Pancreatic & Liver
Pancreatic cancer makes up about 3% of all diagnosed cancer cases.
Yet it's the 4th leading cause of cancer death in women and the 5th leading cause of cancer death in men. It is often viewed by doctors and patients alike as a veritable death sentence. But even with advanced Stage 4 pancreatic cancer, it doesn't have to be.
Cancers arising in the pancreas may not exhibit any noticeable symptoms in the early stage. Because of this, pancreatic cancer is typically diagnosed at a late stage making treatment difficult and prognosis poor.
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.
Oncogenes (genes that are mutated or expressed) such as K-RAS, p16, or p53 BRCA mutations (found in patients with family history of breast and ovarian cancer).
Mismatch repair deficiencies associated with Lynch syndrome
Life style and dietary associations including cigarette smoking, alcohol consumption, processed food intake and obesity
While radical surgery is potentially curative, only a minority of patients are candidates. Patients with advanced, metastatic pancreatic cancer spread to the liver or the abdominal cavity will require systemic therapy.
Most common chemotherapy drugs:
Platins (Cisplatin or Oxaliplatin)
Taxanes (Taxol, Docetaxel, Abraxand)
Capecitabine (oral formulation of 5FU)
Most common chemotherapy combinations:
FOLFIRINOX (oxaliplatin & irinotecan & 5-fluorouracil (5-FU)/leucovorin)
Gemcitabine & Nab-Paclitaxel (Abraxane)
Gemcitabine & Erlotinib
Gemcitabine & Cisplatin
GTX (gemcitabine & docetaxel & capecitabine)
5FU/leucovorin & Capecitabine
5FU/leucovorin & Oxalilatin
Targeted Therapies Available:
What Our Research Has Shown
We find that advanced metastatic pancreatic cancer patients fall into several broad categories:
1) The truly drug sensitive patients who will respond to numerous treatments and can benefit from the least toxic drug combinations.
2) A small minority of patients who are sensitive to "targeted agents" like Erlotinib (Tarceva)
3) A large group of patients have distinct sensitivity to one of the three standard drug regimens used in this disease: Platinum-based (GemOx, Cisplatin & Gemcitabine), Taxane-based (GTX, Abraxane/Gemcitabine), or Irinotecan-based (FOLFIRINOX, FOLFIRI)
4) A final group of patients are resistant to standard chemotherapeutics and should be considered for experimental therapies as early as possible.
Without testing, how do you know which group you may be in?
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 carcinoma is particularly common in patients with underlying liver disease associated with hepatitis and cirrhosis.
Cancer of the bile duct, known as 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 angiosarcomas or hemangiosarcomas. These types of cancers are sometimes associated with exposures to hepatotoxins and typically grow rapidly.
Common Treatments -
Surgery is usually the first form of treatment.
Other liver cancer treatment options 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.
Call us today at 1-800-542-4357 to see how the Nagourney Cancer Institute can help you identify the most effective liver cancer treatment based on your unique tumor makeup.