Glossary of Pancreatic Cancer Terms

A procedure using heat, cold or chemicals to destroy cancer cells.

Not all mutations found via somatic or genetic testing are actionable. While some have FDA approved drugs already, others may be in various stages of development meaning you may have to enroll in a clinical trial, others have no clinical research.

Given pre-surgery to shrink tumors and improve surgical success.

The accumulation of fluid in the abdominal area which causing pain and the stomach to swell. This is common in people with metastatic pancreatic cancer. Treatment usually involves a procedure to drain this liquid called Paracentesis. (Source: PANCAN)

A tumor that may be possible to remove after shrinking with other treatments. (Adjuvant Therapy)

Biliary obstruction occurs when one or more of the ducts that carry bile from the liver to the gallbladder and small intestine become blocked. Bile is a fluid that helps digest fats. When these ducts are blocked, bile can’t flow properly, leading to a build-up in the liver. This can cause symptoms like jaundice (yellowing of the skin and eyes), dark urine, pale stools, itchy skin, and abdominal pai. (Source: WebMD)

Biliary drainage is a medical procedure to help remove bile from the liver when there’s a blockage in the bile ducts. This blockage prevents bile from flowing normally. The procedure involves placing a small tube, called a stent, into the bile duct to allow the bile to drain properly. This helps relieve symptoms like jaundice (yellowing of the skin and eyes), itching, and abdominal pain, and prevents further complications from the bile buildup.

A biliary stent is a small tube inserted into the bile duct to keep it open and ensure bile can flow properly from the liver to the gallbladder and small intestine. This is often used when the bile duct is blocked due to conditions like pancreatic cancer. The stent helps relieve symptoms such as jaundice (yellowing of the skin and eyes), itching, and abdominal pain by allowing bile to bypass the blockage and flow normally.

Cachexia is a condition often seen in people with pancreatic cancer. It causes extreme weight loss and muscle wasting, even if you're eating enough food. This happens because the body starts breaking down its own muscles and fat. Cachexia can make you feel very weak and tired, and it's different from regular weight loss. (Source: PANCAN)

A bundle of nerves located in the upper abdomen which are responsible for sending pain signals to the bladder, stomach, liver, intestines, brain and spinal cord.

A same day procedure which a doctor in which a surgeon will insert a needle through the skin to inject a numbing solution to block pain signals from the Celiac nerves. Treatment can be performed multiple times, with three to six months of pain relief each time.

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A treatment which combines chemo drugs along with the high-energy rays used in radiation therapy to kill cancer cells. Used together, they can be more effective then mono therapies.

Research study conducted with humans to determine the safety, effectiveness and side effects of new medical treatments, drugs, or other interventions.

The structure of clinical trials is organized based on the phase.

Phase I: Tests the safety, dosage, and side effects of a new treatment in a small group of participants (20-80).

Phase II: Expands the study to a larger group (100-300) to assess the treatment’s effectiveness and further evaluate its safety.

Phase III: Involves an even larger group (1,000-3,000) to confirm effectiveness, monitor side effects, compare with standard treatments, and collect data for safe use.

Phase IV: Conducted after a treatment has been approved and marketed to gather additional information on its long-term effects, benefits, and optimal use.

A type of tumour marker that is sometimes evaluated in combination with other tests to quantify cancer growth or shrinkage.

A computed tomography scan, is a imaging test that uses X-rays to create detailed cross-sectional images of the body.

For pancreatic cancer patients, it’s used to visualize the pancreas and surrounding structures, such as blood vessels and lymph nodes, to determine the size and location of tumours to guide treatment planning.

The international standard for processing, storing and displaying medical imaging including any CT, MRI, Ultrasound, or PET scans that you may have taken.

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Clinical Trials

Disease-Free Survival (DFS) refers to the length of time after treatment for cancer, such as surgery or chemotherapy, during which a patient remains free from any signs or symptoms of the disease.

In the context of clinical trials, DFS is an important measure to evaluate the effectiveness of a treatment. A longer DFS indicates that the treatment is effective in preventing the cancer from returning, helping to determine the long-term success of the therapy.

Clinical Trials

Patient characteristics that disqualify participation for applicants. May include the presence or absence of existing conditions, gender, age, specific disease characteristics, or any other characteristics study coordinators create.

