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Pancreatic Cancer

Treatment of Pancreatic Cancer

Treatment for pancreatic cancer comes in 3 forms:

Sometimes a combination of the 3 treatments are used. If the cancer is caught early, surgical intervention can be used; that is usually followed by chemotherapy and radiation therapy. If the cancer has metastasized into other tissues, then chemotherapy plus or minus radiation are needed. Sometimes, if the tumor is encasing the blood vessels around the pancreas, radiation and chemotherapy are given initially to attempt to shrink the tumor and then if feasible, surgery will be attempted.

Surgical Treatment

The Pancreatoduodenectomy (Whipple) procedure is the most common operation where the head of the pancreas, duodenum, gallbladder, and end of the common bile duct are removed. Sometimes the bottom part of the stomach is taken as well, however this is usually based on the surgeon's preference. The end of the bile duct and remaining part of the pancreas and stomach are then attached to your intestines.

Total Pancreatectomies are seldom used because the benefits do not seem to be enough to justify the risk. After this procedure, patients might need insulin injections. Most will need digestive enzymes. The operation also presents serious risks.

Distal Pancreatectomies are for the less common islet cell cancers (glucagonomas and insulinomas). In this procedure only the tail part of the pancreas is removed, the patient will need insulin and glucagon shots for the rest of their life however.

Chemotherapy

Chemotherapy is used after surgery and it is also used for patients that have cancers that have metastasized beyond the pancreas. The chemotherapy drug of choice for pancreatic cancer is gemcitabine. Through testing in new clinical trials, the FDA has approved the use of erlotinib in conjunction with gemcitabine as first line therapy. As with all chemotherapies, the drugs affect all quickly dividing cells such as bone marrow and digestive tract tissue. So it is very important that the patient exercise caution while on chemotherapy drugs.

Radiation Therapy

Radiation Therapy is also used after surgery or for patients that have unresectable tumors. Radiation is when an external device shoots high energy radioactive beams at the affected area, killing any residual tumor cells or shrinking the tumor. You may experience a sunburn-like effect at the area of entry. When radiation therapy is directed at the gastrointestinal area, nausea and vomiting may occur as a side effect. Radiation therapy will also help relieve pain by reducing the size of the tumor.

Finally, if the cancer is too forgone to be treated, palliative procedures are used. Palliative procedures are made to treat the symptoms and to increase the overall quality of life. Many of the obstructed ducts can be bypassed, or held open with wire mesh stents. Pain management is key in palliative care, with medication or even operation on the nerves viable options for patients in severe pain. By using supplement tablets to accommodate for a lack of pancreatic enzymes and insulin, the body may act more normally, and the patient will not receive the harsh symptoms of pancreatic cancer.

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Last Reviewed: Mar 20, 2007

University of Cincinnati Syed A. Ahmad, MD
Assistant Professor of Surgery
Division of Surgical Oncology
Department of Surgery
College of Medicine
University of Cincinnati
Syed A. Ahmad, MD

 
University of Cincinnati Malek Safa, MD
Assistant Professor of Medicine
Division of Hematology/Oncology
Department of Internal Medicine
College of Medicine
University of Cincinnati
Malek  Safa, MD