How Is Pancreatic Cancer Treated?

There are 3 main types of treatment for cancer of the pancreas: surgery, radiation therapy, and chemotherapy. Depending on the stage of the cancer, 2 or even all of these types of treatment could be combined.

Surgery

There are 2 types of surgery for pancreatic cancer, depending on the goal of the treatment. If the tumor is small enough so there’s a chance it can all be removed, then the goal of the surgery is to try to cure the cancer. If the cancer is too widespread to be completely removed, then the goal might be to relieve symptoms or to prevent other future problems. This type of surgery is known as palliative, since its main goal is to promote comfort. 

The type of surgery most often done if it looks like the cancer can be cured is called the Whipple procedure. In this surgery, the head of the pancreas (and sometimes the body) are removed along with parts of the stomach and small intestine, the gallbladder, part of the common bile duct, and some nearby lymph nodes. This is a very complex operation. It is best done by a surgeon who has done it many times in a hospital that has had much experience with this kind of surgery. This is a major operation that carries a relatively high risk of complications that may even be fatal.

Only a small fraction (10%) of cancers of the pancreas appear to be contained entirely within the pancreas when they are found. But even when it looks like the cancer hasn’t spread, a small number of cancer cells may already have spread to other parts of the body. For patients who have surgery to try to completely remove cancer of the exocrine pancreas, the 5-year survival rate is about 20%. 

Palliative surgery might be done to prevent or relieve symptoms if the cancer has spread too far to be cured. For example, surgery can be used to relieve blockage of the bile duct. When this duct is blocked, the result can be pain and problems with digestion. 

There are 2 options for relieving a bile duct blockage. One is to re-route the flow of bile from the common bile duct into the small intestine. This approach requires an incision and it may take weeks for the patient to recover. An advantage is that during the surgery, the doctor may be able to cut the nerves leading to the pancreas. This will reduce or get rid of any pain for the patient. Also, the doctor might re-route the stomach connection to the small intestine with the goal of preventing problems in the future. 

Because this type of cancer can progress so quickly, most doctors don’t recommend palliative surgery by itself. What often happens is that surgery is begun in hopes of curing the cancer. If it becomes clear that the cancer is too advanced, the doctor may switch to the palliative approach to prevent symptoms. 

A second approach to bile duct blockage is to use tubes called stents to keep the bile duct open. The doctor inserts the stents through an endoscope. After several months the stents may become clogged and need to be replaced. Newer stents may be used to keep the small intestine open as well.

Radiation

Therapy 
Radiation therapy is treatment with high energy rays (such as x-rays) to kill or shrink cancer cells. The radiation is given much like a regular x-ray although it takes longer. Treatment is usually given 5 times a week for several weeks or months. Sometimes the radiation is given before surgery, sometimes after. Radiation (often combined with chemotherapy) can also be used for patients whose tumors are too widespread to be removed by surgery. 

One new way to give radiation therapy is being studied at some cancer centers. It consists of giving radiation directly into the tumor during an operation. In this way the doctor can move other organs out of the way and aim the radiation right at the tumor. But so far this approach hasn’t been shown to help patients live longer than regular radiation treatment. 

Side effects of radiation therapy could include mild skin changes that look like sunburn or suntan, upset stomach, loose bowels, or tiredness. Often these go away after a short while. Talk with your doctor if you have side effects since there are ways to relieve them.



Chemotherapy

Chemotherapy refers to the use of drugs to kill cancer cells. Usually the drugs are given into a vein or are taken as a pill. Once the drugs enter the bloodstream, they reach throughout the body, making this treatment useful for cancer that has spread beyond the place where it started. 

A drug called gemcitabine is the drug most often used to treat pancreatic cancer that has spread. Studies are going on to see if it can be used (either alone or with other drugs) to treat cancers found at an earlier stage.

Chemotherapy can have some side effects. These side effects will depend on the type of drugs given, the amount taken, and how long treatment lasts. Temporary side effects might include nausea and vomiting, loss of appetite, hair loss, and mouth sores. Low blood cell counts from treatment can cause an increased risk of infection, bleeding or bruising after minor cuts, and fatigue. Most side effects stop once treatment is over. Anyone who has problems with side effects should talk with their doctor or nurse, as there are often ways to help.

The information and services provided by the National Pancreatic Cancer Foundation are for informational purposes only. The information and services are not intended to be substitutes for professional medical advice, diagnosis or treatment. The National Pancreatic Cancer Foundation does not recommend nor endorse any specific physicians, products or treatments even though they may be mentioned on this site.