Pancreatic Cancer Treatment Options

There are a variety of treatments available for pancreatic cancer, including surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. This is a great advancement from just a decade earlier, thanks to clinical research and participants in clinical trials. 

Most patients receive a combination of several treatments for pancreatic cancer. The set that’s right for you depends mainly on the following:

• The location of the tumor in your pancreas
• The stage of cancer
• Whether the disease has spread outside of the primary area where it started
• Your age and general health condition

Cancer of the pancreas can be cured if it's detected before it has spread and can be removed fully with a surgical procedure. For patients who cannot have surgery, other treatment methods may help them live longer and feel better.

Pancreatic Cancer Treatments Include:

The right treatments for you will be discussed among several specialists: the medical oncologist – who tends to lead the treatment team, the surgeon, the radiation oncologist, and the gastroenterologist, who is likely the doctor who detected and diagnosed the cancer.

Surgery for Pancreatic Cancer

Surgery may be an option for people with an earlier stage of pancreatic cancer. The surgeon usually removes only the part of the pancreas that has cancer. But, in some cases, the whole pancreas may need to be removed.

The type of surgery depends on the location of the tumor in the pancreas. Surgery to remove a tumor in the head of the pancreas is called a Whipple procedure. This type of surgery for pancreatic cancer is the most common. You and your pancreatic cancer surgeon will determine which surgery and which may be right for you.

In addition to part or all of your pancreas, the surgeon usually removes the following nearby tissues:

• Duodenum
• Gallbladder
• Common bile duct
• Part of your stomach

Also, the surgeon may remove your spleen and nearby lymph nodes.

Other surgical procedures that could be used include:

• Distal pancreatectomy: This operation is commonly done if the cancer is located in the left side of the tail of the pancreas. In this procedure, the surgeon removes the tail and body of the pancreas, the spleen, and nearby lymph nodes.
• Total pancreatectomy: This surgery removes the entire pancreas, part of the small intestine, a portion of the stomach, the common bile duct, the gallbladder, and the spleen.

Surgery for pancreatic cancer is a major operation. You will need to stay in the hospital for one to two weeks afterward. Your care team will watch for signs of bleeding, infection, or other problems. It takes time to heal after surgery, and the time needed to recover is different for each person. You may have pain or discomfort for the first few days. It’s common to feel weak or tired for a while. You may need to rest at home for one to three months after leaving the hospital.

It’s also important to note that any surgery to remove all or part of the pancreas can impact how you digest food. Special dietary requirements may be needed, especially as your body is adjusting after surgery.

Ablation or Embolization Treatments for Pancreatic Cancer

Ablation and embolization are non-surgical treatments that may be used to destroy tumors. These methods aren’t used frequently for cancer of the pancreas, although they can be helpful for patients who cannot undergo surgery or if cancer has spread to other organs, especially into the liver. 

Ablation refers to treatments that destroy tumors, usually with extreme heat or cold. Side effects after ablation therapy may include abdominal pain, infection, and internal bleeding. 

Embolization injects substances into an artery to attempt to block the blood flow to cancer cells. This causes them to die. Side effects after embolization might include pain in the abdomen, fever, nausea, infection, and blood clots in nearby blood vessels.

Radiation Therapy for Pancreatic Cancer

Radiation therapy uses high-energy rays to kill cancer cells. It can be given along with other treatments, including chemotherapy. Radiation might also be used for pancreatic cancer after surgery to reduce the chance of cancer returning.

The radiation comes from a large machine that aims beams of radiation at the cancer in the abdomen. Typically, patients go to a hospital or clinic 5 days a week for several weeks to receive radiation therapy. Each session takes about 30 minutes.

Although radiation therapy is painless, it may cause other side effects. The side effects include skin irritation, nausea, diarrhea, or feelings of fatigue.

Chemotherapy for Cancer of the Pancreas

Quite often, pancreatic cancer is detected after it’s spread to the lymph nodes. By entering the lymph system, the cancer cells float throughout the body. Chemotherapy is used to kill cancer cells that are present, whether in the primary location or in other areas of the body. Most people with pancreatic cancer get chemotherapy.

