Pancreatic Cancer: Treatment Options

How is it treated?

Treatment options for Pancreatic Cancer (like all cancers) vary with the stage of development that the disease is in. Pancreatic Cancer is usually treated with some combination of surgery, chemotherapy, and radiation therapy. Advanced stages of Pancreatic Cancer cannot always be treated with the goal of fully curing the cancer. However, combinations of treatments are used to relieve symptoms, prevent tumor spreading, maintain the quality of life, and prolong life expectancy. Treatment options are different for each individual case, but there are several common procedures listed below. The information presented is intended to provide patients with information that they can use when discussing treatment options with their physician.

Surgery for Pancreatic Cancer

Surgery can be used in an attempt to remove the cancer or simply to relieve symptoms. Often in advanced cases, the cancer cannot be fully cured. Surgery is often followed by radiation or chemotherapy to destroy cancer cells that may have spread or may have been missed during surgery.

• Whipple Procedure - The head of the pancreas is removed along with part of the small intestine, part of the stomach, and some surrounding lymph nodes. The Whipple procedure allows the pancreas to still produce digestive enzymes and hormones. This procedure is mostly used to treat Pancreatic Cancer in Stage I. It is one of the most commonly used surgical procedures aimed at curing Pancreatic Cancer.
  
  
• Distal Pancreatectomy - The body and tail of the pancreas are removed. This procedure is normally used to treat Pancreatic Cancer in Stage I or Stage II.
  
  
• Total Pancreatectomy - The entire pancreas is removed along with part of the stomach, the entire small intestine, the bile ducts, the gall bladder, and surrounding lymph nodes. This procedure is normally used for more advanced stages of Pancreatic Cancer.
  

Other Treatments

• Radiation Therapy - In some cases X-rays can be used to kill or shrink cancer cells at the site of the tumor. The radiation may be administered by a machine, such as a linear accelerator or cobalt apparatus, or from a radioactive source implanted within the diseased area. External beam radiation therapy uses radiation from outside the body to focus on the cancer and is, therefore, not the primary treatment for cancer that may have spread.
  
  
• Chemotherapy - Drugs are administered by mouth or injection to kill the cancer cells. The drugs enter the blood stream and can, therefore, reach areas of the body where the cancer may have spread.
  
  
• Clinical Trials - There are always new experimental treatments being tested that often have promising results. The effectiveness and side effects of clinical trials are not always known, but they can sometimes offer hope of survival especially for end stage cancer patients. Clinical trials are very important in Pancreatic Cancer due to the fact that so many cases are diagnosed in advanced stages. Consult your physician or the Rhode Island Cancer Council to find out what clinical trials are going on near you and if you are eligible.
  

What are the side effects of the treatments?

Certain side effects have been associated with different types of treatments. Each patient's response to treatment will be different but there are some common effects.

Possible Side Effects from Surgical Treatment

• Whipple Procedure - This is a complicated surgery that can be associated with complications or death up to 10% of the time. Even when the surgery goes as planned, there can be some other complications besides temporary pain. Some digestive and hormonal problems can occur, but these are normally correctable with medication.
  
  
• Distal Pancreatectomy - The remaining part of the pancreas may not be able to produce enough hormones and digestive enzymes. This can cause a person to become diabetic, but this can be treated with medication.
  
  
• Total Pancreatectomy - Removal of the pancreas requires replacement of the digestive enzymes and hormones normally produced. Once the pancreas is removed, a person becomes diabetic. This can be treated through diet changes and hormonal replacement. Removal of part of the stomach and small intestine may cause some digestive side effects (bloating, nausea, heartburn, etc.), but this can normally be relieved with medication and a change in eating habits.
  

Possible Side Effects from Non-Surgical Treatments

*Most side effects are temporary and can often be relieved with medication.

• Radiation Therapy
  
  • Nausea, vomiting, diarrhea
    
  • Sexual dysfunction
    
  • Irritation to the skin near the radiation site
    
• Chemotherapy
  
  • Nausea and vomiting - Loss of appetite
    
  • Loss of hair
    
  • Mouth sores
    
  • Increased susceptibility to infection
    
  • Premature menopause (permanent)
    
  • Infertility (permanent)
    

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