Pancreatic cancer

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Treatments for pancreatic cancer

If you have pancreatic cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for pancreatic cancer, your healthcare team will consider the size and location of the tumour and your overall health.

The stage of the cancer, including if the tumour is resectable, borderline resectable or unresectable (locally advanced or metastatic), determines which treatments can be offered.

Resectable pancreatic tumours can be completely removed with surgery. Stage 1 or 2 tumours are often resectable. They are treated with surgery to remove part, or all, of the pancreas. Chemotherapy may be given after surgery (called adjuvant chemotherapy). If cancer cells are found in the tissue removed along with the tumour during surgery (called positive surgical margins), radiation therapy or chemoradiation may be given.

Borderline resectable pancreatic tumours are treated in a clinical trial setting, if possible. They may be treated before surgery with chemotherapy and chemoradiation (called neoadjuvant therapy).

Locally advanced pancreatic tumours (stage 3) are treated with chemotherapy, radiation therapy or chemoradiation. In some cases, surgery will be used to relieve symptoms of advanced cancer (called palliative surgery), but it isn’t used to try to remove the entire tumour.

Metastatic pancreatic tumours (stage 4) are treated with chemotherapy, with or without targeted therapy. Surgery, radiation therapy or both may be offered to relieve symptoms and control pain (called palliative therapy).

You may be offered one or more of the following treatments for pancreatic cancer.

Surgery

Depending on the stage, size and location of the tumour, you may have one of the following types of surgery.

The Whipple procedure (also called pancreaticoduodenectomy) is used to remove tumours in the head of the pancreas or in the opening of the pancreatic duct. It removes the head of the pancreas along with the duodenum (the first part of the small intestine), the gallbladder, part of the common bile duct, the pylorus (bottom part of the stomach that attaches to the duodenum) and lymph nodes near the head of the pancreas.

The modified Whipple procedure (also called pylorus-preserving pancreaticoduodenectomy) may also be used to remove tumours in the head of the pancreas that are not large, or bulky, and haven’t grown into the duodenum or spread to the lymph nodes around the pylorus. It is a modification of the Whipple procedure that doesn’t remove the pylorus. Because the modified Whipple procedure doesn’t affect normal stomach function, it avoids nutrition problems that can happen after the Whipple procedure.

Distal pancreatectomy is used to remove tumours in the body or tail of the pancreas. It removes the tail of the pancreas, or the tail and part of the body of the pancreas, and nearby lymph nodes. The spleen is only removed if the tumour has grown into the spleen or blood vessels supplying the spleen. Distal pancreatectomy is not commonly used because cancer that starts in the body or tail of the pancreas has often spread by the time it is diagnosed.

Total pancreatectomy may be used only if necessary to completely remove the tumour. It is very difficult to recover from this surgery, so it is not used as often as the Whipple procedure or the modified Whipple procedure. Total pancreatectomy removes all of the pancreas along with the duodenum, the pylorus, part of the common bile duct, the gall bladder, sometimes the spleen and nearby lymph nodes.

Palliative surgery is used to relieve symptoms of advanced cancer. The types of surgery can include stent placement and surgical bypass. These procedures can help relieve a blockage in the common bile duct or duodenum.

Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. Some chemotherapy drugs are given on their own. But more often, several chemotherapy drugs are given together.

Chemotherapy drugs commonly used to treat pancreatic cancer include:

  • gemcitabine (Gemzar)
  • 5-fluorouracil (Adrucil, 5-FU)
  • nab-paclitaxel (Abraxane)
  • FOLFIRINOX - folinic acid (leucovorin), irinotecan (Camptosar), oxaliplatin (Eloxatin) and 5-fluorouracil

Radiation therapy

Radiation therapy uses high-energy rays or particles, such as x-rays or gamma rays, to damage or destroy cancer cells.

Pancreatic cancer is usually treated with external beam radiation therapy. A machine directs radiation through the skin to the tumour and some of the tissue around it.

Chemoradiation

Chemoradiation combines chemotherapy with radiation therapy. Both are given in the same time period. Some types of chemotherapy make radiation therapy more effective.

If you can’t have or don’t want cancer treatment

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Follow-up care

Follow-up after treatment is an important part of cancer care. You will need to have regular follow-up visits, especially in the first 2 to 3 years after treatment has finished. These visits allow your healthcare team to monitor your progress and recovery from treatment.

Clinical trials

Some clinical trials in Canada are open to people with pancreatic cancer. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

Questions to ask about treatment

To make the decisions that are right for you, ask your healthcare team questions about treatment.

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