Chemotherapy

A chemotherapy drug, Combines four drugs—fluorouracil, leucovorin, irinotecan, and oxaliplatin—for patients with good performance status.

Endocrine Tumour

This type of tumour produces high levels of gastrin, a hormone that stimulates acid production in the stomach, causing peptic ulcers.

Chemotherapy

A chemotherapy drug that is administered alone as a mono-therapy or with other agents like Abraxane, suitable for those unable to tolerate aggressive treatment.

A blood test that determines if there is a genetic, inherited reason for someone with Pancreatic cancer and their familes. There are some drugs developed for certain genetic markers.

Hepatic function refers to the work your liver does to keep your body healthy. For pancreatic cancer patients, it’s important to understand that the liver can be affected by the disease, either directly or indirectly.

Maintaining good hepatic function is important because a healthy liver supports overall health and can help manage some of the side effects of cancer treatment.

Clinical Trials

Patient characteristics required for entry into a specific clinical trial. May include but not limited to specific stages, genetic markers, tumor mutations, presence or absence of existing conditions, gender, or any other characteristics created by study coordinators.

Jaundice is a condition where the skin and the white part of the eyes turn yellow. It happens when there's too much bilirubin in the blood. Bilirubin is a yellow substance that forms when red blood cells break down. In pancreatic cancer, jaundice can occur when the cancer blocks the bile ducts, preventing bile (a fluid that helps digest fats) from flowing normally. Jaundice can cause itching, dark urine, and pale stools. Treatment for jaundice in pancreatic cancer often involves procedures to unblock the bile ducts, which can help relieve symptoms. (Source: PANCAN)

Immunotherapy

Keytruda is a brand name for the drug pembrolizumab, which is an immunotherapy used to treat various types of cancer, including pancreatic cancer in some cases. It works by helping the immune system recognize and attack cancer cells.

Keytruda targets a protein called PD-1 on the surface of immune cells, blocking it from binding with another protein, PD-L1, found on cancer cells. This prevents the cancer cells from hiding from the immune system, allowing the immune cells to destroy them more effectively. Keytruda is administered through an intravenous (IV) infusion, usually every few weeks. (Source: Keytruda)

Stage 1, cancer of the Pancreas which is confined only to the Pancreas and hasn’t spread to other areas of the body.

Stage 2, Locally advanced pancreatic cancer means the cancer has grown and spread to nearby tissues or organs, but it hasn't spread to distant parts of the body.

It's a stage of pancreatic cancer where the tumor is more advanced than early-stage cancer but hasn't metastasized to distant organs yet.

The spread of cancer cells to other areas of the body other than the site in which they originated in. Metastasis in pancreatic cancer refers to the spread of cancer cells from the pancreas to other parts of the body, such as the liver, lungs, or peritoneum.

Chemotherapy

Modified FOLFIRINOX is a chemotherapy regimen used to treat various types of cancer including Pancreatic Cancer. It consists of the following drugs:

1. FOLinic acid (leucovorin) - A vitamin that helps the other chemotherapy drugs work better.
2. FLUorouracil (5-FU) - A chemotherapy drug that interferes with the growth of cancer cells.
3. IRINotecan - Another chemotherapy drug that slows or stops the growth of cancer cells.
4. OXaliplatin - A chemotherapy drug that works by interfering with the DNA in cancer cells.

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Microsatellite instability (MSI) is a condition where the genetic material in cells becomes unstable, which can lead to mistakes in how the cells grow and divide. In pancreatic cancer, knowing if MSI is present can help doctors choose the best treatment options for patients.

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Magnetic Resonance Imaging. Imaging test that uses a combination of magnetic and radio waves to detail the body’s internal structure.

MSI-H stands for Microsatellite Instability-High, a condition where cancer cells have a large number of genetic mutations in certain repeated sequences of DNA called microsatellites. This occurs because the cells’ DNA repair system isn't working properly. In pancreatic cancer, having MSI-H can influence treatment options, as tumors with this characteristic may respond better to certain immunotherapy drugs.

MSI-L stands for Microsatellite Instability-Low, which means there are fewer genetic mutations in the microsatellites (short, repeated sequences of DNA) within cancer cells compared to MSI-High. This indicates that the DNA repair system in the cells is mostly functional but has some deficiencies. In pancreatic cancer, MSI-L is less common and typically has less impact on treatment decisions compared to MSI-High.

