The treatment approach to pancreatic cancer depends on the type, location and stage of the cancer. The patient’s general state of health and ability to withstand therapy are also taken into consideration before embarking on a treatment regimen.
The first aim of treatment is to remove the tumor and any surrounding cancer cells from the body as completely as possible. However, if this is not possible, treatment is aimed at preventing tumor growth and any further damage it may cause. In the end stage of disease, treatment aims to provide as much symptomatic relief as possible.
Pancreatic cancer is a particularly difficult cancer to treat, since it is rarely detected in the early stages due to a lack of symptoms. Once detected, the cancer is usually fairly advanced and less likely to respond favourably to treatment.
Pancreatic cancer is treated using several modalities that are often used in combination. These include :
Surgical resection of the tumor
If a cancer is small and confined to the pancreas, the tumor may be resectable and completely removable with a surgical procedure. This is the most effective treatment for pancreatic cancer in the early stages. However, only 15% to 20% of patients are candidates for surgery due to the difficulty diagnosing the condition while it is still in the early stages and therefore operable. If the cancer has spread and involves important blood vessels, surgery may not be possible.
Surgery for pancreatic cancer is a long and a complex procedure and a patient needs to be in a generally good state of health to be considered for this operation.
The Whipple procedure is the most common surgery performed in cases of pancreatic cancer. The procedure involves the removal of the head of the pancreas, the lower end of the stomach, the duodenum, part of the bile duct and the surrounding lymph nodes. The remaining part of the pancreas, stomach and the bile duct are then connected to the small intestine.
Pancreatectomy or removal of part or the whole of the pancreas is another option. A procedure that involves removal of only the tail end of the pancreas is termed distal pancreatectomy. A total pancreatectomy refers to the removal of the entire pancreas, often along with the bile duct, gall bladder, part of the stomach and small intestine, spleen and surrounding lymph nodes.
Surgery is usually followed by chemotherapy to kill off any remaining cancer cells. Chemotherapy medicines may be given orally or as injections (intravenously).
Radiotherapy uses high energy beams to target the remaining cancer cells and may be performed prior to surgery in order to shrink the tumor and also to relieve pain.
Reviewed by Sally Robertson, BSc