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 needs and may include a combination of different treatments. 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 I or II tumours are often resectable. They are treated with surgery to remove part, or all, of the pancreas. Chemotherapy may be given after surgery (this is 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 with chemotherapy and chemoradiation before surgery. The treatments given before surgery are called neoadjuvant therapy.
Locally advanced pancreatic tumours (stage III) are treated with chemoradiation or chemotherapy. 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 IV) are treated with chemotherapy or targeted therapy. Surgery, radiation therapy or both may be offered to relieve symptoms and control pain (called palliative therapy).
You may be offered the following treatments for pancreatic cancer. Your treatment plan may include a combination of different treatments.
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 nutritional 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 (the lower part of the stomach that attaches to the duodenum), 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 uses drugs to destroy cancer cells. Some chemotherapy drugs are given on their own. But more often, several chemotherapy drugs are given together.
The chemotherapy drugs commonly used to treat pancreatic cancer include:
- gemcitabine (Gemzar)
- 5-fluorouracil (Adrucil, 5-FU)
Radiation therapy uses high-energy rays or particles, such as x-rays or gamma rays, which produce charged ions or molecules 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 combines chemotherapy with radiation therapy. Chemotherapy is given during the same time period as radiation therapy. Some types of chemotherapy make radiation therapy more effective.
Targeted therapy uses drugs or other substances to target specific molecules (usually proteins) involved in cancer cell growth while limiting harm to normal cells. Targeted therapy is sometimes used to treat pancreatic cancer. The most common targeted therapy drug used to treat pancreatic cancer is erlotinib (Tarceva).
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 years after treatment has finished. These visits allow your healthcare team to monitor your progress and recovery from treatment.
Some clinical trials in Canada are open to people with pancreatic cancer. Clinical trials look at new and better 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.