MSI-Stable means that the cancer’s DNA is stable and not making a lot of mistakes when it copies itself. For pancreatic cancer patients, this tells doctors that certain treatments might not work as well because the cancer cells are behaving more normally in terms of their DNA. (Source: National Cancer Institute.)

Chemotherapy

A Chemo drug comprised of anoliposomal irinotecan, 5-fluorouracil, leucovorin and oxaliplatin (NALIRIFOX) which gained FDA- approval in February of 2024. Its status in Canada is complicated. It is approved by Health Canada, but not funded. This means some patients in Canada may have to pay out of pocket if they access this drug.

No evidence of disease. For pancreatic cancer patients, "No Evidence of Disease" (NED) means that, following treatment, no signs of cancer are detectable using the current diagnostic tests available.

This does not necessarily mean the cancer is cured, but rather that it is not visible through imaging techniques, blood tests, or physical examinations at that moment.

Regular follow-ups and monitoring are still needed. The NED status is a hopeful milestone, signifying a period of remission and an absence of detectable cancer cells in the body.

Used post-surgery to eliminate microscopic residual disease. Studies have demonstrated there is a much improved success rate in some patients versus only palliative care options.

Neuroendocrine Tumors (NETs) are a type of cancer that starts in the cells of the neuroendocrine system, which includes cells that have traits of both nerve cells and hormone-producing cells. NETs can develop in various parts of the body, including the pancreas.

In comparison, adenocarcinoma is a type of cancer that starts in glandular cells, which are cells that line the inside of organs and produce secretions. In the pancreas, adenocarcinoma is the most common type of pancreatic cancer.

Key Differences:

• Cell Type: NETs come from neuroendocrine cells; adenocarcinoma comes from glandular cells.
• Growth and Spread: NETs often grow more slowly and may be less aggressive than adenocarcinoma. Adenocarcinoma tends to be more aggressive and spreads more quickly.
• Symptoms: NETs may produce hormones causing specific symptoms, while adenocarcinoma usually causes more general symptoms like weight loss and jaundice.
• Survival Rates: NETs typically have a better prognosis and longer survival rates compared to adenocarcinoma. However, this can vary depending on the stage and location of the tumour.

(Source: Canadian Cancer Society. (n.d.). Neuroendocrine Tumors/ American Cancer Society. Pancreatic Cancer)

A condition where the body has such a low level of neutrophils (a type of white blood cells that helps the body fight off infections) that it’s harder for the body to protect you from bacteria and viruses, increasing risk for infection. This is super common for pancreatic cancer patients undergoing Chemotherapy.

Onivyde is the brand name for irinotecan liposome injection, a specific formulation of the chemotherapy drug irinotecan, encapsulated in liposomes to enhance its delivery to cancer cells.

NALIRIFINOX is a combination chemotherapy regimen that includes Onivyde (irinotecan liposome injection), oxaliplatin, leucovorin, and fluorouracil. This regimen is used to treat metastatic pancreatic cancer, offering a more comprehensive approach by combining multiple drugs to attack the cancer in different ways.

(Source: Onivyde)

Clinical Trials

In the context of clinical trials, Overall Survival (OS) refers to the length of time from either the date of diagnosis or the start of treatment that patients diagnosed with Pancreatic cancer are still alive. It is a key measure used to evaluate the effectiveness of a new treatment or therapy. A higher OS indicates that patients are living longer after receiving the treatment being studied, making it an important endpoint for determining the success of a clinical trial.

More commonly known as the “Whipple” Procedure, is a major surgery used to treat pancreatic cancer. It involves the removal of the head of the pancreas, the duodenum (the first part of the small intestine), the gallbladder, and part of the bile duct and stomach. The remaining organs are then reconnected. Recovery periods can be long and patients can expect to continue use of Pancreatic Enzymes for life.

Palliative care means relieving symptoms and improving quality of life, instead of curative. It should not be confused with end-of-life care—palliative care can be accessed anytime.

Pancreatic cancer is a type of cancer that starts in the cells of the pancreas, an organ in your abdomen that helps with digestion and regulates blood sugar.

