Treatment for pancreatic cancer

Pancreatic cancer is hard to diagnose early, since the signs and symptoms are not obvious. Because of this, the majority of pancreatic cancers are only found after the disease has reached an advanced stage.

Treatment may include:

• surgery
• chemotherapy
• radiation
• immunotherapy
• targeted therapy

Doctors recommend treatment based on:

• Stage and grade
• Subtype
• Location of cancer
• Overall health of their patient
• Additional testing, including biomarkers and genetic testing for an inherited mutation

Surgery

Surgery is used when results of tests suggest that it is possible to remove all the cancer. Only about 20% of patients with pancreatic cancer are able to have surgery because most pancreatic cancers are first diagnosed when the disease has already spread.

• Whipple procedure (pancreaticoduodenectomy) is the most common operation to remove a cancer in the head of the pancreas.
• Distal pancreatectomy is a surgery that removes only the tail of the pancreas or the tail and a portion of the body of the pancreas.
• Total pancreatectomy surgery removes the entire pancreas, as well as the gallbladder, part of the stomach and small intestine, and the spleen.
• Palliative surgery may be used  to relieve symptoms or to prevent certain complications like a blocked bile duct or intestine in instances where the cancer is too widespread to be removed completely.

Chemotherapy

Chemotherapy uses drugs to help kill cancer cells. These drugs can be injected into a vein or taken orally. 

The most common chemotherapy drugs for pancreatic cancer are:

• Gemcitabine (Gemzar)
• 5-fluorouracil (5-FU)
• Oxaliplatin (Eloxatin)
• Albumin-bound paclitaxel (Abraxane)
• Capecitabine (Xeloda)
• Cisplatin
• Irinotecan (Camptosar)

Radiation therapy

Radiation therapy uses high-energy beams, such as X-rays to destroy cancer cells. You may receive radiation treatments before or after pancreatic cancer surgery, often in combination with chemotherapy such as capecitabine or gemcitabine. In specialized medical centers, radiation therapy may be delivered during surgery (intraoperative radiation).

Traditional radiation therapy uses X-rays to treat cancer, but a newer form of radiation using protons is available at some medical centers. Patients who have proton radiation therapy may have fewer side effects compared to patients who have standard radiation therapy.

Timing of treatment

• Neoadjuvant treatment is given before surgery to shrink the tumor and help the surgeon remove as much of the cancer as possible. 
• Adjuvant chemotherapy is given after surgery to prevent the cancer from spreading or coming back.
• Maintenance therapy is given to some people after they complete chemotherapy treatment to keep the cancer from coming back or growing. 
• If the cancer recurs, additional chemotherapy, targeted therapy or immunotherapy may be given, depending on response to initial treatment and tumor biomarker testing.