Redefining What’s Possible for Patients with Locally Advanced Pancreatic Cancer.

A diagnosis of pancreatic cancer often comes with understandable feelings of fear. Pancreatic cancer is one of the most difficult cancers to treat. 

About 1/3 of pancreatic cancers are diagnosed at a late stage, after the cancer has involved major abdominal arteries and veins near the pancreas. It is called Locally Advanced Pancreatic Cancer (LAPC), an intermediate stage (Stage 3) between resectable earlier cancers (Stage 1-2) and metastatic, when cancer spreads to other distant sites (Stage 4).  

LAPC is the form of pancreatic cancer that most guidelines consider unresectable, or unremovable with surgery. The pancreas sits in a “downtown location.” The body’s major highways (arteries and veins) are nearby, transporting blood to and from major organs like the liver, the intestines, stomach, spleen and the pancreas. When cancer spreads from the pancreas to these highways, surgery becomes complicated, often considered impossible.

MedStar Health is challenging that assumption, offering hope for patients with this complex cancer. We are one of the few centers in the world offering surgical treatment for LAPC.

The deep expertise of our hepato-pancreato-biliary and transplant surgery teams and our state-of-the-art technologies empower us to accept complex pancreatic surgical cases when other centers say “no.” Moreover, our surgical team, if needed, performs multiple arterial and venous resection thus enabling organ preservation approach while accomplishing complete removal of the cancer.

In addition, we offer this operation to elderly patients with LAPC. The median age of diagnosis is 70-71, and some centers rule out complex surgery because of a patient’s age. We believe that age shouldn’t be a barrier to advanced cancer care. 

Across the U.S., the five-year relative survival rate for all stages of pancreatic cancer is low, at about 13%. Patients who get LAPC resection surgery at MedStar Health have a chance at a five-year survival rate of around 15-20%, similar to the survival of patients with earlier stages of pancreatic cancer.

Surgical innovation for LAPC treatment.

Our willingness to operate on complex cancers that others refuse comes from MedStar Health surgeons’ extensive  experience  with transplantation techniques. Surgeons trained in multi-organ transplantation are familiar and comfortable with repairing and reconstructing complicated blood vessel structures. 

We translate this expertise into opportunities for patients. While these surgeries are complex, our aggressive approach to removing the cancer is straightforward:

• Tumor and vessel resection: Surgeons remove the tumor and portions of major blood vessels that show signs of the cancer invasion.

• Vessel replacement: We replace the removed blood vessels with a section of the patient’s own healthy vessels; for example, the saphenous vein from the leg, the same one often used in heart bypass surgery. This technique allows us to perform extensive resections and completely remove the tumor without compromising blood supply to other organs that are not affected by cancer.

Surgery is just one aspect of our comprehensive approach to LAPC. Successful treatment requires a multidisciplinary effort from several specialists using the latest technologies. 

Related: Read "Study Finds New Targeted Therapy Slows Growth in Rare NRG1 Fusion Tumors."

Advanced technologies enable comprehensive therapy.

Treatment often begins with neoadjuvant therapy, chemotherapy and/or radiation therapy given before surgery. This strategy helps stabilize the disease and make the tumor safer to remove.

To lower the chances the cancer will come back (called recurrence), we use the latest tools such as intraoperative radiation therapy (IORT). In this technique, radiation oncologists deliver a precise, high dose of radiation directly to the tumor during surgery. IORT helps ensure that even microscopic cancer cells are eliminated from the tumor site, a step that is critical to lowering the chance of cancer coming back where it started.

MedStar Health’s unique approach.

If you’ve been diagnosed with pancreatic cancer, it can feel overwhelming. At MedStar Health, our unique program provides cancer treatment expertise and coordinated care that can help you make informed decisions about your care:

• A high-volume center: In the Pancreas and Liver Diseases (HPB) Program, we see a lot of patients with complex cases. Research shows that being treated at a center like ours means better outcomes for complex procedures. Ours is one of the very few programs in the world offering a surgical approach to LAPC treatment.

• Holistic care: Our HPB Program is integrated and multidisciplinary. This means experts from medical oncology, radiation oncology, surgery, and more meet regularly to collaborate on personalized treatment plans for our patients. A team approach means patients get continuous support and the best possible care from our combined expertise.

• Clinical trials: Our teams are at the forefront of research into the latest therapies, breaking new ground and offering patients access to the most advanced treatments sooner.

Related: Read "Gene Therapy Research Springs Optimism for Pancreatic Cancer Care."

Redefining outcomes for patients with LAPC.

For patients diagnosed with LAPC, hope for successful outcomes requires innovative treatment. The goal of our program is to provide more life for patients who’ve been told their cancer is inoperable. 

If you or a loved one has been told pancreatic cancer is inoperable, seek another option. There still may be hope. Here, we can offer many patients a surgical solution and a treatment path forward, even when they’ve been told their options are limited.