Treatment Options

Pancreas cancer is often far advanced by the time symptoms occur and the diagnosis is established. As indicated by the poor five-year survival rates, successful treatment is rare.

Pancreas cancer is difficult to manage, but much can be done to control symptoms and prolong life. A team of specialists, which may include surgeons, medical oncologists, radiation oncologists, and endocrinologists, treat patients with pancreas cancer. Many patients are treated with surgery, radiation therapy (using high-energy rays to kill cancer cells), or chemotherapy (using drugs to rid cancer cells). Researchers are also testing several types of biological therapy (stimulating the body's immune system) to fight pancreas cancer, or to protect the body from treatment side effects.

Surgery

For patients whose cancer has not spread, surgery is typically the only hope for a cure. For patients whose cancer has spread outside the pancreas, surgery is usually not performed unless it is necessary to relieve blockage or symptoms related to the cancer. This type of surgery is known as palliative. Effective pain management is one of the major focuses of this treatment.

The most common type of surgery is the pancreaticoduodenectomy, also known as a Whipple procedure, because Dr. Alan O. Whipple first described the procedure in 1935. In this procedure, the surgical team removes the head of the pancreas, as well as the gallbladder, part of the stomach, the lower half of the bile duct, and part of the small intestine. The surgery takes about six to eight hours in the operating room.

Other less commonly used procedures include: a total pancreatectomy (total removal of the pancreas, along with the gallbladder, part of the stomach, part of the small intestine, the bile duct, the spleen, and nearby lymph nodes); and a distal pancreatectomy (performed when the tumor is growing in the tail of the pancreas-the tail of the pancreas is removed, along with the spleen).

Radiation Therapy

Radiation therapy usually combined with chemotherapy, is often used to treat patients after surgery to prevent recurrence of pancreas cancer. Radiation therapy is also often used to treat patients whose pancreas cancer is too widespread to be removed surgically. The most common type of radiation therapy is called external beam radiation therapy. Patients may also receive a new treatment, called intraoperative radiation therapy. In this procedure, the surgeon removes the tumor, and the patient receives a high-dose of radiation therapy while still in the operating room. 

Radiation therapy is sometimes also given prior to surgery in order to shrink the tumor, as a means of improving the surgical result.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells, delivered through the bloodstream that goes throughout the body. The most common chemotherapy used for the treatment of pancreatic cancer is gemcitabine, shown to improve survival outcomes in patients with advanced pancreatic cancer, as well as improve cancer-related symptoms in some patients.

Since its approval in 1997, gemcitabine remains the standard of care for advanced pancreas cancer. Many studies have looked at combining gemcitabine with other drugs (e.g. erlotinib, capecitabine, cisplatin, oxaliplatin, taxanes) however no combination has emerged as far and away better than gemcitabine alone. Clinical trials are investigating different combinations with gemcitabine in an attempt to improve upon the standard of care.

If a tumor continues to grow after treatment with gemcitabine, there may be a benefit from additional treatment using different agents.

Side effects of chemotherapy depend on which drugs are being used. These include poor appetite, nausea, vomiting, diarrhea, mouth sores, hair loss, and a lack of energy. People undergoing chemotherapy also are more likely to get infections and bruise and bleed easily. Certain drugs used in pancreatic cancer are also associated with specific side effects. Erlotinib may cause a skin rash similar to acne. Capecitabine can cause redness and discomfort on the palms of the hands and the soles of the feet (hand-foot syndrome). These side effects go away between treatments and after the treatments have ended. The doctor can suggest ways to relieve these side effects.