Introduction
The pancreas is further up the abdomen and is a vital part of the digestive system.1 Its role in the body is to help digest food and to release hormones which manage blood sugar.2 Pancreatic cancer is a type of cancer that contains a cancerous tumour in the pancreas, called a malignant tumour.
Chemotherapy is a drug treatment which is used to kill cancerous cells in the body, as these cells grow and divide faster than other body cells.3 This can be an effective way to treat pancreatic cancer, but it also provides side effects. This article will explore the effects of chemotherapy on pancreatic cancer.
Understanding pancreatic cancer
The pancreas lays across the body, where the ribs meet, and is located behind the stomach.1 It is split up into 3 parts:
- Head: the wide end
- Tail: the thin end
- Body: the area in the middle
The pancreas is an organ and a gland having two main functions:4
- Exocrine (this consists of glands that make substances travel through a tube): this means it produces enzymes which help with digestion
- Endocrine (this consists of glands that release hormones in the bloodstream): this sends out hormones that control the amount of sugar in the blood
Pancreatic cancer is a severe disease that affects many individuals. Some people are more susceptible to pancreatic cancer, including:5
- Smokers
- Individuals over 55 years old
- Diabetics
- People with obesity
- People suffering from chronic
- Pancreatitis (this is where the pancreas has been damaged from inflammation and does not work properly)6
- Individuals with Cirrhosis of the liver (scarring of the liver caused by damage)7
- Those exposed to chemicals
- Males
- African Americans, and
- Those who experienced cases of pancreatic cancer in their family
However, there are different types of pancreatic cancer:8
- Adenocarcinoma is the most common type of pancreatic cancer and occurs in the lining of the tubes (ducts) in the pancreas. Symptoms include abdominal pain, nausea and weight loss, skin rashes and joint pain
- Squamous cell carcinoma is a rare cancer which forms in the ducts. Due to its rare nature, is it to date not fully investigated
- Adenosquamous carcinoma is a rare cancer in the exocrine system and is more aggressive
- Colloid carcinoma is a rare cancer in the exocrine system but is easier to treat than other pancreatic cancers
Chemotherapy basics
Chemotherapy uses medication, called cytostatic, to stop cancer cells from dividing uncontrollably.9 There are various types of chemotherapy, such as:
- Curative chemotherapy: eliminates all cancer cells from the body and makes metastases disappear
- Adjuvant chemotherapy: fights cancer cells which might be left in the body after surgery. This therapy is used to prevent the cancer from resurfacing
- Neoadjuvant chemotherapy: some tumours are too big, so this method shrinks the tumour, so it can be surgically removed
- Palliative chemotherapy: helps relieve symptoms, slow the progression of the disease, or stop it temporarily, as it is no longer possible to remove all the tumour cells
Chemotherapy can be applied in a range of ways, such as:
- Systemic treatment: here, medication is either injected into the vein (IV drip) or taken orally through tablets
- Local chemotherapy: is not given through the bloodstream, it is rather injected into the body part which is affected. It can also be applied through a cream or ointment
- Radiotherapy: chemotherapy is combined with radiotherapy, and radiation is applied to places where needed. This method is also known as chemoradiotherapy
- A port: is a device which is inserted under the skin and connects a large vein with a thin tube. It supplies drugs and remains in the body for as long as needed
Treatment is given in cycles for a few days or weeks and is stopped to allow the body to recover.
Chemotherapy for pancreatic cancer
You might have chemotherapy:10
- Before surgery (neoadjuvant chemotherapy)
- After surgery (adjuvant chemotherapy)
- With radiotherapy (chemoradiotherapy)
- To relieve symptoms and control cancer
Some common drugs are:10,11
- Gemcitabine
- Capecitabine
- Fluorouracil (5FU)
- Irinotecan
- Oxaliplatin
- Nab-paclitaxel (Abraxane)
- Cisplatin
One or more of these can be taken together.
Before surgery, you might have to endure neoadjuvant chemotherapy, as the cancer is next to a main blood vessel and not all of it can be removed. This can shrink the cancer and make surgery possible. After surgery, you might undergo adjuvant chemotherapy to lower the risk of cancer coming back. This can continue for up to 6 months and starts within 3 months of the surgery.
Those who suffer from advanced pancreatic cancer might have to experience chemoradiotherapy after chemotherapy.
However, chemotherapy does not help everyone with pancreatic cancer. Depending on individual circumstances, some may feel better with treatment while others will not.
You might be able to have different treatments if the first one is not working or gives you side effects. This is called second-line treatment, which will need to be discussed with a doctor.
For those who are fit, you are likely to have a drug combination of FOLFIRINOX which is made of the chemotherapy drugs:
- Fluorouracil (5FU)
- Irinotecan, and
- Oxaliplatin
On the other hand, this can present side effects and lower amounts of drugs need to be used, this is called modified FOLFIRINOX. Other combinations can be used for pancreatic cancer, such as:
- Gemcitabine and nab-paclitaxel
- Gemcitabine and capecitabine
- Oxaliplatin and fluorouracil
- Oxaliplatin and capecitabine
- Gemcitabine and cisplatin
If you are also having radiotherapy, you usually consume capecitabine.
