Giving chemotherapy, either alone or with radiation therapy, after surgery is called adjuvant treatment.
Sometimes, if the tumor is thought to be removable but is very large, or has many nearby large lymph nodes, chemotherapy or chemoradiation may be given before surgery. Neoadjuvant treatment is used to shrink the tumor first. This may make it easier to remove all of the cancer tissue at the time of surgery. Additional chemotherapy may still be recommended after surgery.
A small number of pancreatic cancers have reached nearby blood vessels. If the cancer tumor has not grown deeply into these blood vessels it may be considered removable by surgery. The odds of removing all of the cancer are lower, so they are considered borderline resectable.
Borderline resectable cancers are often treated first with neoadjuvant chemotherapy to try to shrink them to aid in removal. Imaging tests are done to make sure cancer is still considered removable by surgery. This might be followed by more chemotherapy.
Locally advanced cancers have grown too far into nearby blood vessels or other tissues to be removed completely by surgery. These types of cancer are considered unresectable. They may have not spread to the liver or distant organs and tissues yet.
Surgery to remove these cancers does not help people live longer as cancer cells have already entered the circulatory system (blood and lymph vessels). If surgery is done, it is palliative.
Chemotherapy, sometimes followed by chemoradiation, is the standard treatment option for locally advanced cancers. This may help some people live longer even if the cancer tumor doesn’t shrink.
Giving chemo and radiation therapy together may work better to shrink the cancer tumor, but this combination has more side effects. The side effects of chemotherapy and radiation can be harder on patients than either treatment alone.
Pancreatic cancers often first spread within the abdomen (belly) and to the liver. They can also spread to the lungs, bone, brain, and other organs.
These cancers have spread too much to be removed by surgery. If imaging tests show cancer tumors have spread to other parts of the body, it is often assumed that cancer is metastatic
Chemotherapy is the main treatment for these cancers. It can sometimes shrink or slow the growth of cancer for a time. Chemotherapy may help people live longer, but it is not expected to be a cure.
In certain cases, immunotherapy or targeted therapy may be options for people whose cancer cells have specific genetic markers.
If cancer continues to grow during treatment or comes back treatment options will depend on:
It’s important to understand the goal of any further treatment, as well as the benefits and risks involved.
When pancreatic cancer recurs, it most often shows up first in the liver. This is usually treated with chemotherapy if you are healthy enough to get it. If you have had chemo before and it was helpful, the same therapy may be helpful again. If pancreatic cancer progresses while you are getting chemotherapy, another type of chemotherapy might be tried if you are healthy enough.
At some point, it might become clear that standard treatments are not effective. It is your choice to continue treatment. At this point taking part in a clinical trial may be an option. While these are not proven effective, they may benefit you, as well as future patients.
