Key Points
- Pancreatic cancer is one of the deadliest and most difficult cancers to detect and treat, underscoring the need for new therapeutic approaches.
- Focused ultrasound can provide thermal or mechanical tissue ablation, mechanical stimulation, drug delivery, and immunomodulatory effects.
Focused ultrasound is approved to treat pancreatic cancer outside the US, and there are ongoing clinical trials that may be of interest to patients in the US and around the world.
Pancreatic cancer begins in the pancreas, an organ behind the lower stomach that makes digestive juices and hormones. This devastating disease affects more than 500,000 people worldwide and over 50,000 people in the US each year. The mortality rate for pancreatic cancer is alarmingly high: In 2021, there were more than half a million deaths globally. This disease accounts for 4.6% of all cancer deaths, despite representing only 1.8% of all cancer cases. Some common factors that increase the risk of pancreatic cancer include smoking, obesity, and type 2 diabetes.
Multiple focused ultrasound approaches—including thermal or mechanical tissue ablation and non-tissue destructive mechanical stimulation – along with other immunomodulatory modalities, have the potential to treat pancreatic cancer.
Physicians lack good diagnostic tools for the early detection of pancreatic cancer, which does not show clear warning signs. Most patients are not diagnosed until the cancer has already spread beyond the pancreas (around 85%), making it too late for potentially curative surgery. Diagnosis and staging are based on imaging, and patients are categorized into one of three groups: resectable (tumor can be removed entirely), borderline resectable (tumor has some blood vessel involvement but might be operable), and unresectable.
Pancreatic cancer treatment depends on the stage of the disease and the patient’s overall health. Modern treatment usually combines surgery with chemotherapy, though the timing depends on how advanced the cancer is; some patients can have surgery right away, while others need chemotherapy first to stabilize the disease. Surgery for pancreatic cancer is complicated, because the pancreas is wrapped around major blood vessels, making it difficult to remove all the cancer while preserving these essential structures. Surgical techniques have not changed much over time, and better hospital care has made the primary procedure (called a Whipple procedure) much safer. However, surgeons often cannot remove all cancer cells since they must preserve crucial arteries.
Chemotherapy is often used before surgery (neoadjuvant) to shrink the tumor, after surgery (adjuvant) to kill remaining cancer cells, or as the primary treatment for advanced cancers. Standard chemotherapy regimens include FOLFIRINOX and gemcitabine/nab-paclitaxel. Radiation therapy may be used in combination with chemotherapy (chemoradiation), especially for locally advanced cancers that cannot be surgically removed. Targeted therapy and immunotherapy may be options for some patients, particularly those with specific genetic mutations. For advanced cancers, treatment focuses on managing symptoms and improving quality of life.