How is pancreatic cancer treated?

The most effective treatment for pancreatic cancer is surgery, says Charles St. Hill, MD, an oncologist at Sunrise Hospital. In this video, he describes how different procedures depend on the location of the cancer in the pancreas.
Surgery is the standard treatment for pancreatic cancer, often offering the best chance for cure when the cancer has not spread beyond the pancreas. Specialists at the Center for Advanced Digestive Care customize pancreatic surgery for each patient to remove the tumor when possible, while preserving healthy tissue. We specialize in surgery to remove all cancerous tissue.

We often give patients who have inoperable tumors neoadjuvant chemotherapy, frequently combined with radiation therapy, to shrink tumors so that surgery is possible. More than one-third of patients traditionally considered inoperable at other institutions become candidates for surgery at the Center for Advanced Digestive Care.

The Whipple Procedure (pancreaticoduodenectomy) developed at NewYork-Presbyterian, is the surgical paradigm for pancreatic cancer, and is performed throughout the world to treat pancreatic (and other non-pancreatic) tumors once considered inoperable.

Other surgical procedures include:

• Laparoscopic distal pancreatectomy
• Central pancreatectomy
• Total pancreatectomy

Chemotherapy. Although pancreatic cancer is known to be resistant to chemotherapy, researchers at NewYork-Presbyterian Hospital/Weill Cornell Medical Center have developed a number of multi-drug regimens that have produced excellent results. For patients with pancreatic cancer that has spread throughout the abdomen, Center physicians will use a protocol, developed at NewYork-Presbyterian, to surgically remove as much of the tumor as possible, followed by continuous heated chemotherapy administered directly into the abdomen to treat any residual disease. We are also testing a number of new drug combinations, including gene therapy and a peptide drug that kills only cells with pre-malignant or cancerous genetic mutations.

Radiation. Our radiation oncologists use IMRT to map the tumor and destroy it while reducing damage to the surrounding healthy tissue. Brachytherapy is used for patients with tumors of the bile ducts, to reduce the tumor's size and open up the bile duct.
Ajay K. Sahajpal, MD
Transplant Surgery

This depends on the extent of the tumor and stage. If it has not clearly metastasized on imaging, then the recommended approach is surgery. If the tumor is in the head of the pancreas, the approaches include a combination of surgery with chemotherapy and radiation vs. neoadjuvant chemotherapy/radiation followed by surgery. It is not clear yet which approach is better. If the tumor is too extensive, or has already spread, then the approach changes to chemotherapy and/or radiation and surgery is generally not an option.

Recommended treatment options for pancreatic cancer 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.
Treatments for pancreatic cancer in general include those that remove the cancer, those that prevent the cancer from advancing, and those that relieve symptoms. If the pancreatic cancer is discovered in an early stage when there is still a chance it may be removed, surgery may be an option. Depending on where the tumor is located, the surgery may remove the pancreas or part of the pancreas. Other organs, or parts of organs, such as the spleen, stomach, and intestines, may need to be removed as well. Ablative treatments use heat or cold to kill tumors.

However, only a small percentage of pancreatic cancers are discovered in time to be surgically removed. Surgery may still be used as a treatment, but the surgery involved is meant to relieve symptoms, not eliminate the cancer. Stents may be  inserted in the body to help bile drain or allow the intestines to function. Chemotherapy and radiation therapy may also be used to kill cancer cells or keep the cancer from advancing quickly.

Newer treatments include targeted therapy, which uses drugs that identify cancer cells and attack them; immunotherapy (or biologic therapy) uses drugs that allow the body's own immune system to destroy cancer cells. Other drugs may be used to relieve pain and effects of the cancer or its treatment.
A patient's treatment plan depends on the stage of the disease, as well as the patient's general health and additional factors. It is important to understand that each person's cancer is slightly different - even if the stages are exactly the same. If you are diagnosed with pancreatic cancer, you should discuss your treatment options carefully and thoroughly with your physician.

Options for treating pancreatic cancer include surgery, chemotherapy, radiation therapy, and palliative care, depending on the specific characteristics of the cancer.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.