While every disease has unique characteristics and challenges, pancreatic cancer can be particularly difficult to treat.

Research teams around the world are working to uncover novel ways to attack this disease. Every day doctors learn more about how new treatments, such as immunotherapies, could help treat pancreatic cancer more effectively.

Johns Hopkins surgical oncologist Kelly Lafaro, M.D., M.P.H., explains what makes pancreatic cancer so challenging and why immunotherapy may result in treatment improvements in the near future.

Treating Pancreatic Cancer on Two Fronts

According to Lafaro, curing pancreatic cancer means completely eliminating all cancer from the body. "In order to do this we have to address two fronts: the tumor itself as well as any microscopic cells throughout the body”

Comprehensive pancreatic cancer treatment must address the following.

• Local disease: This refers to the primary tumor in the pancreas, and is called Stage 1. If caught at an early stage, surgery (sometimes with chemotherapy after surgery) may effectively win this battle, completely removing all signs of cancer.
• Systemic disease: Pancreatic cancer cells can spread — undetected — to other parts of the body. At some point, cells shed off of a pancreatic tumor, enter the blood stream and circulate throughout the body. Some of these cells may spread or metastasize to other organs such as the liver or lungs. This spreading can happen before patients show symptoms. Lafaro refers to these cells as “seeds” of metastatic disease. “Just as the wind blows and spreads dandelion seeds, new ones can grow great distances away. Even though at first the seeds are in the ground and you cannot see them, they are there and ultimately will grow given the appropriate conditions,” she says. Because doctors can’t always detect this microscopic disease at first, it can be much more difficult to fight.

Local Pancreatic Cancer Treatment

At the early stages of pancreatic cancer, surgery may effectively treat a tumor in the pancreas.

Procedures for local cancer may include the following.

• Whipple operation: This procedure, officially called a pancreaticoduodenectomy, treats tumors in the head or neck of the pancreas. During this surgery, a surgeon aims to remove all potential disease in and around the pancreas, and then reconnects all structures so the digestive system works more effectively. Surgeons at Johns Hopkins have revolutionized the performance of this operation over the previous four decades, dramatically decreasing complications and mortality from the operation. Johns Hopkins surgeons perform the most Whipple operations annually in the United States.
• Distal pancreatectomy: When a tumor grows in the body or tail of the pancreas, it’s removed with a distal pancreatectomy. In this procedure, a surgeon removes a portion of the pancreas (where the tumor resides) as well as the spleen, which could harbor microscopic cancer cells.

Systemic Pancreatic Cancer Treatment

Until recently, combinations of chemotherapy, radiation and surgery were only somewhat effective at treating systemic pancreatic cancer (cancer that has spread or metastasized to other parts of the body). Today, researchers are focused on developing biological therapies that are more targeted in how they attack pancreatic cancer cells.

For example, advances in immunotherapy are changing the way doctors treat pancreatic cancer. In clinical trials, doctors use a novel pancreatic cancer vaccine to fuel the pancreatic cancer cells with certain molecules, or markers. These markers make the cancer cells vulnerable to attack by the immune system. Another type of immunotherapy drug is then used to help the body’s immune system identify and destroy pancreatic cancer cells.

More research is necessary, but these evolving therapies have the potential to revolutionize how doctors treat pancreatic cancer both today and in the future.