Treating pancreatic cancer

Treatment for pancreatic cancer will depend on the type, location and stage of your cancer.

It will also depend on your age, general health and personal preferences.

The first aim is to completely remove the tumour and any other cancerous cells in your body. If this is not possible, your doctors will focus on preventing your tumour getting any bigger and causing further harm to your body.

In some cases, it is not possible to get rid of the cancer or to slow down its progress. In this case, your treatment will aim to relieve your symptoms and make you as comfortable as possible.

Cancer of the pancreas is currently very difficult to treat. Because early-stage pancreatic cancer rarely causes any symptoms, the condition is often not detected until the cancer is relatively advanced. When the tumour has grown larger, curing or treating the cancer is much harder.

Discussing your treatment

Deciding on what treatment is best for you can be a difficult process. There is a lot to take in, so it is important you talk through your thoughts and decisions with a member of your family or a friend.

You should also make sure you have a thorough discussion with your GP and consultant. They will be able to inform you of the pros, cons and side effects of all the different treatments available to you.

If at any stage you do not understand the treatment options being explained to you, make sure you ask your doctor for more details.

Cancer of the pancreas can be treated in three main ways:

• surgery 
• chemotherapy
• radiotherapy

Some forms of pancreatic cancer will only require one form of treatment, whereas others may require a combination, sometimes of all three.

Surgery

Surgery is usually the only way pancreatic cancer can be completely cured. Because pancreatic cancer is usually advanced by the time it is diagnosed, surgery is only suitable for around 15 to 20% of patients.

If your tumour has wrapped itself around important blood vessels, surgery will not be a suitable option. If your cancer has spread to other areas of the body, then you will also not be recommended for surgery. This is because the risks of surgery often outweigh the potential benefits.

Surgery for pancreatic cancer can usually only be carried out on patients who have good general health. This is because surgery on the pancreas is often long and complex, and the recovery process can be slow.

This type of surgery is not always successful. It is usually very difficult to completely remove all the cancerous cells. This is because sometimes abnormal, cancerous cells break off and begin to form in other parts of the body.

Sometimes these collections of cells are so small that they cannot be detected by scans or X-rays, so your doctor is unable to remove them.

Your doctor will discuss whether surgery is a suitable option with you.

There are several possible surgical procedures, which are outlined below.

Whipple procedure 

The Whipple procedure is the most common operation used to treat pancreatic cancer. It involves removing the head of the pancreas.

Your surgeon must also remove the first part of your small intestine (bowel), the muscular sac that stores bile (gall bladder) and part of your bile duct. Sometimes part of your stomach also has to be removed.

The end of the bile duct and the remaining part of your pancreas is then connected to your small intestine. This means that bile and pancreatic enzymes (chemicals that speed up chemical reactions in the body) can still be released into the digestive system.

After this operation, around one in three patients need to take enzymes to help them digest food. The Whipple procedure involves long and intense surgery, but is easier to recover from than a total pancreatectomy.

Distal pancreatectomy

A distal pancreatectomy involves having the tail and body of your pancreas removed. Your surgeon will normally remove your spleen at the same time. Sometimes they will also remove part of the stomach and even a part of the bowel, left adrenal gland, left kidney and left diaphragm (muscle separating the chest cavity from the abdomen).

As with the Whipple procedure, a distal pancreatectomy is a long and complex operation which will not be done unless your doctor thinks it is necessary.

Total pancreatectomy

During a total pancreatectomy, your entire pancreas is removed. This is sometimes necessary because of the position of the cancer.

Your surgeon will also remove your:

• bile duct
• gall bladder
• spleen
• part of your small intestine
• part of your stomach (sometimes)
• surrounding lymph nodes (part of your body’s immune system)

After a total pancreatectomy, you will need to take enzymes to help your digestive system digest your food. You will also be diabetic for the rest of your life, as your pancreas is responsible for producing insulin.

Removing your spleen can increase your risk of developing infections and may also affect your blood’s ability to clot. This means you will be on penicillin (or an alternative antibiotic if you are allergic to this) all your life and you will need to have regular vaccinations.

Sometimes, you may need to take tablets for a short period to stop the platelets in your blood sticking to each other (platelets are small cells that make the blood clot).

Surgery to ease your symptoms 

Although surgery may not be a suitable way of removing your cancer, you may be offered it to help ease your symptoms. This type of surgery will not cure your condition, but will make your cancer easier to manage and make you more comfortable.

To help ease symptoms of jaundice, a stent can be placed in your bile duct using ERCP (see diagnosis of pancreatic cancer) to help keep it open. A stent is a small tube that will allow your bile to be processed by the liver, stopping the yellow chemical present in bile (bilibrubin) from building up and causing jaundice.

If a stent is not a suitable option for you, you may require an operation to bypass your blocked bile duct. During the operation, your surgeon will cut the bile duct just above the blockage and reconnect it to your intestine, which will allow your bile to drain away.

These forms of surgery are far less intensive than surgery carried out on the pancreas. Patients normally recover much more quickly and find that their jaundice symptoms have been significantly eased.

Chemotherapy

Chemotherapy is a type of cancer treatment that uses anti-cancer medicines to either kill the malignant (cancerous) cells in your body or stop them from multiplying. Chemotherapy medicines can either be injected into a vein or given to you orally (by mouth).

Chemotherapy can also attack normal, healthy cells in your body, which is why this form of treatment can have many side effects. The most common ones include:

• vomiting
• nausea
• mouth sores
• fatigue

These are usually only temporary and should improve once you have completed your treatment.

Chemotherapy treatment is often used alongside surgery and radiotherapy (see below) to help ensure as much of the cancer is treated as possible.

Radiotherapy

Radiotherapy is a form of cancer therapy that uses high-energy beams of radiation to help shrink your tumour and relieve your pain.

Side effects of this type of treatment can include:

• fatigue
• skin rashes
• loss of appetite
• sores in your oesophagus (gullet) 

These side effects are usually only temporary and should improve once you have completed your treatment.