Seattle Cancer Care Alliance (SCCA) experts offer comprehensive care for pancreatic cancer and pancreatic neuroendocrine tumors (NETs), including advanced treatments and new options available only through clinical studies.
Many patients are seen at our Pancreatic Cancer Specialty Clinic. At this clinic, all of the specialists who will be involved in your care will meet to design treatment that's tailored to you. You will receive a multidisciplinary treatment plan in a single day — truly one-stop shopping.
Some patients see a single specialist, based on their individual needs. Either way, we see you quickly so you can start your treatment quickly.
A diagnosis of cancer can feel overwhelming. We have an experienced, compassionate team ready to help.
- Expertise at SCCA
- Targeted therapy
- Radiation therapy
- Other treatments for NETs
- Pain management
- Clinical studies
- Next steps
Pancreatic cancer and NETs expertise at SCCA
Everything you need is here
We have surgical oncologists, medical oncologists, radiation oncologists, gastroenterologists and pathologists who specialize in pancreatic cancer and pancreatic NETs; the most advanced diagnostic, treatment and recovery programs; and extensive support.
Innovative pancreatic cancer and NETs therapies
SCCA patients have access to advanced therapies being explored in clinical studies for pancreatic cancer or pancreatic NETs conducted here and at our founding organizations Fred Hutchinson Cancer Research Center and UW Medicine. We'll talk with you about any studies, as well as standard treatments, that might be relevant for you.
SCCA was among the first institutions in the Pacific Northwest region to offer peptide receptor radionuclide therapy (PRRT) as a treatment option for patients with NETs. Lutathera® (lutetium Lu 177 dotatate) uses radiation to target cancer cells while minimizing the harm to healthy tissue.
Pancreatic cancer and NETs treatment tailored to you
Your SCCA doctors will collaborate on a comprehensive treatment plan to get the best results for you based on your health and the type, stage and location of your cancer. Genomic profiling (laboratory methods to learn about the genetic make-up of your cancer cells) helps us personalize your care by targeting specific pathways, an approach known as precision medicine.
Your personal team includes more than your pancreatic cancer and pancreatic NETs doctors. Additional experts who specialize in treating people with cancer will be involved if you need them — experts like a dietitian, pain specialist, social worker, palliative care professional or chaplain.
Ongoing care and support
During and after treatment, your team continues to provide follow-up care on a schedule tailored to you. The SCCA Survivorship Clinic is also here to help you live your healthiest life as a pancreatic cancer survivor.
Surgery for pancreatic cancer or NETs
Surgery is the only treatment with the potential to cure cancer that starts in the pancreas — but only if all the cancer can be removed. Taking out only part of the cancer generally does not improve treatment results for patients, and the surgery is complex with a lengthy recovery.
- If imaging studies, such as computed tomography (CT) scans, suggest that surgeons will be able to remove all of your cancer, your team may recommend surgery.
- If surgery is not a good option for you, you have other options, such as chemotherapy and radiation therapy.
Surgery for SCCA patients with pancreatic cancer or pancreatic NETs is performed at University of Washington Medical Center (UWMC) by expert surgeons specially trained to do your type of operation.
- Our surgeons participate in the American College of Surgeons National Surgical Quality Improvement Program for pancreatic surgery to track and improve outcomes.
- After your surgery, your care team at UWMC follows evidence-based guidelines to enhance your recovery (“early-recovery after surgery” protocols).
The main surgeries for pancreatic cancer or pancreatic NETs are:
- Whipple procedure (pancreatoduodenectomy)
- Distal pancreatectomy
- Total pancreatectomy
- Central pancreatectomy
In this complex operation, surgeons remove part of your stomach, part of your small intestine (the duodenum and part of the jejunum), your bile duct that's outside your liver, your gallbladder and the wide end of your pancreas near the center of your abdomen (called the head, neck and uncinate process).
Then they pull your remaining jejunum up and connect your remaining bile duct, pancreas and stomach to it.
- The risk of complications from this operation is significantly lower when it’s performed at an experienced cancer center by a surgeon who does the procedure frequently.1,2
- The National Comprehensive Cancer Network recommends that pancreatic resections should be done at institutions that perform a large number of them annually (at least 15-20).2
- We have two surgeons at UWMC who perform pancreatic resections. They typically perform 70-90 of these procedures each year.
