Pancreatic Cancer Treament Types
The spread and the stage of the pancreatic cancer determine the best treatment. Although the stages are easy to understand, a major surgery is normally required to stage the cancer. In practice, imaging and a personal history are key determinants in the kind of treatment chosen by the doctors.
- Stage 0: No spread.
- Stage I: Local growth limited to the pancreas (growth <2 cm - stage IA or >2 cm - stage IB).
- Stage II: Local spread to nearby lymph nodes.
- Stage III: Wider spread to nearby major blood vessels and nerves.
- Stage IV: Confirmed spread of cancer cells is found in distant organs.
Based on imaging, doctors first determine whether the cancer can be removed by surgery (termed resectable) or not. It is then categorized as below:
- Resectable: If the cancer hasn't spread too far and all of it may be removable (10-15% cases).
- Unresectable (locally advanced): The cancer has grown into major blood vessels and thus cannot be safely removed by surgery.
- Metastatic: The cancer has clearly spread to other organs.
Resectable Pancreatic Cancer
People whose pancreatic cancer is considered resectable have a small chance of cure and may undergo one of three surgeries:
- Whipple procedure, a difficult and complicated surgery, to remove the head of the pancreas along with other affected organs and reconnect the remaining parts to allow for normal digestion.
- Distal pancreatectomy, where the tail and/or body of the pancreas are removed, but not the head. This surgery is uncommon because most tumours arising outside the head are unresectable.
- Total pancreatectomy, where the entire pancreas is surgically removed. Although once considered useful, this operation is uncommon today.
Chemotherapy and/or radiation therapy can also be used in conjunction with surgery for resectable pancreatic cancer in order to:
- Shrink the cancer before surgery, improving the chances of resection (neoadjuvant therapy)
- Prevent or delay the cancer from returning after surgery (adjuvant therapy)
Chemotherapy includes cancer drugs that travel through the whole body. Either of two chemotherapy drugs can be used:
- 5-fluorouracil (5-FU)
In radiation therapy, high-energy X-rays are beamed externally over the affected areas. These X-rays penetrate through the skin and kill the cancer cells.
Unresectable (locally advanced) Pancreatic Cancer
Since the cancer cannot be removed surgically in this case, nonsurgical therapies including chemo and/or radiation therapy are the best available options.
Metastatic Pancreatic Cancer
Similar to unresectable cancer, metastatic pancreatic cancer cannot be removed and thus, chemotherapy with gemcitabine is the best available treatment.
As the cancer progresses beyond cure, the priority may shift from extending life to reducing symptoms and the pain associated with it.
- Bile duct stents can reduce itching and loss of appetite associated with bile obstruction.
- Morphine and other strong painkillers can help relieve pain.
- Antidepressants and counselling can help treat depression, common in late stage cancer.