There are different treatments available for patients with pancreatic cancer, including surgery, radiation therapy and drug therapy. Your doctor will use the following criteria to develop a treatment plan:
- Your overall health and well being and preferences regarding treatment.
- Whether or not the cancer can be removed by surgery.
- Whether the cancer has just been diagnosed or has recurred, which means that it has come back.
About 15 percent to 20 percent of patients with pancreatic cancer are diagnosed early enough that their tumor can be removed surgically. Typically, however, only smaller tumors are surgically removed and even then, cancer often returns.
Pancreatic cancer surgery is a complex procedure. Studies have found that patients do better overall when their surgery is performed at a medical center with a high volume of these surgical procedures.
Although the definition of high volume varies by study, UCSF surgeons perform major pancreatic surgeries at a rate well above that which is considered high volume. We are among the most experienced and successful in performing this exacting surgery to treat pancreatic cancer.
Surgery may be performed to remove all or part of the pancreas and nearby tissue. Surgery is also used to try to minimize the complications caused by pancreatic cancer. The kind of surgery recommended depends on your type of cancer, location of the tumor, your symptoms, whether the cancer involves other organs and whether the cancer can be completely removed. It is important to note that even after having surgery, the cancer often recurs.
If imaging studies show that all of your tumor may be potentially removed, one of the following procedures may be performed:
- Whipple Procedure (Pancreaticoduodenectomy) — This is the most commonly performed surgery used to remove tumors of the pancreas. The surgeon removes the head of the pancreas, and sometimes the body of the pancreas. The bottom section of the stomach, parts of the small intestine, gallbladder, a portion of the bile duct and lymph nodes near the pancreas are also removed. The remaining tail of the pancreas and bile duct is reattached to the small intestine so that bile from the liver can flow into the small intestine.
- Distal Pancreatectomy — The surgeon removes the body and the tail of the pancreas. The spleen is also often removed.
- Total Pancreatectomy — In this procedure, the entire pancreas, duodenum, bile duct, gallbladder, spleen and nearby lymph nodes are removed. While a total pancreatectomy is usually effective in removing the cancer, it induces permanent diabetes, requiring patients to take insulin shots or use an insulin pump for the rest of their lives. This is because the pancreas contains Islets of Langerhans — also known as islets or islet cells — that secrete insulin to regulate the body’s blood sugar levels. In some cases, the cancer cannot be completely removed and other surgeries and procedures can be considered to alleviate symptoms.
- Biliary Bypass — This surgery is performed if cancer blocks the free flow of bile juice through the bile ducts. This obstruction can cause pain, infection, digestive problems and jaundice, a yellowing of the eyes and skin. Biliary bypass involves rerouting the flow of bile from the common bile duct directly into the small intestine, bypassing the pancreas.
- Biliary Stent — This procedure may be performed if cancer blocks the flow of bile in the bile ducts. It involves placing a stent — a small thin plastic or metal tube — to help keep the bile duct open. A biliary stent can be placed either during an endoscopic retrograde cholangiopancreatography (ERCP) or via a route through the skin, into the liver or common bile duct. The stents may be changed or cleared periodically due to buildup from the bile.
- Gastroduodenal Stent — Pancreatic tumors may cause an obstruction of the gastric tract, particularly within the duodenum, a part of the small intestine. Symptoms associated with obstruction are severe nausea, vomiting, malnutrition and dehydration. Gastroduodenal stent placement is a minimally invasive technique that can help relieve such symptoms and improve one’s quality of life. The procedure is performed in similar fashion to that of the biliary stent described above.
- Gastric Bypass — In some cases, the duodenum — the first part of the small intestine — may be blocked by the tumor, causing pain, vomiting and digestive problems. Gastric bypass may be performed to reroute the stomach connection to the duodenum to alleviate symptoms and to allow patients to eat normally.
- Celiac Plexus Block — Sometimes a celiac plexus block (CPB) or celiac plexus neurolysis (CPN) is performed for pain control. This procedure blocks a group of nerves in the abdomen called the celiac plexus, which can deliver sensations of pain from the abdomen to the brain. CPN involves the injection of an agent, usually alcohol, to permanently destruct nerves. CPB involves the injection of medications such as corticosteroids and numbing medications. This approach usually lasts a few months and is not intended to permanently destroy nerves.
Radiation therapy is the use of X-rays or high-energy rays to kill cancer cells and shrink tumors. Radiation is typically delivered by a machine outside the body, called external radiation therapy. Less common, experimental approaches use materials called radioisotopes delivered inside the body through intravenous or local injection.
The use of radiation therapy depends on a number of factors including tumor location, size, organ involvement and previous treatments. Radiation can be used alone or in addition to surgery and chemotherapy. Newer approaches, such as stereotactic radiosurgery with a machine called a CyberKnife are also being explored.
Cancer Drug Therapy
Cancer drugs may be taken by mouth as a pill or may be put into the body by a needle in the vein. Cancer drugs are a systemic treatment, which means that they enter the bloodstream and travel throughout the body. They attempt to wipe out any cancer cells after surgery or to control disease when surgery is not feasible. These medications are sometimes taken at the same time as radiation therapy to try to achieve a better result. Drug therapy aims to control cancer, prevent complications and help people live longer and feel better.
Sometimes newer cancer drugs are referred to as targeted therapy. Targeted therapy is a general term that typically refers to a new class of drugs or agents that are designed to target specific parts or pathways that regulate cancer cell growth. In addition, doctors hope that targeted therapies will be less likely to cause unpleasant side effects by minimizing damage to normal cells.
This is an area of research that is ever-growing; our pancreatic scientists and doctors are increasingly involved in research studies and clinical trials developing targeted therapies.
UCSF researchers are at the forefront of studying new therapies for pancreatic cancer. Patients may participate in clinical trials to test new therapies for pancreatic cancer. Clinical trials are experiments designed to improve existing treatment or to test the safety and effectiveness of new treatments.
Participation in a clinical trial is voluntary. Prior to enrollment in a clinical trial, patients are given a document called a consent form that explains the goals of the trial, the therapy to be used, risks and benefits and any associated costs, if applicable. There are a number of mechanisms in place, both legal and ethical, to protect the rights and safety of clinical trial volunteers.