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Treatment for pancreatic cancer
Treatment will depend on the type of pancreatic cancer you have, how advanced it is and your general health.
Surgery to remove the cancer, in combination with chemotherapy and possibly radiation therapy, is generally the most effective treatment for early pancreatic cancer.
Pancreatic cancer usually has no symptoms in its early stages, so many people are diagnosed when the cancer is advanced. Surgery to remove the cancer may not be possible. Instead treatments will focus on relieving symptoms without trying to cure the disease. This is called palliative treatment. Palliative treatments may include surgery, chemotherapy and radiation therapy, either on their own or in combination.
The aim of surgery for early pancreatic cancer is to remove all the tumour from the pancreas, as well as a margin of healthy tissue. The type of surgery you have will depend on the size and location of the tumour, your general health and your preferences. Your surgeon will talk to you about the most appropriate surgery for you, as well as the risks and any possible complications.
Types of surgery include:
Whipple procedure – removes the part of the pancreas with cancer, usually the head, the first part of the small bowel, part of the stomach, the gall bladder and part of the common bile duct.
Distal pancreatectomy – removal of the tail of the pancreas, or the tail and a portion of the body of the pancreas. The spleen is usually removed as well.
Total pancreatectomy – removal of the entire pancreas and spleen, along with gall bladder, common bile duct, part of the stomach and small bowel, and nearby lymph nodes.
There are three main approaches to surgery:
- Open surgery involves one larger cut in the abdomen.
- Laparoscopic surgery involves several small cuts in the abdomen. The surgeon inserts a light and camera (laparoscope) into one of the cuts and performs the surgery using images from the camera for guidance.
- Robotic-assisted surgery uses a robotic device to help the surgeon perform laparoscopic surgery.
Sometimes a surgeon may have planned to remove a pancreatic tumour during an operation but discovers the cancer has spread. If the tumour cannot be removed, the surgeon may perform surgery to relieve symptoms.
Surgical options to manage blockages of the common bile duct or duodenum (obstructions) include:
- Stenting – Inserting a small tube into the bile duct or duodenum
- Double bypass surgery – connecting the small bowel to the bile duct or gall bladder to redirect the bile around the blockage, and connecting a part of the bowel to the stomach to bypass the duodenum so the stomach can empty properly
- Gastroenterostomy – connecting the stomach to the jejunum (middle section of the small bowel)
- Venting gastrostomy – connecting the stomach to an artificial opening on the abdomen so waste can be collected in a small bag on the outside the body.
Chemotherapy uses drugs to kill or slow the growth of cancer cells. It is sometimes used in combination with radiation therapy (chemoradiation) to slow the growth of locally advanced cancer that has spread beyond the pancreas and cannot be removed with surgery. Chemotherapy is also used palliatively to relieve symptoms.
Chemotherapy is usually given as a liquid through a drip inserted into a vein in the arm or as tablets you swallow. Each chemotherapy treatment is called a cycle and is followed by a rest period to give your body time to recover. Your medical oncologist will assess how the treatment is working based on your symptoms and wellbeing, as well as scans and blood tests. They will talk to you about how long your treatment will last.
Side effects of chemotherapy
People react to chemotherapy differently – some people have a few side effects, while others have many. Side effects may include fatigue and tiredness; feeling sick (nausea); vomiting; mouth ulcers and skin rashes; hair loss; diarrhoea or constipation; flu-like symptoms such as fever, headache and muscle soreness; and poor appetite. Chemotherapy can also affect your blood count, increasing your risk of infection and anaemia, which can leave you weak and breathless.
Also known as radiotherapy, radiation therapy uses a controlled dose of radiation to kill cancer cells or injure them so they cannot multiply. The radiation is usually in the form of focused x-ray beams targeted at the cancer.
For locally advanced pancreatic cancer, radiation therapy is usually given with chemotherapy (chemoradiation). The chemotherapy drugs make the cancer cells more sensitive to radiation therapy. Chemoradiation may also be used before or after surgery for early pancreatic cancer.
Radiation therapy is delivered over a number of treatments known as fractions. Each fraction delivers a small dose of radiation that adds up to the total treatment dose. You will usually have treatment as an outpatient once a day, Monday to Friday, for up to five or six weeks. Each session takes 10–15 minutes. You will lie on a table under a machine that delivers radiation to the affected parts of your body. Your radiation oncologist will advise you about your treatment schedule.
Side effects of radiation therapy
Radiation therapy can cause both short-term side effects and late side effects, which are mainly related to the area treated. Side effects may include tiredness; nausea and vomiting; diarrhoea; poor appetite; and skin irritation. Late side effects are uncommon, but may include damage to the liver, kidneys, stomach or small intestine. Talk to your radiation oncologist or radiation oncology nurse about ways to manage these side effects.
Palliative care helps to improve people’s quality of life by managing the symptoms of cancer without trying to cure the disease. Palliative treatment is one aspect of palliative care, in which a team of health professionals aim to meet your physical, emotional, practical and spiritual needs.