How is pancreatic cancer treated?

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.
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.
Aurora Health Care
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.
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.

Johns Hopkins Medicine
As with many cancers, surgery, chemotherapy and radiation are used alone or in combination to treat pancreatic cancer. There are, however, many surgical options to consider for pancreatic cancer, depending on the type and extent of the disease. The following are available surgical options:
•Whipple Surgery - During this procedure, surgeons remove the head of the pancreas, most of the duodenum (a part of the small intestine), a portion of the bile duct, the gallbladder, and associated lymph nodes. In some cases, the entire duodenum and a portion of the stomach must be removed. In these instances, surgeons reconstruct the digestive tract. Surgeons at Johns Hopkins honed the procedure, drastically reducing the mortality rate associated with the surgery.
•Distal Pancreatectomy - Surgeons remove tumors of the body and the tail of pancreas and leave the head of the pancreas intact.
•Total Pancreatectomy - This procedure is the least common of all of the surgeries and is used when tumors extend throughout the pancreas. In a total pancreatectomy, surgeons remove the entire pancreas and the spleen, gallbladder, common bile duct, and portions of the small intestine and stomach.
•Minimally-Invasive Pancreas Removal - Offered at only a select group of cancer centers like Johns Hopkins, this procedure can reduce blood loss, risk of infection and speed recovery. Eligibility depends on the tumor’s location, size and other medical factors.
•Palliative Surgical Procedures - These operations, such as a biliary and gastric bypass (double bypass) or a celiac nerve block, are performed to improve a patient's quality of life by reducing disease symptoms and pain.
Chemotherapy and radiation can also be employed - usually in combination with surgery - to cure the cancer (in early-stage diagnoses) or to prolong life:
•Chemotherapy - The leading chemotherapy agent is a drug called gemcitabine or Gemzar, and combined with a drug called taxol, also known as Abraxane, has shown increases in survival length.
•Radiation - Employing multiple beams of radiation, treatment can be very focused on the tumor, while limiting exposure to normal tissue. Stereotactic radiation therapy provides high doses of radiation over a shorter period of time than traditional radiation.
A pancreatic cancer vaccine, developed at Johns Hopkins Kimmel Cancer Center, is being tested with promising results, showing a modest, yet real improvement in survival time.
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.

Continue Learning about Pancreatic Cancer Treatment

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.