Pancreatic tumors occur mainly in the gland's duct system. They rarely occur in the endocrine portion of the pancreas (which produces a number of hormones, e.g. insulin, among others). Those that do, however, are called PNETs, have a better prognosis, and their treatment entails special rules and procedures.
Pancreatic cancer is a very serious disease that is typically quite severe. It has a strong tendency to produce further lesions (metastases) especially in the liver and the peritoneum. The treatment of pancreatic tumors is very difficult and often unsuccessful.
Over 2,000 people are diagnosed with pancreatic cancer in the Czech Republic each year. The incidence increases in people over the age of 50. Risk factors for the development of pancreatic cancer are not clearly defined. They certainly include smoking, alcoholism, and recurring inflammations of the pancreas (pancreatitis).
The disease lacks early symptoms. It is usually diagnosed at an advanced stage. The very first symptom is often yellowing (jaundice, not to be confused with infectious hepatitis, i.e. a viral inflammation of the liver). Other symptoms include intense pain in the upper part of the abdomen, loss of appetite (with a particular aversion to meat) and significant weight loss. The symptoms of advanced stage include persistent nausea and recurrent vomiting.
Various methods are used in the treatment of pancreatic tumours (in medical terminology: modalities), the choice and progression of which are strictly established.
In the treatment of pancreatic tumours, surgery (pancreatic resection, full or partial), including the resection of the duodenum, as well as surgery of the small intestine are of paramount importance. If it is not possible (for any reason), the disease is treated principally by chemotherapy, which can be followed by radiation (radiotherapy). The irradiation makes sense solely in the context of chemotherapy, i.e. in relation to chemotherapy. Successful resection is followed by postoperative chemotherapy, also supplemented by irradiation. Special rules apply to postoperative irradiation.
For pancreatic tumours, radical surgical treatment always comes first, if feasible. In other words, if the surgeon is able to perform radical surgery, it is best to do so as soon as possible. (Options are determined by the extent of pancreatic involvement and the health of the patient. Radical surgery means complete removal of the section of the organ.) If a radical procedure is not possible, the may perform surgery to bring the patient relief, depending on the situation (e.g. interconnection of the stomach and small intestine, which relieves from gastrointestinal issues).
If a radical procedure is not possible but the surgeon believes that the objective may be achieved through chemotherapy or irradiation, they will still plan the surgery, but will also request pre-surgical chemotherapy or radiotherapy. If the possibility of radical surgery can be achieved through pre-surgical treatment, it should be performed immediately.
Radiotherapy can be performed performed:
- Postoperatively, following radical surgery. Aimed at the eradication of any residual microscopic cancerous tissue.
- Independently, if surgery is not possible, in order to destroy the tumor.
- Pre-surgically. If the surgeon believes in the possibility of performing radical surgery for tumor reduction.
- In particular cases of recurrent cancer following radical surgery.
The irradiation follows several strict rules:
- Proper efficacy is achieved only if irradiation is applied in the context of chemotherapy. This means that chemotherapy is administered first, and after a certain period, irradiation follows.
- From a technical and biological standpoint, irradiation of the pancreas is extremely difficult. This is because the pancreas is surrounded by a number of organs which may be damaged by irradiation (liver, duodenum, kidneys, stomach, etc.). Proton therapy can solve this problem, making it the perfect tool for the job.
Chemotherapy is a fundamental method in the treatment of pancreatic tumours. Indications:
- Post-surgical – following radical surgery (aimed at the eradication of residual microscopic cancerous tissue).
- Pre-surgical – as with radiotherapy, aimed to achieve the possibility of a radical procedure.
- Independently – if radical surgery is not possible, and there is chance of its feasibility in the future.
- For these indications, irradiation procedures follow after a specific number of chemotherapy cycles.
Esophageal tumors are a very serious condition generating from the inner esophageal layer, the treatment of which is extremely difficult, but can be highly successful in that it can lead to a complete recovery.
Treatment consists of various sequences of chemotherapy, irradiation, and surgery. Typically, the process principally comprises of concurrent chemo- and radiation therapies, which is then followed by a surgical procedures.
Over 500 people are diagnosed with esophageal tumors in the Czech Republic each year. It is most frequently diagnosed in patients between 50 and 70 years of age.
The risk factors include smoking, the consumption of hard liquor, alcoholism, and low-residue unbalanced diet.
Esophageal tumor symptoms manifest early on, and include difficulties swallowing, painful swallowing, rapid weight loss, vomiting, bleeding and/or the vomiting of partly digested blood, persistent chest pain.
Various methods are used to treat esophageal tumors (in medical terminology: modalities), the choice and progression of which are strictly established. The treatment is always determined after a thorough medical consultation between the surgeons and oncologists.
Tumors are treated surgically, with resection, either initially (in case of small initial findings), or following the preparatory phase of irradiating the site, or the application of chemotherapy (in progressed tumours). The resection is a very complex and complicated procedure, which will be described in greater detail by the surgeon. The choice between irradiation and chemotherapy is made on the basis of the site of the tumor.
