Treatments for borderline resectable pancreatic cancer

The following are treatment options for borderline resectable pancreatic cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Chemotherapy is often the first treatment given for borderline resectable pancreatic cancer. Chemotherapy is given to try to shrink the tumour before other treatments (called neoadjuvant therapy). Chemotherapy may be first given alone then followed by chemoradiation. After these treatments, doctors will use CT scans to reassess the tumour.

Chemotherapy drug combinations used to treat borderline resectable pancreatic cancer include:

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

Radiation therapy may be given along with chemotherapy (called chemoradiation). Chemoradiation may be given after chemotherapy if the tumour responds to chemotherapy. It is not usually given if the tumour progresses during chemotherapy because it is unlikely it will help shrink the tumour. Tumours that progress during chemotherapy before surgery are treated as locally advanced tumours.

You may be offered surgery if CT scans show that the tumour has shrunk and doctors think that the tumour can be completely removed (is resectable) after neoadjuvant therapy. The type of surgery done depends on the size and location of the tumour. Doctors may need to rebuild major veins after they remove the tumour.

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 the blood vessels supplying the spleen. Distal pancreatectomyis 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.

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.