REVIEW ARTICLE - CURRENT TREATMENT AND OPTIMAL PATIENT-MANAGEMENT IN PANCREATIC-CANCER

This review analyses the current state of knowledge and understanding concerning the optimum treatment and therapeutic management of patient s who suffer from pancreatic cancer. It outlines recent advances in sc ientific understanding and assesses their potential future value to cl inicians in confronting this disease. Despite a significant expansion in scientific knowledge relating to factors underlying the early devel opment of pancreatic carcinoma, the clinician continues to be restrict ed to a severely limited therapeutic armoury for this disease. Local t herapies (surgery and radiation) are inevitably of limited value in th e face of a disease that is normally encountered at a stage where meta stasis is already highly developed. Despite such limitations, however, surgery performed in specialist units may be of value for 10-20% of p atients, with a 5-year survival rate in such units of between 10 and 2 4%. This may be improved even further by appropriate use of adjuvant t reatment. The advanced stage of the disease when normally encountered emphasizes the potential value of systemic treatment in this therapeut ic area. Unfortunately systemic treatment (chemotherapy) has been foun d to be ineffective to date in significantly extending survival, with a low rate and duration of remission being identified in most trials. The challenge for bath the health service and the pharmaceutical indus try is to harness recent and future developments in scientific knowled ge to the practical benefit of clinicians. Where cure is possible it s hould be vigorously pursued; where it is not, in this field above all others, clinicians have a duty of care. To achieve this it is necessar y to abandon the therapeutic nihilism that has characterized the attit udes of clinicians towards this disease in the past. It is time that s uch nihilism was replaced by a recognition of the challenges and the o pportunities available to clinicians in enhancing the quantity and qua lity of life available to patients. The dictum of 'curing whenever pos sible but caring always' should be the future therapeutic philosophy u sed to guide clinicians in this important and rapidly changing therape utic area.