Pancreatic Cancer Treatments
Treating pancreatic cancer is complex and requires a team approach often including, surgery, medical and radiation oncology, radiology, gastroenterology and other specialists.
Recommended treatment options depend on your stage of the disease and individual circumstances.. Pancreatic cancer may be treated with surgery, radiation therapy, chemotherapy or a combination of any of these modalities. Surgically removing the entire tumor is preferred when possible and offers the best chance to extend survival. For more advanced disease, other treatment modalities can have an impact on controlling your symptoms and improving your quality of life.
Surgery may be used alone or in combination with radiation and chemotherapy. The type of surgery depends on your tumor’s location and size, stage of the disease and your general health. All or part of the pancreas may be removed. They can be done safely. Some patients may require insulin or dietary enzymes after these operations
Whipple Procedure: the most common type of surgery for pancreatic cancer. If your tumor is in the head of the pancreas, your surgeon will remove the head, part of the small intestine, part of the stomach and part of the bile duct. The gallbladder is also removed. Generally, after this procedure you are still able to produce adequate amounts of insulin and digestive enzymes.
Distal Pancreatectomy: during this procedure, your surgeon removes the tail of the pancreas, or the tail and a portion of the body of the pancreas, as well as the spleen. This procedure is often done using minimally invasive techniques.
Total Pancreatectomy: during this procedure, your surgeon removes the entire pancreas, part of the small intestine, part of the stomach, part of the bile duct, the gallbladder and spleen. Following this procedure, you no longer have the cells that produce insulin. This means you'll be diabetic and dependent on insulin and will also need to take pancreatic enzymes with meals.
These types of surgeries may make it difficult for you to digest foods. Nutritional counseling and supportive care are often necessary following pancreatic surgery. You need to be encouraged to take in enough calories and protein to maintain your weight and strength and also promote healing. You’ll be instructed to eat four to five small meals during the day rather than three large meals. Sometimes tube feedings are required until you’re able to transition back to normal eating. Some patients may require enzymes in the form of medications taken by mouth to help in digesting foods.
Biliary Bypass: sometimes the tumor may block your common bile duct. This surgery re-directs the flow of bile around the tumor and will relieve jaundice (yellow skin and eyes).
Gastric Bypass: sometimes tumors block the portion of your small intestine that connects to your stomach (duodenum). This surgery will allow food to move through your stomach past the blockage.
Stents: these are small plastic or metal tubes that can be inserted to keep your bile duct, pancreatic duct or duodenum open if they are blocked.
Chemotherapy is a systemic treatment. Chemotherapy drugs are given intravenously (through a needle in a vein) and travel in your bloodstream throughout your body. Even after surgery pancreatic cancer can sometimes metastasize (spread). Chemotherapy is often given after surgery to try to prevent the cancer from coming back (adjuvant therapy). Chemotherapy may be given alone, with radiation, or with surgery and radiation. If you have tumors that are potentially resectable (removable by surgery), you may receive chemotherapy before or after surgery.
Radiation therapy uses high-energy rays to kill cancer cells. Radiation is a local therapy. It affects cancer cells only in the area being treated. You will often receive low doses of chemotherapy along with radiation to increase the effectiveness of the treatment. Radiation may be given alone, with surgery, chemotherapy or both.
The most common type of radiation therapy used in treating pancreatic cancer is called external beam radiation therapy. Types of external beam therapy used in the treatment of pancreatic cancer include Intensity-Modulated Radiation Therapy and CyberKnife radiosurgery.
Clinical trials offer additional treatment options for some patients. Some promising new treatments may only be available in a research setting. Aurora offers access to these clinical trials of therapies that might not be widely available elsewhere.