Treatment for pancreatic cancer begins with a personalized plan developed by pancreatic oncologists, surgeons, pathologists and other medical experts at the Multidisciplinary Pancreatic Cancer Clinic's tumor board. For most patients, the plan uses multiple kinds of treatments, or therapies, in order to control the disease and improve outcomes. The sequence of therapies - chemotherapy, radiation therapy and surgery - is tailored to patients individually and depends on the tumor's location and the extent of disease. Overall health status and quality of life are also factored heavily into the decisions for treatment and recommended therapies.
Eligibility for clinical trials and exciting new innovative therapies should always be considered.
Surgery for pancreatic cancer
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 operation.
Diagnostic tests give information about the size, location and involvement of other surrounding tissues 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 the patient can tolerate the surgical procedure. Each case is individual. In some cases, chemotherapy and radiation therapy, or other new agents, given as part of a clinical trial, will be recommended to potentially reduce the size of the tumor and improve the outcome of surgery. If the tumor is found to be in the head of the pancreas and is operable, the surgical procedure performed is a pancreaticoduodenectomy, also called a 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 these structures can drain properly.
When does a patient see a gastroenterologist?
Gastroenterologists provide complex diagnostic services and treatment for complications related to pancreatic cancer:
Jaundice is the most common complication of pancreatic cancer that is treated by gastroenterology experts. When a mass, or cancer blocks the bile duct, there is a buildup of fluid causing jaundice, which is evident by a yellow appearance of the skin. To treat jaundice, a stent is placed in the bile duct to allow the bile to drain into the intestine again as it did prior to the blockage by the tumor. Occasionally, due to changes in a patient's anatomy such as prior obesity surgery or a blockage that cannot be traversed using an endoscope, the patient will require placement of a biliary stent through the abdominal wall or skin (percutanously). This will occur in the Radiology department and is called a 'PTC', or percutaneous transhepatic cholangiocatheter. In this case the bile may sometimes drain into a bag on the outside of the body rather than internally.
In the case of family history of pancreatic cancer, or a genetic disorder that predisposes people to pancreatic cancer, there are also surveillance examinations. Gastroenterologists use endoscopic ultrasound (EUS) for this exam, which involves using an endoscope, which is a lighted, flexible tube, about the thickness of a finger, to examine the pancreas and to create detailed pictures using ultrasound imaging. EUS is the most sensitive test for picking up small cancers.
Radiation therapy for pancreatic cancer
Radiation therapy is used in three ways:
- to decrease the risk of local recurrence after surgery
- to reduce the size of the tumor before surgery (preoperative or neoadjuvant therapy) and
- as part of a treatment regimen for patients who have a tumor that is found to be unresectable.
When radiation is used, it is often in combination with chemotherapy, or with other new treatments as part of a clinical trial, which enhances the effectiveness of the radiation. Radiation and chemotherapy together have been found to benefit patients with locally advanced pancreatic cancer.
Chemotherapy for pancreatic cancer
The goals of chemotherapy treatment are to control the cancer, keep it from spreading by slowing the cancer's growth and improve or reduce the symptoms of the disease. Chemotherapy is often used for cancer that is found to be locally advanced or metastatic (spread to other organs). These drugs can have an effect on the cancer by stopping the growth of cancer cells or their ability to multiply.
Make an appointment/referral
To make a first time appointment, please call the Patient Care Center at 800-865-1125. If you would like to refer a patient, please contact our M-Line service: 800-962-3555. For more information, visit our Make an Appointment web page.
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