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Treatment

Pancreatic cancer can be classified (or staged) into three main groups

These classification groups help to detemine the most effective way to treat the cancer. If it's determined that the cancer can be successfully removed, then surgery is considered. For patients with localized, but not operable, cancer, two treatment strategies are used:

For patients with cancer that has spread, chemotherapy can be offered as treatment.

Doctors and nurses discussing treatment options stress the importance of treating the disease while at the same time making those treatments as tolerable as possible. The goal of treatment is to stop the growth of the cancer, to shrink it, if possible, and to help the patient live a quality life for as long as possible.

How does a patient decide on treatment?

Pancreatic cancer is very hard to control with our current treatment options. When patients are first diagnosed they are overwhelmed. Shock and stress can make it difficult to think of everything you might want to know. It is always helpful to have family or friends accompany the patient for dicussions about treatment.

At the Multidisciplinary Pancreatic Cancer Clinic, surgeons, medical oncologists and radiation oncologists gather to review and discuss the individual cases. Treatment generally starts within a few weeks of the initial evaluation. There is time to discuss options and to learn more about pancreatic cancer, treatment approaches, and the clinical trials that are avalable at the U-M Comprehensive Cancer Center.

What factors affect prognosis or chance of recover and treatment options?

The prognosis (chance of recovery) and treatment options for pancreatic cancer depend on many factors. Some of these are:

• the stage of the cancer (the size of the tumor and whether the cancer has spread outside the pancreas to nearby tissues or lymph nodes or to other places in the body).
• Whether or not the tumor can be removed by surgery, or is "operable" or "resectable".
• the patient's general health.

Pancreatic cancer can be controlled for a lifetime, or cured, only if it is found before it is spread and it can be removed in its entirety by surgery. If the cancer has spread, or is inoperable, the doctors will discuss treatments that can improve quality of life by controlling the symptoms and complications of the disease.

Surgery

When patients are diagnosed with pancreatic cancer, approximately 20% of the tumors are found to be operable or resectable. The location of the pancreas adds to the technical difficulties of a surgical operations.

Ideally, surgery would remove the tumor with a wide band of surrounding normal tissue. However, important veins and arteries are located near the pancreas and it may not be possible to do surgery.

Diagnostic tests give information about the size, location and involvement of other surrounding tissue and vessels. These tests help the surgeon determine whether a cancer is operable or resectable. In addition, a surgeon will evaluate the patient's overall health to determine if they can tolerate the surgical procedure. Each case is individual. In some cases, chemotherapy and radiation therapy will be recommended to potentially reduce the size of the tumor and improve the outcome of surgery.

Pancreaticoduodenectomy (Whipple Procedure)

If the tumor is found to be in the head of the pancreas and is operable, the surgical procedure performed is a Pancreaticoduodenectomy, also known as the Whipple Procedure. This surgery involves removing the head of the pancreas, the gallbladder, part of the bile duct, and part of the stomach. Surgery includes re-connecting the remainder of the bile duct, pancreas and stomach to the bowel so that these structures can drain properly.

Distal Pancreatectomy

Tumors that are in the body or tail of the pancreas, which are less common, can be removed by removing the distal part of the pancreas and spleen. This is called a distal pancreatectomy.

Other Procedures

At the time of diagnosis, 80% of patients are not candidates for ptoentially curative resection. Other procedures may be necessary to relieve the symptoms caused by the cancer. These symptoms include:

Bile Duct Obstruction

Patients who develop bile duct obstruction due to the tumor are candidates for biliary stent placement, eithr done with a scope through the mouth (endoscopically) or through the abdominal wall or skin (percutaneously). The endoscopic procedure is called "ERCP."

Percutaneous Placement

When a patient is jaundiced due to a bile duct obstruction it may not be possible to place a stent endoscopically. A "PIC" (percutaneous transhepatic cholangiogram) procedure may be done to place a tube directly into the liver bile ducts through the skin on the right of the abdomen. This tube will drain the bile into a bag outside the body. Local anesthesia is most commonly used for this procedure. Most patients will stay overnight in the hospital after the procedure. This allows time to make sure the tube is working correctly and to instruct you in the care of the drainage tube.

Over time, the liver bile duct should be relieved of pressure with this external drainage. Once that happens, it may be possible to perform a second procedure that places the stent inside the body.

Gastric Outlet Obstruction

Patients who develop gastric outlet obstruction, which appears as severe nausea and vomiting, may undergo either a surgical bypass or placement of a duodenal stent. The stent is placed endoscopically.

For more information

Print our Pancreatic Cancer Patient Handbook.

If you still have questions, please contact the Cancer AnswerLine™ by telephoning 800-865-1125.

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Last update 6/2007

Developed by the staff of the Multidisciplinary Pancreatic Cancer Program at the U-M Comprehensive Cancer Center. In addition, the GI Oncology Program, Patient Education Program, Gastrointestinal Surgery Department, Medical Oncology, Radiation Oncology and Surgical Oncology contributed.

This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. The aim is promoting active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician.