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Tuesday, March 11, 2014
Treatment for pancreatic cancer comes in three forms:
Sometimes a combination of the treatments are used. If the cancer is caught early, surgical intervention can be used; that is usually followed by chemotherapy and radiation therapy. If the cancer has metastasized, or spread, to other tissues, then chemotherapy plus or minus radiation are needed. In this situation, surgery has no role in the treatment algorithm. Sometimes, if the tumor is encasing the blood vessels around the pancreas, radiation and chemotherapy are given initially to attempt to shrink the tumor and then if feasible, surgery will be attempted.
The Pancreatoduodenectomy (Whipple) procedure is the most common operation where the head of the pancreas, duodenum, gallbladder, and end of the common bile duct are removed. Sometimes the bottom part of the stomach is taken as well, however this is usually based on the surgeon's preference. The end of the bile duct and remaining part of the pancreas and stomach are then attached to your intestines. The most common risk after this surgery is leakage of pancreas juice where the pancreas is connected to the intestine. Fortunately, this usually heals on its own.
Total Pancreatectomies are seldom used because the benefits do not seem to be enough to justify the risk. After this procedure, patients will need insulin injections and digestive enzymes for the rest of their lives. When necessary, the operation is performed similar to the Whipple, however, a connection to the pancreas and intestine is not necessary.
Distal Pancreatectomies are performed when the cancer is in the tail of the pancreas. In this procedure only the tail part of the pancreas is removed, and no anastamosis are necessary. This operation is easier to perform and is associated with a quicker recovery. Often times this operation can be performed laparoscopically. Similar to the Whipple, the most common complication is leakage of where the pancreas is cut.
Chemotherapy is used after surgery and it is also used for patients that have cancers that have metastasized beyond the pancreas. The chemotherapy drug of choice for pancreatic cancer is gemcitabine. Other drugs that can be utilized include 5-flurouracil and oxaliplatinum. Through testing in new clinical trials, the FDA has approved the use of erlotinib in conjunction with gemcitabine as first line therapy. As with all chemotherapies, the drugs affect all quickly dividing cells such as bone marrow and digestive tract tissue. So it is very important that the patient exercise caution while on chemotherapy drugs.
Radiation Therapy is also used after surgery or for patients that have unresectable tumors. Radiation involves using an external device to shoot high energy radioactive beams at the affected area, killing any residual tumor cells or shrinking the tumor. You may experience a sunburn-like effect at the area of entry. When radiation therapy is directed at the gastrointestinal area, nausea and vomiting may occur as a side effect. Radiation therapy will also help relieve pain by reducing the size of the tumor.
Finally, if the cancer is too forgone to be treated, palliative procedures are used. Palliative procedures are made to treat the symptoms and to increase the overall quality of life. Many of the obstructed ducts can be bypassed, or held open with wire mesh stents. Pain management is key in palliative care, with medication or even operation on the nerves are viable options for patients in severe pain. By using supplement tablets to accommodate for a lack of pancreatic enzymes and insulin, the body may act more normally, and the patient will not receive the harsh symptoms of pancreatic cancer. Sometimes an endoscopy can be performed to numb the nerves to the pancreas to alleviate pain. This procedure is called a celiac plexus block.
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Last Reviewed: Jun 04, 2009
Syed A Ahmad, MD
Associate Professor of Surgery
College of Medicine
University of Cincinnati