The pancreas has two main jobs: producing enzymes that help break down food and releasing hormones, like insulin, that control blood sugar levels. When cancer develops, it means that some of the cells in the pancreas start to grow uncontrollably and form a tumor.

Pancreatic Cancer has no methods for early detection, and because the pancreas is deep inside the body, the early symptoms are usually mild or absent. By the time it is diagnosed, the cancer might have already spread to other parts of the body.

Symptoms can include jaundice (yellowing of the skin and eyes), weight loss, loss of appetite, and pain in the upper abdomen or back.

Treatments may include surgery, chemotherapy, radiation, or a combination of these, depending on the stage of the cancer and overall health of the patient.

A condition where the pancreas does not produce enzymes properly, meaning the body may be unable to digest food properly or absorb vitamins, minerals and nutrients as well.

Mostly referring to the encapsulated form of enzymes (Lipase, Protease, Amylase) sourced from pig pancreas and developed for those living with Pancreatic Cancer, or others with some degree of Pancreatic Insufficiency.

A Procedure used to remove ascites, the buildup of fluid in the abdominal cavity, often seen in pancreatic cancer. It involves inserting a thin needle into the abdomen to drain the fluid, providing relief from symptoms like abdominal swelling and discomfort. While paracentesis can improve quality of life, it is considered a palliative measure and does not cure pancreatic cancer. There is also the option to place a permanent drain of fluid accumulation is reoccurring quickly.

The thin membrane that lines the abdominal area and covers most of the abdominal organs.

Positron Emission Tomography scan, is an imaging test that uses a small amount of radioactive sugar injected into the body to highlight areas of high metabolic activity, such as cancer cells. For pancreatic cancer patients, a PET scan helps detect tumors, assess the spread of cancer, and monitor the effectiveness of treatments.

A major blood vessel that transports blood to the liver from the digestive organs.

See Targeted Therapy.

A treatment using high-energy rays or particles to target and destroy cancer cells.

Stands for Response Evaluation Criteria in Small Tumors. A methodology that measures physical sizing of existing tumors, development and location of new growth and uses this framework to judge if your treatment is working.

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A tumor that is possible to remove surgically.

A type of test performed on the your tumor biopsy sample, examining the genetic mutations in the tumor itself, rather than your inherited genes. It looks at the specific mutations that may be responsible for driving cancer growth.

The evaluation of a your diagnosis or treatment plan by another doctor or specialist to ensure its accuracy and effectiveness. It provides patients with additional information and potential alternatives, helping you make more informed decisions about the direction your treatment is going.

In the context of Canadian patients seeking to apply for clinical trials outside of Canada, self-referral is the process by which patients independently contact and apply to clinical trials in the United States. Since Canadian physicians are unable to refer patients directly to these international trials, individuals must take the initiative to research, reach out, and submit applications to participate in the trials themselves.

Staging in pancreatic cancer describes how much the cancer has grown and spread. It helps doctors determine the best treatment. For Pancreatic Cancer, there are five stages from 0-5.

Stage 0: The cancer cells are present only in the lining of the pancreas.

Stage 1: Cancer is small and only in the pancreas.

Stage 2: Cancer has grown a bit and may have spread to nearby tissues and lymph nodes.

Stage 3: Cancer has spread to major blood vessels and more lymph nodes.

Stage 4: Cancer has spread to other parts of the body, like the liver or lungs.

The use of drugs specifically designed to attack cancer cells by targeting specific genetic or tumor mutations. Compared to Chemotherapy which effects all cells including the healthy ones, targeted therapy therefore has the potential to minimize side effects.

Substances created by either your body’s cells, or cancer cells in response to the cancer.

Tumor mutational burden (TMB) is a measure of how many genetic changes are present in a tumor. It helps doctors understand how "busy" the tumor is with mutations. This level can influence treatment options, including Keytruda.

Refers to a tumour that is unable to be removed by surgery.

Vascular resection for pancreatic cancer involves removing and reconstructing blood vessels that the tumor has invaded. This surgery helps ensure the complete removal of the cancer while maintaining blood flow to essential organs.

Sources

• Mayo Clinic: Pancreatic Cancer Treatment
• National Cancer Institute: Surgery for Pancreatic Cancer

See Pancreaticoduodenectomy.

Chemotherapy

Fluorouracil, or 5FU is a type of chemotherapy drug typically used in combination with other chemo drugs.