If you have pancreatic NETs that have spread to your liver, your team may recommend removing tumors from your liver either before or at the same time as the Whipple procedure. If liver surgery is not right for you, your team will offer other options to treat liver metastases.
If cancer is in the tail of your pancreas (the narrow end, near your side) and not in the head, your surgeon may remove the tail and body of your pancreas. Whenever possible, our surgeons try to leave your spleen, but they may have to remove it in order to get all the nearby lymph nodes.
In some situations, the entire pancreas is removed along with surrounding structures. Your surgeon may recommend this if your tumor is large, it involves almost your whole pancreas or it spans the central area from the neck to the body of the pancreas.
This approach may also be used for people with familial pancreatic cancer. They might have a Whipple procedure or distal pancreatectomy first. Then if follow-up care shows a lesion has developed in their remaining pancreas, the rest of the gland may be removed.
For pancreatic NETs, surgeons may be able to remove tissue from the center of your pancreas, leaving the rest. This is not an option for pancreatic ductal adenocarcinoma because of the likelihood of cancer spreading to your lymph nodes.
This is surgery to remove only pancreatic NETs (not exocrine pancreatic cancer), leaving the rest of your pancreas in place. It may be an option if you have small NETs in just one part of your pancreas. Based on the location of the NETs and whether they are likely to have spread, your surgeon may need to remove some other structures in the area, like part of your small intestine and nearby lymph nodes.
Minimally invasive surgery
Our surgeons perform minimally invasive laparoscopic surgery (through small "keyhole" incisions) whenever possible. Benefits can include less pain, less narcotic pain medicine, less time in the hospital, fewer complications and better overall recovery.
Open surgery (through a longer incision) is necessary in some situations, such as when a pancreatic tumor involves nearby blood vessels.
Your surgeon may perform laparoscopic surgery using the robotic da Vinci Surgical System. With da Vinci, your surgeon sits at a console and uses hand and foot controls to move robotic arms that hold a laparoscope (camera) and surgical instruments. The console gives your surgeon a 3D view (not a flat view, like on a monitor screen). Da Vinci allows your surgeon to make very precise, complex motions (more than traditional laparoscopic instruments do), and the ideal ergonomics help prevent fatigue during long operations.
Learn more about surgical oncology.
Chemotherapy for pancreatic cancer or NETs
Usually chemotherapy medicines are given by infusion into a vein. Some are taken by mouth in pill form.
- For exocrine pancreatic cancer, you are likely to have chemotherapy for one of these reasons:
- Before surgery to shrink your tumor so it’s easier to remove
- After surgery to kill remaining cancer cells that couldn’t be seen
- Instead of surgery if your cancer is too widespread to remove
- For pancreatic NETs, chemotherapy may help control the disease. You might have chemotherapy to slow or stop tumor growth:
- If your cancer cannot be removed
- If the cancer has spread to other parts of your body
Your SCCA team will talk with you about the specific drugs we recommend for you, how you’ll receive them, your treatment schedule and what to expect. We’ll also explain how to take the best possible care of yourself during treatment and after, and we’ll connect you with medical and support resources throughout SCCA.
Learn more about chemotherapy in our medical oncology section.
Targeted therapy for pancreatic cancer or NETs
Targeted therapies are newer cancer treatments that work more selectively than standard chemotherapy. They target a gene or protein responsible for allowing cancer to grow, they seek out and damage cancer cells, or they prompt your immune system to attack particular cells (also called immunotherapy).
Examples are these targeted therapies for pancreatic NETs:
- Everolimus (Afinitor) — which blocks a protein that prompts cells to divide and grow
- Sunitinib (Sutent) — which stops the growth of blood vessels that tumors need in order to grow (anti-angiogenesis therapy) and targets other features of cancer cells
For exocrine pancreatic cancer, we perform molecular profiling of tumors to try to detect targets that might respond to treatment.
Learn more about targeted therapy in our medical oncology section.
Radiation therapy for pancreatic cancer or NETs
Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells.
- For exocrine pancreatic cancer, you may have radiation therapy or a combination of radiation and chemotherapy (chemoradiation), before or after surgery or instead of surgery if you cannot have surgery. Chemo medicines can make cancer cells more sensitive to radiation.
