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Treatment

How Is Pancreatic Cancer Treated?

At present, pancreatic cancer is potentially curable only in its early stages. The best treatment option(s) depends on several factors, including the location of the tumor(s), whether the cancer has spread, and the patient’s age and general health.

Surgery

Surgery is currently the most effective treatment for pancreatic cancer. The two types of surgery used to treat pancreatic cancer are potentially curative surgery and palliative surgery. Potentially curative surgery is performed if it appears the cancer can be removed entirely. If the cancer has spread too far to be completely removed, patients may be treated with palliative surgery. Rather than try to cure the cancer, the goals of palliative surgery are to relieve symptoms and prevent problems caused by the cancer, such as the cancer blocking the bile ducts or the intestine.

Potentially Curative Surgery

The type of operation performed depends on where the cancer is located within the pancreas. For cancers in the uncinated process, head, and neck, a Whipple operation is performed. The Whipple procedure (pancreatoduodenectomy) removes part of the pancreas, the first portion of the small intestine (duodenum), the gallbladder, and part of the bile duct, as well as several nearby lymph nodes. In some cases, a small portion of the stomach may also be removed. For cancers located in the body or tail of the pancreas, more often a distal pancreatectomy is performed. In this operation, part of the pancreas is removed along with the spleen and the surrounding lymph nodes.

After surgery, patients may require medication to aid pancreatic function, such as digestive enzymes and/or insulin.

Potentially curative surgery, such as the Whipple procedure, is only performed if the cancer can be entirely removed. Removing only part of the cancer does not help the patient live longer (American Cancer Society 2015a). In some cases, surgeons may begin potentially curative surgery, only to discover the cancer is too widespread to be removed entirely. In these instances, the procedure may be stopped, or the surgeon may perform palliative surgery.

Palliative Surgery

For many patients, potentially curative surgery is not an option because the cancer is already too widespread to operate on when it is discovered. For these patients, palliative surgery may be an option. Palliative surgery is meant to treat the symptoms of the cancer and prevent problems that may potentially arise as a result of the cancer.

One problem palliative surgery may be able to treat is blockage of the bile duct. Having a blocked bile duct can not only be painful, it can also interfere with digestion and cause jaundice.

The two main options to relieve blockage are stent placement and bypass surgery.

Endoscopic Stent Placement

Stent placement is the most common procedure used to relieve blockage in the bile ducts. For this less invasive procedure, the gastroenterologist uses an endoscope to place small plastic or metal stents into the duct to relieve blockage. Larger stents can be used to relieve intestinal blockage.

Stents are not a permanent solution to blockage. Over time, the stents may become clogged and need to be replaced.

Operative Biliary and Intestinal Bypass

Instead of bile flowing from the common bile duct through the pancreas, bypass surgery redirects the flow of bile from the common bile duct into the small intestine. Additionally, if the duodenum or stomach is blocked by the tumor, a loop of intestine can be sewn to the stomach further up to allow food to be more easily digested.

The recovery time for bypass surgery is longer than for stent placement surgery, but this type of surgery offers longer-term relief.

Medical Therapy

Medical therapy uses drugs to destroy cancer cells.

Chemotherapy

Chemotherapy is a medication or combination of medications used to treat cancer. Chemotherapy can be given orally (as a pill) or injected intravenously (IV). When chemotherapy drugs enter the bloodstream, they destroy cancer cells. Chemotherapy is particularly useful for cancers that have metastasized, or spread. Chemotherapy attacks all quickly-dividing cells, regardless of whether they are cancerous which can cause a number of side effects, including hair loss, mouth sores, loss of appetite, nausea and vomiting, diarrhea, and low blood counts. Low blood counts can increase a patient’s risk of infection, bruising or bleeding, fatigue, and shortness of breath. The side effects of chemotherapy are generally temporary and often go away once treatment is completed. Chemotherapy regimens vary from patient to patient. They are generally repeated several times in cycles, with three to four weeks separating each cycle to allow damaged normal cells time to recover. After the first two or three sessions of chemotherapy, patients may have a CT or PET scan to see if the drug(s) is effective. If the drug(s) is not working, it may be switched out for a new drug(s).

Targeted Therapy

Targeted therapy is a type of cancer treatment that uses drugs or other substances to precisely identify and attack cancer cells. Usually, targeted therapy does less damage to normal cells than other cancer treatments.  