Chemotherapy is preferred in tumors originating in the passage between the esophagus and the stomach.
In tumours originating in the cervical section of the oesophagus, it is impossible to perform surgeries.
The radiotherapy of oesophageal tumours is applied as:
- pre-surgical, which means that the tumour is irradiated in relation to the subsequent surgical procedure, in a precise succession of time;
- independent – irradiation is carried out without the prospect of the surgery, either for tumours in the cervical section of the oesophagus, or in situations where surgery is out of the question for any reason;
- radiotherapy is sometimes also indicated as post-surgical treatment, usually in cases where the cancerous tissue was discovered during resection to be larger than originally estimated. The anatomic placement of esophagus – between two lungs and close to the heart – requires application to a geometrically complex area in the midst of organs to which irradiation needs to be minimised. That is why proton radiotherapy is used with great benefit.
Chemotherapy in esophageal tumors is predominantly applied concurrently with of irradiation. The goal of this type of chemotherapy treatment is to make the tumor more sensitive to irradiation. This type of chemotherapy is applied in lower doses and using a decreased concurrent number of substances - two at the most. It is therefore well-tolerated by the patients. Chemotherapy as an independent form of treatment is used in tumours originating in the passage between the esophagus and the stomach.
Anal tumors are a highly specific type of condition originating in the sphincter area, or even in the area of the transition between the sphincter and the skin. Currently, radiotherapy in anal tumours treatment is predominantly preferred over a surgical procedure, which requires the introduction of a permanent (lifelong) colostomy.
For a treatment that is extremely difficult and high-risk, 90% of cases can be cured using radiotherapy alone. Treatment using proton radiotherapy is less difficult.
170 to 190 people are diagnosed with anal tumours in the Czech Republic each year. The incidence increases after 40 years of age. Anal tumour incidence risk factors include HPV infection (vaccination available), smoking, and unusual sexual practices.
Although the anal tumour symptoms are early, they are often mistakenly diagnosed as mere haemorrhoids.
The main symptom is bleeding, as well as undefined pain in the sphincter, painful defecation, or sometimes finding of enlarged inguinal lymph-nodes.
The progression of anal tumours follows specific rules. The choice of therapeutic modalities is completely different from tumours of the adjacent anatomical site – rectum. It is thus necessary to quite clearly (and accurately, of course) establish the diagnosis: Anal tumour vs. rectal tumour.
The choice of therapeutic modalities is completely different from tumours of the adjacent anatomical site – rectum. It is thus necessary to quite clearly (and accurately, of course) establish the diagnosis: Anal tumour vs rectal tumour.
The treatment process is always chosen in consultation with the patient who has the choice between a surgical procedure and irradiation. Irradiation is always complemented with concurrent chemotherapy. Radiotherapy is very complicated and demanding, accompanied by a number of adverse effects not only in the areas of the sphincter skin and epithelium and surroundings, but also those adverse effects manifesting themselves in the blood count. For this reason, proton radiotherapy techniques have been developed to limit the adverse effects, typically allowing for the application of irradiation without needing to perform a temporary (relief) colostomy.
Surgical treatment of anal tumours has not been used as a first course of action since the 1980s. This is because a distinct radiation effect has been discovered leading in a high proportion of affected patients (depending on the disease stage between 80 % and 95 %) to a complete cure without surgery.
Nonetheless, the surgical procedure is still available as a standard procedure as an alternative modality to radiation treatment. It consists in the complete removal of the sphincter, i.e. it requires the introduction of permanent colostomy.
Currently, the main indication factor for surgery is a so called “life-saving treatment,” in situations when there is a relapse of the disease, or the disease is not completely cured with irradiation (depending on the disease stage the risk is between 5 % and 15 %).
The realm of surgical treatment also includes the question of a temporary colostomy for the period of radiotherapy application, facilitating better tolerance in post-radiation skin and epithelium response.
Radiotherapy is considered to be the primary treatment modality in anal tumours, unless the patient decides to undergo surgery.
Radiotherapy in anal tumours is an extremely complicated form of treatment. Standard application of chemotherapy concurrently with irradiation forms its integral part. It is accompanied by an array of adverse effects to the skin, epithelia, urogenital system, and the blood count as well.
This is why proton radiotherapy is used, applying a more favourable dose distribution than conventional photon radiotherapy with the reduction (but not elimination, of course) of adverse effects.
In the majority of cases, proton radiotherapy can be performed without introducing a temporary colostomy, however, not in all cases. The anticancer efficacy of both proton and photon radiotherapy is identical.
Chemotherapy is customarily administered concurrently with irradiation, while as a standalone modality it is considered as a secondary option only. It is indicated in cases of large tumorous masses prior to radiotherapy with the goal of reducing the size of the radiated mass. It is also indicated for relapses in the form of distant metastases (local relapse can be resolved with life-saving surgery).