- For pancreatic NETs, radiation therapy is used selectively in certain situations where surgery is not possible or for cancer that has spread to other parts of your body.
Conventional external-beam radiation therapy (EBRT)
Doctors commonly recommend conventional EBRT for pancreatic cancer.
- A machine called a linear accelerator sends beams of X-ray radiation toward your tumor.
- Some patients have a type of EBRT called stereotactic body radiation therapy (SBRT), which precisely delivers high doses of radiation over just a few treatments.
Learn more in our radiation oncology section.
In some situations, your doctor may recommend proton therapy, a unique form of EBRT that targets protons at your tumor.
- Proton therapy may significantly limit radiation exposure to surrounding healthy tissue near the pancreas, such as the bowel, liver, kidneys and spinal cord.
- This may reduce side effects from treatment, particularly when combined with chemotherapy.
- Proton therapy may be especially useful if you have recurrent tumors and had radiation therapy to the same area in the past.
Intraoperative radiation therapy (IORT)
Another option for some pancreatic tumors is IORT, a fast and effective form of radiation therapy that uses electron-beam radiation during surgery.
- Your surgeon moves normal structures out of the way to expose the target area for this precise, high-dose treatment.
- It takes only a few minutes to deliver and uses only a fraction of the total radiation given over a traditional multi-week course of external-beam radiation.
UWMC is the only hospital in the WAMI region (Washington, Alaska, Montana and Idaho) to offer this treatment. Learn more about IORT.
Other treatments for NETs
If you have functional NETs (those that secrete hormones), you might receive medicines other than conventional chemotherapy or targeted therapy to treat your cancer or your symptoms. For example, octreotide (Sandostatin) may help stop NETs from releasing hormones. This can reduce symptoms caused by high hormone levels.
- Octreotide may also stop NETs from growing.
- Proton pump inhibitors may help control stomach acid in people with gastrinomas.
- Diazoxide may help stabilize blood sugar levels in people with insulinomas.
Doctors typically use these medicines to control symptoms of functional NETs before doing surgery to remove the tumors. Your SCCA team will offer you options like these if they might help reduce your symptoms or control your disease.
Your pancreas aids in digestion and regulates your blood glucose levels, so pancreatic cancer is likely to affect the way your body uses food.
To anticipate and prevent potential problems or to diagnose and deal with them early, it’s important to meet with a dietitian when you begin cancer treatment. You might also need enzymes, taken in pill form, to help with digestion.
Pancreatic tumors can affect digestion differently depending on their type and location. Your SCCA dietitian will evaluate your needs and create an individualized nutrition plan for you.
Pain management in pancreatic cancer
Pain is a common symptom of pancreatic cancer, and managing pain is one of the most important aspects of your care. Fortunately, pain can be well controlled.
Your medical oncologist in the SCCA Pancreatic Cancer Specialty Clinic will work with you to effectively manage any pain you have. If needed, we'll refer you to specialists from the SCCA Pain Clinic to:
- Control any pain you have with medicines and other treatments.
- Minimize any side effects you experience from pain medicines.
- Enhance your quality of life.
Learn more about options for managing pain in pancreatic cancer.
Clinical studies for pancreatic cancer or NETs
For some people, taking part in a clinical study may be the best treatment choice. Access to clinical studies by researchers at SCCA and our founding organizations Fred Hutch and UW Medicine is one reason many patients come to SCCA.
Our scientists and doctors are conducting novel pancreatic cancer studies, and we're part of the Pancreatic Cancer Action Network Precision Promise Clinical Trials Consortium, designed to quickly and dramatically improve outcomes for the disease.
Pancreatic cancer is difficult to treat in part because the tumor builds a biological barrier around itself that keeps chemotherapy out. SCCA’s Sunil Hingorani, MD, and his research team found a way to dissolve this barrier with an enzyme known as PEGPH20. Their research led to a series of clinical trials combining PEGPH20 with chemotherapy with promising results.
Your SCCA team will talk with you about available studies that are appropriate for you and could give you access to promising new options.
- Request an appointment to see an SCCA pancreatic cancer expert.
- Learn about pancreatic cancer symptoms, diagnosis and risk factors.
- Read stories of people who’ve had pancreatic cancer.
- Find resources and support for new SCCA patients.