Treatment and care of people with cancer is usually provided by a team of health professionals, both medical and allied health, called a multidisciplinary team.
Treatment for pancreatic cancer depends on:
- the stage of the disease
- the location of the cancer
- the severity of symptoms
- your general health and wishes.
Treatment may involve the following.
Surgery may be used to remove all the cancer, if this appears possible. If the cancer has spread too far to be removed completely, surgery may be used to relieve symptoms or prevent complications (palliative surgery).
Pancreatic neuroendocrine tumours are more likely to be resectable than exocrine cancers.
Most pancreatic cancers have spread beyond the pancreas by the time they are diagnosed. These cancers are not able to be fully removed by surgery. The chance of successful removal of all the cancer is greatest for pancreatic neuroendocrine tumours and cancers in the head (widest part) of the pancreas. Cancers in the head of the pancreas often cause jaundice because they can press against the bile duct, causing bile to build up in the liver. The symptoms of jaundice mean that they can be detected early enough to be removed.
Surgery for pancreatic cancer usually involves a pancreaticoduodenectomy (Whipple procedure). This removes the head of the pancreas, and may also remove the body of the pancreas, part of the small intestine, part of the bile duct, the gallbladder, lymph nodes near the pancreas and part of the stomach. The surgeon then connects the remaining parts of the bile duct, pancreas, small intestine and stomach so that digestion of food can continue. This operation usually requires a large cut down the middle of the abdomen, although laparoscopic (keyhole) surgery may be possible in some cases, especially for pancreatic neuroendocrine tumours.
Because this is a major, complex operation, there can be complications, including leakage from the surgical connections, infections, bleeding, problems with the stomach emptying after eating, weight loss, changes in bowel habits and diabetes.
Other types of surgery for pancreatic cancer involve removing the tail (thinnest part) of the pancreas and the spleen (distal pancreatectomy); or removing the whole pancreas, the spleen, part of the small intestine, the bile duct, the gallbladder, lymph nodes near the pancreas and part of the stomach (total pancreatectomy). Total pancreatectomy is not common. It results in diabetes because it removes the insulin-producing cells, and insulin injections are needed to maintain blood sugar levels. Pills containing pancreatic enzymes are also needed to enable digestion of certain foods.
Palliative surgery (to relieve symptoms but not to destroy the cancer) may be required if the cancer is blocking the common bile duct, which passes through the head of the pancreas. Blockage of the bile duct can also be relieved by placing a small tube called a stent inside the bile duct to keep it open. Another option is bypass surgery, which reroutes the bile from the common bile duct into the small intestine, bypassing the blocked part of the duct.
Ablation and embolisation
Ablation uses treatment with heat (radiowaves or microwaves that heat the cancer) or cold (cold gases that freeze the cancer) to destroy tumours. These treatments are delivered using thin probes that are guided into the cancer tissue.
Embolisation involves injection of substances into an artery to block the flow of blood to the cancer tissue, causing it to die.
Ablation and embolisation are unlikely to cure pancreatic cancer. They are most often used to relieve symptoms.
Along with surgery, some people may receive radiotherapy.
Usually, the radiation for pancreatic cancer is delivered to the cancer from a machine outside the body. Radiotherapy is more helpful for exocrine pancreatic cancer than for pancreatic neuroendocrine tumours, which do not respond well to standard radiation. Endocrine cancers can be treated with a special form of radiation that is infused or injected by a specialist such as nuclear physician.
Along with surgery, some people may receive chemotherapy.
Targeted therapy refers to treatment with medicines that are designed to specifically attack cancer cells without harming normal cells. These types of medicines affect the way that cancer cells grow, divide, repair themselves or interact with other cells.
Medicines used for targeted therapy of pancreatic cancer include sunitinib and everolimus (used for advanced pancreatic neuroendocrine tumours).
Other treatments that may be used for functional pancreatic neuroendocrine tumours include hormone therapy (to block the action of the excess hormones) and specific medicines to relieve the symptoms caused by the excess hormones.
After treatment, you might need regular physical examinations and other tests to check whether the cancer has come back (recurred) or metastasised, or to check for side effects of treatment. You might also need help to ensure that your nutritional needs are being met, because many people experience weight loss due to poor nutrition as a result of pancreatic cancer or its treatment.
In stage III or stage IV pancreatic cancer, the cancer has spread too far to be removed by surgery. However, surgery may be used to relieve symptoms, or problems such as blockage of the bile duct or the intestine by pressure from the cancer.
Chemotherapy, with or without radiotherapy, is the main treatment for advanced forms of exocrine pancreatic cancer. This may shrink the tumours or slow their growth, possibly helping people to live longer.
Pancreatic neuroendocrine tumours are often slow growing. If they have spread so that they cannot be removed by surgery, medicines may be given to relieve symptoms such as diarrhoea or hormone problems. Chemotherapy or targeted therapy may be used, and surgery or ablation may be used to treat metastases in the liver.
Pancreatic cancer can recur (come back) after treatment. Secondary cancer is when the cancer spreads to another part of the body. Secondary cancers from pancreatic cancer often develop in the liver, but they may occur in the lungs, bone or other organs.
Recurrent pancreatic cancer is treated in the same way as metastatic (stage IV) cancer – that is, with chemotherapy, and possibly other treatments to relieve symptoms.
American Cancer Society (2015). Pancreatic cancer http://www.cancer.org/cancer/pancreaticcancer/detailedguide/index.
National Comprehensive Cancer Network (2014). NCCN guidelines for patients: pancreatic cancer, version 1.2014 http://www.nccn.org/patients/guidelines/pancreatic/index.html.
National Cancer Institute (2015). Pancreatic neuroendocrine tumors (islet cell tumors) treatment (PDQ®) http://www.cancer.gov/cancertopics/pdq/treatment/isletcell/Patient, patient version.
National Cancer Institute (2015). Pancreatic cancer treatment (PDQ®) http://www.cancer.gov/cancertopics/pdq/treatment/pancreatic/Patient, patient version.