Side effects of chemotherapy
There are many side effects of chemotherapy, but luckily you will not experience all of them:12
- Tiredness: this can happen while doing everyday activities
- Nausea
- Hair loss: this happens within a few weeks of your first treatment and should re-grow after treatment
- Infections: chemotherapy disrupts the immune system making it more likely for you to fall ill
- Anaemia: the treatment lowers the amount of red blood cells, which carry oxygen around the body
- Bruising and bleeding: chemotherapy reduces the number of platelets in the blood, these stop bleeding when cut
- Sore mouth: this causes the lining of the mouth to be sore, called mucositis
- Loss of appetite
- Skin and nail changes
- Memory and concentration problems
- Sleep problems: some people may find it hard to sleep or wake up, known as insomnia
- Fertility issues and low sex drive
- Diarrhoea and constipation
- Emotional issues
Monitoring and Follow-up
Contact your doctor immediately if you exhibit an infection with the following symptoms12
- Temperature above 37.5°C or below 36°C
- You feel too hot or shivery
- Difficulty breathing
- Flu-like symptoms
- Sore mouth
- Pain when swallowing
- Nausea
- Diarrhoea
- Pain, redness, swelling, discharge, or heat where surgery has taken place or where the tube has been inserted
However, chemotherapy can be shown to work, and its effectiveness can be shown through the decrease in symptoms. But the only way to definitively know if the treatment has worked is through follow-up tests, which can include:
- Blood tests: which test red and white blood cells
- CT scans: which create images of the tissues and organs to determine the size and location of the cancer
- MRI scans: also create a picture of the body
- Tumour markers: cancer produces tumour markers and whether these increase, decrease or stay the same shows the effectiveness of chemotherapy
Research and advances in pancreatic cancer
New treatments for pancreatic cancer are being developed in clinical trials, these include immunotherapy and targeted therapy.13 Immunotherapy uses substances to stimulate the immune system to help the body fight cancer. Targeted therapy, on the other hand, uses drugs to target specific cancer cells which divide and spread. Due to the complex nature of this cancer, treatments need to go through clinical trials, even in their early stages.
Summary
In conclusion, pancreatic cancer is a disease with many different layers and considerations. There are different variants which can affect both the endocrine and exocrine systems, and there are groups of people who are more vulnerable to this condition.
Fortunately, a treatment known as chemotherapy has been developed for cancer, and specifically for pancreatic cancer these treatments are commonly used. There are a range of drugs which can be taken individually or even combined. Specifically for pancreatic cancer, it is taken through IV or orally by tablets.
However, there are many side effects of this treatment which need to be monitored while undergoing treatment and after, to ensure cancer does not worsen or arise again. This field is growing and changing, and advancements in treatments are a huge possibility.
References
- What is pancreatic cancer? [Internet]. [cited 2023 Dec 15]. Available from: https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer/about
- Mayo Clinic [Internet]. [cited 2023 Dec 15]. Pancreatic cancer - Symptoms and causes. Available from: https://www.mayoclinic.org/diseases-conditions/pancreatic-cancer/symptoms-causes/syc-20355421
- Chemotherapy - mayo clinic [Internet]. [cited 2023 Dec 15]. Available from: https://www.mayoclinic.org/tests-procedures/chemotherapy/about/pac-20385033
- Cleveland Clinic [Internet]. [cited 2023 Dec 15]. Pancreas: what is it, function & location. Available from: https://my.clevelandclinic.org/health/body/21743-pancreas
- Puckett Y, Garfield K. Pancreatic cancer. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Dec 15]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK518996/
- nhs.uk [Internet]. 2018 [cited 2023 Dec 15]. Chronic pancreatitis. Available from: https://www.nhs.uk/conditions/chronic-pancreatitis/
- nhs.uk [Internet]. 2017 [cited 2023 Dec 15]. Cirrhosis. Available from: https://www.nhs.uk/conditions/cirrhosis/
- Pancreatic cancer types [Internet]. 2021 [cited 2023 Dec 15]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/pancreatic-cancer/pancreatic-cancer-types
- How does chemotherapy work? In: InformedHealth.org [Internet] [Internet]. Institute for Quality and Efficiency in Health Care (IQWiG); 2019 [cited 2023 Dec 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279427/
- Chemotherapy for pancreatic cancer [Internet]. [cited 2023 Dec 15]. Available from: https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer/treatment/chemotherapy
- Hajatdoost L, Sedaghat K, Walker EJ, Thomas J, Kosari S. Chemotherapy in pancreatic cancer: a systematic review. Medicina (Kaunas) [Internet]. 2018 Jul 11 [cited 2023 Dec 15];54(3):48. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122094/
- nhs.uk [Internet]. 2017 [cited 2023 Dec 15]. Chemotherapy - Side effects. Available from: https://www.nhs.uk/conditions/chemotherapy/side-effects/
- Advances in pancreatic cancer research - nci [Internet]. 2019 [cited 2023 Dec 15]. Available from: https://www.cancer.gov/types/pancreatic/research