3. PANKREATIC CANCER
Pancreatic cancer is a very common and fatal cancer type. In more than 90% of the cases, the tumor type is adenocarcinoma, which originates from the exocrine glands and has a poor prognosis. In about 5% of the cases, the tumor type is neuroendocrine tumor, which originates from the islet cells and has a better prognosis. The remaining 5% is composed of metastases and rare primary tumors of the pancreas.
In pancreatic cancer, definitive diagnosis is usually made with percutaneous biopsy. Although the biopsy can also be performed endoscopically or surgically, today, the most commonly performed technique is ultrasound or CT-guided percutaneous biopsy.
The ideal treatment of pancreatic cancer is surgical operation. However, surgery is possible only in 15-20% of the patients at the time of diagnosis. The reason for this is the very close location of pancreas to mesenteric and portal vessels and early involvement of them by the tumor, which makes surgery impossible, and also cause distant metastases via the blood circulation. In patients not suitable to surgery, standart therapies include chemotherapy, radiotherapy or their combination.
In some centers, percutaneous ablation techniques such as radiofrequency, microwave and cryoablation are also performed. However, because of the risk of harming the bile ducts, stomach and bowel, which are inside or around the pancreas, these thermal ablation techniques have not become popular. Despite that, use of radiofrequency ablation at lower temperatures have been reported to be safe and effective for pancreas by some investigators.
For this reason, it is preferred to thermal techniques in pancreatic tumor ablation. In recent studies, IRE has been found to be safe and effective in pancreatic carcinoma, but its effect on patient survival is not yet known.
The neuroendocrine tumors of the pancreas have a slower course compared to adenocarcinoma, and for this reason, they can benefit more from interventinal treatments. In such patients, percutaneous ablation is preferred whenever possible because it is a potentially curative treatment. In recent years, somatostatin receptor analogues like Lutetium 177 DOTATATE, have been found to be safe and effective in neuroendocrine tumors. These drugs are normally given via the arm vein. However, they can also be given intraarterially, directly into the feeding arteries of the tumors, and can be more effective.
In the management of pancreatic tumors, one single treatment is rarely successful. In most patients, it is necessary to use surgery, chemotherapy, radiotherapy and interventional radiology, sometimes concomitantly and sometimes one after the other. The application of these methods in the correct order with a team approach may sometimes result in very successful outcomes even in the most difficult cases.