This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

There are 3 main types of treatment for cancer of the pancreas: surgery, radiation therapy, and chemotherapy (often called just "chemo"). Depending on the stage of the cancer, some or even all of these types of treatment could be used.

Surgery

There are 2 types of surgery used for cancer of the pancreas:

• Potentially curative surgery is used when it looks like it is possible to remove all the cancer.

• Palliative surgery may be done if tests show that the tumor is too widespread to be completely removed. Surgery is done to relieve symptoms or to prevent certain problems, such as blockage of the bile ducts or the intestine by the cancer.

Studies have shown that removing only part of the cancer does not help patients to live longer. Pancreatic cancer surgery is one of the hardest operations a surgeon can do. It is also one of hardest for patients to have. There may be complications and it can take many weeks for patients to recover. Patients need to weigh the pros and cons of such surgery carefully.

Surgery to try to cure the cancer (potentially curative surgery)

The type of surgery most often done if it looks like the cancer can be cured is called the Whipple procedure. It is the most common type of surgery for cancer of the pancreas. In this surgery, parts of the pancreas are removed along with parts of the stomach and small intestine, the gallbladder, part of the common bile duct, and some nearby lymph nodes. This is a very complex operation. It is best done by a surgeon who has done it many times in a hospital that has had much experience with this kind of surgery. A Whipple procedure is a major operation that carries a relatively high risk of complications that may be fatal.

Only a small number of cancers of the pancreas (about 1 out of 10) appear to be contained entirely within the pancreas when they are found. But even when it looks like the cancer hasn't spread, a small number of cancer cells may already have spread to other parts of the body. For patients who have surgery to try to completely remove the cancer, the 5-year survival rate is about 20%.

Palliative surgery

Because pancreatic cancer can progress quickly, most doctors do not advise surgery to relieve symptoms. Sometimes surgery may be tried in the hope of curing the patient, but during the operation the surgeon discovers this is not possible. In this case, the surgeon may continue the operation as a palliative procedure to relieve or prevent symptoms. For example, surgery can be used to relieve blockage of the bile duct. When this duct is blocked, it can cause pain and problems with digestion.

There are 2 options to relieve a bile duct blockage. One is to re-route the flow of bile from the common bile duct into the small intestine. This requires a large cut (incision) and it may take weeks for the patient to recover. An advantage is that during the surgery, the doctor may be able to cut the nerves leading to the pancreas. This will reduce or get rid of any pain for the patient. Also, the doctor might re-route the stomach connection to the small intestine with the goal of preventing problems in the future.

A second way to treat bile duct blockage is to use metal tubes called stents to keep the bile duct open. The doctor puts the stents in through a thin, flexible tube called an endoscope. Over time the stents may get clogged and need to be replaced. Bigger stents may be used to keep the small intestine open, too. In most cases, of the use of stents has replaced palliative by-pass surgery to relieve bile duct blockage.

Other types of surgery

Other types of surgery, called ablative techniques, may be used to treat areas of spread from pancreatic exocrine cancer when only a few are present. By treating the metastases, symptoms can improve and the patient may live longer.

Radiofrequency ablation: Radiofrequency ablation (RFA) uses radio waves to heat and destroy tissues, such as areas of cancer spread.

Microwave thermotherapy: In this procedure, microwaves are used to heat and destroy the cancer.

Cryosurgery: In cryosurgery, a probe is put right into the tumor to freeze the tissue with liquid nitrogen or liquid carbon dioxide. The area being frozen is destroyed. This technique is also known as cryoablation.

Embolization: For an embolization procedure, a catheter is used to find the blood vessel feeding the tumor. Then a substance is put into the blood vessel, cutting off the blood supply to the tumor. This causes the tumor to die. The substance used can be tiny beads (called microspheres). Sometimes the beads used are radioactive and deliver radiation as well. The catheter can also be used to put in chemo drugs. This is called chemoembolization.

Radiation therapy

Radiation therapy is treatment with high energy rays (like x-rays) to kill cancer cells or shrink tumors. Having radiation is much like getting a regular x-ray but it takes longer. Treatment is usually given 5 times a week for several weeks or months. Sometimes the radiation is given before surgery, sometimes after. Radiation (used along with chemo) can also be used for patients whose tumors are too widespread to be removed by surgery.

Side effects of radiation therapy could include skin changes that look like sunburn, upset stomach, loose bowels, weight loss, or tiredness. Often these go away over time after treatment ends. Talk with your doctor if you have side effects because there are ways to relieve them.

Chemotherapy

Chemotherapy (often called just "chemo") is the use of drugs to kill cancer cells. Usually the drugs are given into a vein or are taken as a pill. Once the drugs enter the bloodstream, they go throughout the body. This makes chemo useful for cancer that has spread beyond the place where it started.

Chemo may be used at any stage of pancreatic cancer. It is can be used for people with advanced cancer. Chemo may also be used after the cancer has been removed to try to kill any cancer cells that may have been left behind. This may help stop the cancer from coming back later. In people who are going to have surgery, chemo and radiation may be given to shrink the tumor ahead of time.

Chemo can cause side effects. These side effects will depend on the type of drugs given, the amount taken, and how long treatment lasts. Short-term side effects might include diarrhea, nausea and vomiting, loss of appetite, hair loss, and mouth sores. Low blood cell counts from treatment can cause an increased risk of infection, bleeding or bruising after minor cuts, and tiredness (fatigue). Most side effects go away once treatment is over. Anyone who has problems with side effects should talk with their doctor or nurse, as there are often ways to help.

Targeted therapy

Newer drugs that target certain parts of cancer cells are now being studied. These drugs work differently from regular chemo drugs and they often have fewer side effects. A drug called erlotinib (Tarceva^®) has helped some patients with advanced pancreatic cancer. It is taken as a pill. When combined with gemcitabine (Gemzar^®) it has been shown to be slightly better than gemcitabine alone. Common side effects of this drug can include an acne-like rash, diarrhea, loss of appetite, and feeling tired.

Last Medical Review: 10/21/2009
Last Revised: 10/21/2009