If your pancreatic cancer grows beyond the confines of the pancreas and invades surrounding vital structures it may be considered "unresectable" or "locally advanced" by your surgeon.
The determination of unresectable pancreatic cancer is based on a careful evaluation of a high quality, detailed, thin section CT scan (3-D) of the pancreas sometimes with supporting information from an endoscopic ultrasound or ERCP. The determination of whether a pancreatic tumor can be resected, should be made by an experienced pancreatic surgeon since in selected situations apparent unresectable tumors may be resectable by an experienced pancreatic surgeon with specialized techniques including localized resection of the blood vessels. Furthermore, in some cases chemotherapy and/or radiation can be used to shrink the tumor so that it can become resectable.
A pancreatic cancer in the head of the pancreas is usually unresectable when the tumor has invaded blood vessels called the superior mesenteric artery and vein. Pancreatic cancer in the body and tail of the pancreas is unresectable if the tumor has invaded the blood vessels called the celiac artery and the hepatic artery.
If after careful evaluation, the pancreatic tumor is not thought to be resectable, then chemotherapy and radiation therapy can be used to slow down growth of the tumor and decrease the pressure of the tumor on surrounding structures. This can often improve symptoms and is thought to improve quality of life and in some cases can extend life when compared to no treatment. The common chemotherapy drugs that are utilized for treatment of pancreatic cancer include 5-FU and gemcitabine. Newer drugs and vaccine therapies are also being evaluated in clinical trials.
Radiation therapy is delivered in daily fractions over a six week period Monday thru Friday. The chemotherapy may be administered together or sequentially with the radiation therapy. The exact type of chemotherapy would depend on the treating oncologist. Here at Johns Hopkins we utilize a 4-D CT scan which is essentially a movie of your pancreas as you breathe. This allows us to monitor the motion of your pancreas and normal tissues (kidneys and liver) during radiation treatment. This should result in less toxicity and allow us to treat the tumor and/or tumor bed to a higher dose or radiation.