For early pancreatic cancer, chemotherapy is usually given after surgery (adjuvant), but in some cases, it’s given before surgery (neoadjuvant). For advanced cancer, chemotherapy is used alone, with targeted therapy, or with radiation therapy to shrink the tumor without performing surgery.

Chemotherapy for pancreatic cancer is usually given with an IV and is given in cycles. This means you’ll have treatments every few weeks.  

Every treatment cycle is followed by a period of rest. The number of treatment cycles and how long the rest period lasts depend on the anticancer drugs used and the patient’s response.

Some drugs used for pancreatic cancer also may cause tingling or numbness in your hands and feet.

Targeted Therapy to Treat Pancreatic Cancer

People with pancreatic cancer who can’t have surgery may receive a type of drug called targeted therapy along with chemotherapy.

Targeted therapy slows the growth of cancer by targeting the specific changes in pancreatic cancer cells that help them grow. It also helps prevent cancer cells from spreading. The drug is taken by mouth.

Side effects may include diarrhea, nausea, vomiting, a rash, and shortness of breath.

Immunotherapy for Pancreatic Cancer

Immunotherapy uses medications to alert the body's immune system to recognize and fight cancer cells effectively. It is a relatively new treatment method for pancreatic cancer and is currently only used in certain cases.

Drugs called checkpoint inhibitors are an option for treating pancreatic cancers in patients whose pancreatic cancer cells have tested positive for specific gene changes, such as high microsatellite instability (MSI-H) or mismatch repair deficiency (dMMR).

Side effects vary based on the type of immunotherapy received.

Palliative Care for Pancreatic Cancer

If the pancreatic cancer has spread too far to be removed completely, the oncologist may recommend palliative care in addition to other treatments. Palliative care aims to help manage symptoms, such as jaundice, nausea, and vomiting, that can occur when the growing cancer blocks the bile duct. Palliative care to help relieve symptoms and improve quality of life can include:

• Endoscopic stent placement: If the tumor is blocking the bile duct, a stent (a thin tube) might be inserted through a catheter to drain the built-up bile in the area.
• Bypass surgery: This procedure reroutes the bile flow from the bile duct directly into the small intestine, bypassing the pancreas. Typically, this requires a large incision (cut) in the abdomen. However, there are times it can be done laparoscopically.
• Radiation or chemotherapy: Palliative radiation therapy or palliative chemotherapy may be administered to help relieve pain by shrinking the tumor. Still, the primary goal is not to completely kill the tumor(s).
• Medications: Morphine or similar drugs (opioids) can help control the pain associated with pancreatic cancer. An injection of medicine to block nerves in the abdomen might also be recommended. 

Clinical Trials for Pancreatic Cancer in Portland & Vancouver

Cancer research trials are a very important part of improving the treatment available to pancreatic cancer patients. You may be eligible to participate in a clinical trial. Your oncologist will talk to you if one is available that is a good fit. You will still receive your treatments at the Compass Oncology cancer centers from our oncologists, plus you’ll have access to the most advanced and latest treatments available to treat pancreatic cancer. You’re never added to a trial without your consent. If this is an option for you, we encourage you to ask as many questions as you’d like and then choose what you’re most comfortable with. 

Pancreatic Cancer Care and Treatment at Compass Oncology

If you or a loved one has received a diagnosis of pancreatic cancer, our oncologists are ready to guide you through this journey. We provide patients in the Portland and Vancouver areas with the latest pancreatic cancer treatment options based on their unique cancer type. Our nurses and other team members will help you through each of the treatments with tips on what to expect and how to handle side effects.

Our oncologists also provide second opinions before starting a cancer treatment plan. This will ensure you’re informed about your treatment options and feel confident about the plan you choose. Request an appointment with an oncologist at Compass Oncology to discuss a personalized treatment plan.