are cancerous.
The liver is not typically a primary tumor site, especially in the United States. More often, cancer in this organ has originated elsewhere and metastasized. But, in adult primary liver cancer there are three subtypes. The majority – about 90 percent – are hepatocellular carcinoma, which can either begin as a single tumor that increases in size or as a collection of tumors (multifocal). Hepatocellular carcinomas are particularly common in patients with underlying liver disease associated with hepatitis and cirrhosis.
Bile duct cancers (cholangiocarcinomas) occur in less than 10 percent of all cases. The cancer starts within the tubes that course through the liver carrying bile fluids and can then spread throughout the liver and to distant sites. These tumors also arise in the gallbladder itself. The last type is even more rare, starting in the blood vessels within the liver. It can either be classified as angiosarcoma or hemangiosarcoma. These types of cancers are sometimes associated with exposures to hepatotoxins and typically grow rapidly.
Common Treatments for Liver Cancer
Surgery is usually the first form of treatment. Other treatment methods are also used in conjunction with surgery: Including thermal ablation, radiation, transplantation, alcohol injection and chemoembolization.
Partly because the liver is so active in its role as a detoxifying organ, it is characteristically resistant to many forms of "cytotoxic" chemotherapy. As a result, many active forms of therapy have little effect on this disease. Nonetheless, doxorubicin, cisplatin, Mitomycin-C, 5-FU, FUDR, gemcitabine and some of the newer targeted therapies like sorafenib and bevacizumab have shown favorable results in select patients.