Treatment for Pancreatic Cancer

Pancreatic cancer is potentially curable in a small number of cases if it can be removed, but the vast majority of cases are not diagnosed until too late. Pancreatic cancer (adenocarcinoma) is one of the most devastating cancers with generally poor progress. There is however hope, in particular when surgery is possible.

When imaging suggests that the entire tumor can be removed and there is no evidence of obvious spread to other organs, surgical removal can be considered and may achieve cure. No other therapy can cure pancreatic cancer. Five-year survival rates approach 25% if the cancers are surgically removed while they are still small and have not spread to the lymph nodes.

Most curative surgery is designed to treat cancers in the head of the pancreas, near the bile duct. Some of these cancers are found early enough because they block the bile duct and cause jaundice. There is evidence that surgical complications are lower and survival is improved when pancreatic cancer surgery is performed at specialised centers, compared to surgery performed at hospitals where pancreatic cancer surgery is not commonly performed.

About 10-25% of pancreatic cancers are contained within the pancreas at the time of diagnosis allowing surgery to be considered. In many cases cancer cells too few to detect may already have spread to other parts of the body. This may explain why the cancer recurs in a large portion of patients after surgical removal.

The type of surgery performed is guided by the location of the tumour. In cases of cancers within the head of the pancreas, a pancreaticoduodenectomy is most commonly performed. Also known as the Whipple procedure, this operation removes:

  • Head of the pancreas
  • Lymph nodes near the pancreas
  • Gallbladder
  • Part of the common bile duct
  • Part of the stomach
  • Duodenum (first part of the small intestine)
  • A small portion of the jejunum (second part of the small intestine)

This is a very complex operation and outcomes are generally optimal when the surgery is performed by a specialised surgeon who has performed many of these operations at a hospital with extensive experience in pancreatic surgery. Even in the most experienced centers, there is a 1-5% chance of death related to surgery within the first 30 days after surgery. Complications occur in 30-50% of patients. However, most complications do not cause major long-term debility and can be managed by relatively simple means.

In cases of tumours located within the tail or body of the pancreas a distal pancreatectomy may be indicated. This removes only the tail of the pancreas and a portion of the body of the pancreas. The spleen is often removed in this operation.

The entire pancreas may need to be removed in some cases of very advanced cancers or when multiple cancers are found within the pancreas. This is called a total pancreatectomy and removes the entire pancreas and the spleen. In such cases patients develop diabetes and require insulin injections.

Chemotherapy is offered to all patients with pancreas cancer, even when tumor removal is achieved. This reduces the risk of the cancer returning. Chemotherapy is often used on its own to treat pancreas cancer that has spread and may lengthen survival. Given the generally poor prognosis of pancreatic adenocarcinoma, patients should strongly consider being involved in treatment trials if they are available. Always ask your oncologist if a clinical trial for treatment of pancreatic cancer is available in your region.

Radiation therapy, combined with low dose of chemotherapy may be used to reduce the chances of the cancer returning locally. Radiotherapy is rarely required for the treatment of pancreatic cancer. Sometimes radiotherapy is administered in cases of more advanced cases to try and reduce the tumor size, with the hope of allowing subsequent surgical removal. It may also be offered to treat certain symptoms or when there is residual cancer noted after surgical removal of the tumor.

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