Radiation Therapy

Radiation uses special equipment to deliver high-energy particles, such as x-rays, gamma rays, electron beams or protons, to kill or damage cancer cells. Radiation (also called radiotherapy, irradiation, or x-ray therapy) can be delivered internally through seed implantation or externally using linear accelerators (called external beam radiotherapy, or EBRT). Radiation may be used as a solitary treatment or with surgery and/or chemotherapy. The equipment used to deliver the radiation therapy is called a linear accelerator. The linear accelerator has a moveable arm, which enables the radiation to be focused on the part of your body where the cancer is located. Developments in EBRT equipment have enabled physicians to offer conformal radiation. With conformal radiation, computer software uses imaging scans to map the cancer three-dimensionally. The radiation beams are then shaped to conform, or match, the shape of the tumor.

Radiation works by breaking a portion of the DNA of a cancer cell, which prevents it from dividing and growing. Radiation therapy can be systemic, meaning it moves throughout your bloodstream. Systemic therapies are usually given as an injection into a blood vessel or are taken as a pill. Systemic treatments expose your entire body to cancer-fighting medication. Radiation therapy is typically given as a "local" treatment however, meaning it affects only the part of the body that needs therapy.

CyberKnife

CyberKnife delivers highly targeted beams of radiation directly into tumors, in a pain-free, non-surgical way. Guided by specialized imaging software, we can track and continually adjust treatment at any point in the body, and without the need for the head frames and other equipment that are needed for some other forms of radiosurgery.

Palliative Care

Patients receive palliative care to control pain and other symptoms caused by the cancer and to relieve the side effects of treatment.

There are several methods of pain control, including pain medicines, nerve blocks (a procedure in which alcohol is used to block pain), and complementary therapies (such as massage or acupuncture).

Palliative surgery, such as stent placement or bypass surgery, may also be used to relieve bile duct blockage and the symptoms it may cause.

Our Team

BMC’s comprehensive pancreatic cancer team includes surgeons, medical and radiation oncologists, gastroenterologists, palliative care physicians, and interventional radiologists. The team’s patient-centered, multidisciplinary approach assures each patient benefits from the collaborative expertise of physicians uniquely focused on their individual needs.

Cancer Clinical Trials

BMC offers a number of clinical trials specifically for pancreatic cancer patients. Promising new techniques in the diagnosis, treatment, and care of patients with cancer are tested in these studies. The number and types of clinical trials available are constantly changing. View an up-to-date list of ongoing trials here. Those interested in participating in any clinical trials at BMC should speak with their physician.

Cancer Support Services

A diagnosis of cancer can be a life-altering experience. The team at Boston Medical Center understands that cancer affects patients and their loved ones in many ways. They support patients during all aspects of care—from diagnosis through treatment and recovery. BMC’s Cancer Support Services Program is dedicated to providing patients and their loved ones with a comprehensive set of services that address a wide range of needs. Services include:

  • Cancer support/discussion groups
  • Support activities
  • Special programs and events
  • Complementary services

To learn more, see the most recent quarterly newsletter and event calendar or visit Cancer Support Services.

Additional Support

Patient Navigators

Patients have the option of working with a patient navigator who may be able to provide support services related to their care. Patient navigators frequently assist with:

  • Appointment reminders
  • Helping patients understand complex treatment schedules
  • Transportation
  • Insurance questions
  • Interpreter services
  • Connecting patients to Cancer Support Services programs and events
  • Referrals to community resources

Social Workers

Social workers are available to provide additional support services to patients and families and to help with emotional, psychological, and social service needs. They are available on inpatient and outpatient units. Social workers can meet with patients before or after their appointments. Patients can discuss these options with their physician or ask for a referral.

Nutritionists

Patients with concerns about their diet and nutrition during the course of their cancer treatment can meet with one of BMC’s nutritionists. Nutritionists are also available to meet with patients before or after their other appointments. Patients should talk with their physician or social worker if they are interested in seeing a nutritionist.

References

American Cancer Society. 2015a. Pancreatic Cancer Overview. PDF.

-----2015b. “What are the risk factors for pancreatic cancer?” Last modified January 9, 2015.
http://www.cancer.org/cancer/pancreaticcancer/detailedguide/pancreatic-cancer-risk-factors

American Joint Committee on Cancer. 2009. Pancreas Cancer Staging. 7th ed. PDF. https://cancerstaging.org/references-tools/quickreferences/Documents/PancreasSmall.pdf

National Cancer Institute. 2010. What You Need To Know About™ Cancer of the Pancreas. Bethesda: National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services. http://www.cancer.gov/publications/patient-education/pancreas.pdf

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