Pancreatic cancer, often diagnosed at an advanced stage due to its insidious progression and late-onset symptoms, leaves many patients ineligible for surgical treatment. However, Irreversible Electroporation (IRE) is emerging as a promising alternative. Unlike conventional techniques, IRE destroys tumor cells while preserving blood vessels, leading to a survival benefit nearly twice as long as traditional methods. The procedure is now being implemented in leading medical centers worldwide.

Risk Factors for Pancreatic Cancer

The pancreas, a 15 cm-long organ located behind the stomach in the upper abdomen, plays a crucial role in digestion and blood sugar regulation. Pancreatic cancer accounts for approximately 2% of all malignancies but contributes to 5% of cancer-related deaths due to its aggressive nature.

The disease predominantly affects individuals over 40 years of age and occurs at similar rates in both men and women. Established risk factors include smoking, alcohol consumption, and genetic predisposition. The symptoms of pancreatic cancer vary widely, but in pancreatic adenocarcinoma, tumors located in the head of the pancreas can obstruct the bile duct, leading to jaundice. Tumors in the body or tail of the pancreas often remain asymptomatic until advanced stages, at which point severe abdominal pain may develop.

Diagnosis of Pancreatic Cancer

Pancreatic cancer is diagnosed primarily through radiological imaging. The key modalities for detecting and differentiating pancreatic masses include:

• Ultrasonography
• Computed Tomography (CT)
• Magnetic Resonance Imaging (MRI)

For staging pancreatic adenocarcinomas, triphasic CT scanning is considered the most effective imaging technique. Additionally, liver function tests and tumor markers such as CA 19-9 and CEA are assessed. For comprehensive staging, abdominal and thoracic CT as well as PET-CT are utilized.

Treatment of Pancreatic Cancer

Surgical resection remains the most effective treatment for pancreatic cancer. However, only 15% of patients are eligible for surgery at the time of diagnosis. The remaining 85% have either locally advanced (stage III) or metastatic disease (stage IV), making them unsuitable for surgical intervention.

For stage I and II tumors, the standard treatment consists of surgery followed by chemotherapy and radiotherapy. In advanced-stage cases, where surgery is not an option, treatment is limited to chemotherapy and radiotherapy. However, for stage III pancreatic cancer, a new therapeutic approach—Irreversible Electroporation (IRE)—is now being utilized.

Treatment of Stage III Pancreatic Cancer

In recent years, major medical centers have begun employing the IRE technique in the treatment of stage III pancreatic adenocarcinoma. This innovative procedure selectively destroys tumor cells while preserving surrounding blood vessels, making it a significant treatment alternative. Compared to chemotherapy and radiotherapy alone, IRE has been shown to double patient survival rates.

Advantages of the IRE Method

Traditional thermal ablation techniques, such as radiofrequency ablation (RFA) and microwave ablation, are ineffective for pancreatic tumors due to the risk of damaging major blood vessels. Unlike these heat-based methods, IRE does not cause vascular injury. Instead, it induces microscopic perforations in the tumor cell membranes, disrupting cellular homeostasis and leading to tumor cell death.

This technique offers a viable treatment option for patients with vascular invasion, who would otherwise be deemed inoperable (stage III). During the procedure, a 1,500-watt direct electrical current per centimeter is applied, creating microscopic pores in the tumor cell membranes. The tumor subsequently undergoes cell death in situ.

IRE can be performed using ultrasound or CT guidance, but the safest approach involves conducting the procedure in an operating room, with an interventional radiologist applying the treatment after abdominal access is achieved. If necessary, following IRE, a general surgeon may proceed with surgical tumor resection.

Preventive Measures: Quit Smoking and Monitor Genetic Risk

To reduce the risk of pancreatic cancer, individuals should avoid smoking and excessive alcohol consumption. Those with a family history of pancreatic cancer should undergo regular screenings for early detection.

Professor Okan Akhan, MD.
Head of Radiology Department, Bayındır Söğütözü Hospital