When stage 4 pancreatic cancer progresses through metastasis to abdominal organs and potentially spreads to distant sites including lungs, bones, and brain, the patient is no longer considered a candidate for radical surgery. However, there are other effective stage 4 pancreatic cancer treatment options that can help improve both life expectancy and quality of life.
Chemotherapy
The foundation of treatment is chemotherapy. It typically involves a combination protocol, which includes four different medications. While combination therapy proves more effective, it also carries higher toxicity, so it’s primarily prescribed to patients in relatively good health. The selection between single-agent or combination chemotherapy regimens is based on factors such as the patient’s performance status, comorbidities, and personal preferences in discussion with their oncologist.
While chemotherapy cannot cure the cancer, it helps extend survival, reduces pain and other symptoms, and decreases the risk of digestive tract obstruction, jaundice, bone pain, and other manifestations.
As part of a comprehensive treatment plan, chemotherapy is often combined with other approaches such as radiation therapy, creating a multi-modal strategy that addresses both the primary tumor and its complications.
Targeted and Immunotherapy Approaches
To determine whether a patient is a candidate for targeted and/or immunotherapy, additional diagnosis and testing are required to identify specific tumor genetic alterations.
Some patients with pancreatic cancer may be candidates for BRAF, NTRK, RET, KRAS, EGFR, PARP, or HER2 and HER3 inhibitors. This personalized therapy is selected based on laboratory diagnostics.
Immunotherapy is less commonly included in treatment protocols. It’s primarily prescribed for patients with Lynch syndrome and high tumor mutational burden (TMB-H). These patients receive PD-1 inhibitors, which prevent the tumor from evading immune response.
Some German clinics use dendritic cell vaccines, which have shown promising results. This treatment approach allows for the creation of natural anticancer immunity. When standard therapy options have been exhausted, patients may consider participating in research studies or exploring alternative and holistic medicine approaches.
Palliative Care
Patients with pancreatic cancer often require interventions for pain, jaundice, and digestive tract obstruction. Supportive care is prescribed to reduce symptoms and improve overall health status.
Abdominal pain becomes a frequent challenge for patients in advanced stages. They are prescribed opiates – strong narcotic analgesic medications. Since even these don’t always adequately control pain, invasive procedures or surgical interventions may be necessary. For example, doctors may perform celiac plexus neurolysis: destroying abdominal nerves through chemical injection to block pain signals.
For more pronounced and lasting effects, surgical removal of celiac nerves (splanchnicectomy) may be performed. In advanced cases, this surgery is performed thoracoscopically (through small chest incisions), which helps reduce recovery time. This approach is the preferred method of pain management for patients with relatively good survival prognosis who require longer-lasting results.
Radiation therapy is employed to reduce bone pain and prevent fractures in cases of bone metastases.
For jaundice relief, bile drainage procedures may be necessary: either percutaneous (through an abdominal puncture) or endoscopic (through the digestive tract) drainage of the biliary system.
In some patients, the tumor may invade the duodenum and block food passage. This situation may require stent placement to keep the duodenal lumen open, or jejunostomy – creating an opening in the jejunum that exits through the anterior abdominal wall.
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