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Pancreatic cancer

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From MayoClinic.com


Treatment for pancreatic cancer depends on the stage and location of the cancer as well as on your age, overall health and personal preferences. Especially when cancer is advanced, choosing a treatment plan is a major decision, and it's important to take time to evaluate your choices.

You may also want to consider seeking a second opinion. This can provide additional information to help you feel more certain about the option you're considering.

The goal of treatment is always to eliminate the cancer completely. When that isn't possible, the focus may be on preventing the tumor from growing or causing more harm. In some cases, an approach called palliative care may be best. Palliative care refers to treatment aimed not at removing or slowing the disease, but at helping relieve symptoms and making you as comfortable as possible.

Surgical options

The only way to eliminate pancreatic cancer is an operation to remove the tumor. Unfortunately, this is possible only in a small percentage of people. Once the cancer has spread beyond the pancreas to other organs, lymph nodes or blood vessels, surgery is usually no longer an option. When surgery is possible, your surgeon may use one of the following procedures, depending on the extent and location of the tumor:

  • Whipple procedure (pancreatoduodenectomy). This is the most common procedure used to treat pancreatic cancer, including resectable cancers of the ampulla of Vater. It has undergone a number of changes since it was first described nearly 70 years ago, and today doctors perform several variations of the operation. In general, the Whipple procedure involves removing the wide end (head) of your pancreas. To do that, your surgeon must also remove your duodenum, gallbladder and the end of the common bile duct. Sometimes part of your stomach is removed as well. The end of your bile duct and remaining part of your pancreas are then connected to your small intestine so that bile and pancreatic enzymes continue to reach the small intestine. The procedure has risks, including infection and bleeding. In addition, leaking of pancreatic juices after surgery can cause the pancreas to begin digesting itself and nearby tissues.

  • Total pancreatectomy. In this procedure, your surgeon removes your entire pancreas as well as your bile duct, gallbladder and spleen; part of your small intestine and stomach; and most of the lymph nodes in the area. After a total pancreatectomy, you'll need insulin injections and pancreatic enzymes, and the operation presents serious risks. Some studies have questioned the value of total pancreatectomy for people with pancreatic cancer.

  • Distal pancreatectomy. In this procedure, which is primarily used to treat islet cell cancers, only the tail — or the tail and a small portion of the body of your pancreas — is removed. Sometimes your spleen may also be removed.

Operations for pancreatic cancer are extremely complex. The most successful outcomes occur when these procedures are performed in cancer centers by highly experienced surgeons.

Radiation therapy

Radiation therapy uses high-energy X-ray to kill cancer cells. You may receive radiation treatments before or after cancer surgery, often in combination with chemotherapy. Or, your doctor may recommend a combination of radiation and chemotherapy treatments when your cancer can't be treated surgically.

Radiation that comes from a machine outside your body (external beam radiation) is generally used to treat pancreatic cancer. You normally receive treatments five days a week for several weeks. Side effects of radiation therapy may include a burn on your skin similar to sunburn where the radiation enters your body, nausea, vomiting and fatigue.


Chemotherapy uses drugs to help kill cancer cells. Injected into a vein or taken orally, these drugs travel through your bloodstream. For that reason, they're often used to treat cancers that have spread. Chemotherapy, or chemotherapy in combination with radiation, is the usual treatment for pancreatic cancers that have spread to nearby tissues or distant organs. Although chemotherapy won't eliminate the cancer, it may help relieve symptoms. It may also help improve survival when used as an adjuvant therapy after an operation to remove a tumor in the pancreas.

For years, the drug fluorouracil (5-FU) was the only chemotherapy option for people with pancreatic cancer. But fluorouracil wasn't always effective. Now doctors are having more success with a newer drug, gemcitabine. The drug is normally used alone but may be used in combination with other drugs as part of a clinical trial. Doctors are also testing a number of other new medications.

Chemotherapy drugs affect normal cells as well as malignant ones, especially fast-growing cells in your digestive tract and bone marrow. For that reason, side effects — including nausea and vomiting, mouth sores, an increased chance of infection due to a shortage of white blood cells, and fatigue — are common. Not everyone experiences side effects, however, and there are new and better ways to control them if you do. Be sure to discuss any questions you may have about side effects with your treatment team.

Palliative procedures

If your cancer has spread too far to be completely removed by an operation, the primary goal will be to relieve your symptoms. Treatments that focus on making you more comfortable include:

  • Surgical bypass. Tumors that block your bile duct, pancreatic duct or duodenum can cause pain, digestive difficulties, nausea, vomiting, jaundice and severe itching. To help ease some of these symptoms, you may have an operation to reroute the flow of bile by going around (bypassing) the tumor.

  • Stent insertion.When a bypass operation isn't an option, your surgeon may place a stainless steel or plastic tube (stent) in the bile duct to keep it open. A stent is usually the best choice for people who have metastatic cancer or who are very weak.

  • Pain management. Tumors pressing on surrounding nerves can cause severe pain, especially in the later stages of the disease. Although pain is a real concern for people with pancreatic cancer, treatment with morphine or similar medications can provide relief in many cases. Long-lasting forms of morphine that need to be taken only once or twice a day may be especially helpful. When medication isn't enough, your doctor may discuss other options with you, such as cutting some of the nerves that transmit pain signals or injecting alcohol into these nerves to block the sensation of pain. A 2004 Mayo Clinic study showed that a nerve block may control pancreatic cancer pain more effectively and for longer periods than drugs do.

  • Pancreatic enzyme tablets. By replacing the digestive enzymes your pancreas no longer produces, these tablets can improve your body's ability to absorb nutrients and may help reduce diarrhea and weight loss.

  • Insulin therapy. When pancreatic cancer affects insulin production, you may need insulin injections to help control your blood sugar levels.

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
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