Pancreatic cancer metastasis and chemotherapy

Metastatic Pancreatic Cancer 

Metastasis is the term applied to cancer that has spread from its place of origin to other places in the body or the process by which the cancer cells spread. When a tumor is formed by metastasized cancer cells, then it is referred to as a metastatic tumor. Metastasized cancer cells contain the same type of cancer cells like those of their place of origin, so they are still named according to the original cancer site.

Most metastatic cancers cannot be cured by today’s available treatments and are responsible for most deaths. However, some types of metastatic cancers may have more positive prognoses. Most treatment plans for patients with metastatic pancreatic cancer aim to control the further spread of cancer, relieve symptoms, and prolong the patient’s life.

Cancer cells metastasize depending on the properties of mutation, as well as the susceptibility of the immune system. Not all cancerous cells have the ability to metastasize, and some noncancerous cells can prevent cancer cells from metastasizing. It’s been found that some cancer cells that have metastasized can remain dormant for a few years before they start growing or may not even grow at all.

Pancreatic cancer usually metastasizes to nearby lymph nodes, liver, duodenum, stomach, colon, peritoneum, and even the lungs. At times, it can spread to the patient’s skin forming nodular metastases which can be quite painful, and to the brain to produce meningeal carcinomatosis.


Chemotherapy is a treatment that involves anti-cancer drugs that are injected intravenously or orally. It quickly enters the bloodstream and spreads to the entire body which makes it effective in battling cancer that has metastasized to various parts of the body. It functions by killing cells and stopping them from dividing. Chemotherapy can be used in various stages of cancer, but most of the time, it is patients with more advanced cancers that are given this treatment.

Adjuvant Treatment

This is when chemotherapy is administered to a patient after surgery to kill any cancer cells that may have been left behind. This helps prevent cancer from possibly returning afterward.

The most commonly used adjuvant chemotherapy drug is Gemcitabine (also known as Gemzar). However, for more advanced pancreatic cancer, the Picozzi regimen is used. This is a treatment of Cisplatin (also known as Platinol) and alpha interferons in combination with radiation therapy.

Neoadjuvant Treatment

This is chemotherapy that is given to patients before getting surgery. It is meant to shrink the tumor beforehand to make it easier to remove the tumor surgically.

Drugs Used

Gemcitabine (marketed as Gemzar) is the most commonly used chemotherapy drug for pancreatic cancer. Another commonly used one is 5-fluorouracil (5-FU). Gemcitabine is the first choice for patients in more advanced stages of pancreatic cancer and has been a standard chemotherapy drug since it was first introduced in 1997. Studies have found that Gemcitabine increases the survival rate of patients and it prolongs the time it would usually take for the disease to return. Sometimes, a combination of drugs can be more effective.

Here are some of the combinations that have been undergoing clinical trials:

Gemcitabine + Fluorouracil

Gemcitabine + Capecitabine

Gemcitabine + Cisplatin

Gemcitabine + Oxaliplatin

Gemcitabine + Erlotinib

Although combination treatments have been found to be more effective, a downside is that there are also more side effects in combination treatments than when Gemcitabine is used alone. It’s wise for patients to go over each combination with their doctor to see which would work best for them.

Questions To Ask Your Doctor

Some questions you may want to ask your physician before choosing to get chemotherapy are these:

Will chemotherapy help with my stage of cancer?

Will it be harmful to my body?

What can I do to help relieve some of the side effects?

Is it painful?

Pancreatic Cancer Prognosis

In some cases of pancreatic cancer, the prognosis is good but in most cases; it has spread into the blood stream, and the tumor cannot anymore be removed at the time of diagnosis. Chemotherapy and radiation therapy are usually indicated to people with pancreatic cancer. Surgery is the first choice but for those who are at the advanced stage, the chance of surviving is less than a year. About 95% of people diagnosed with this condition will not survive five years after the diagnosis.

Recurrent Pancreatic Cancer

Cancer is defined as recurrent when it returns following the treatment. Cancer could recur in the same place, or it could start in a distant organ. When pancreatic cancer recurs, patients are given the same treatment as with metastatic cancer. Chemotherapy, radiation therapy, and surgery may be performed to relieve symptoms.

Dr. Adem Gunes
Dr. Abdullah El-Hossami