Treatment Options

Surgery is the best option for people whose cancer can be safely and effectively removed. This usually means that the tumor has not grown into any of the major blood vessels located near the pancreas or spread to surrounding structures. The type of surgery will depend on the location of the tumor in the pancreas. However, not every patient is eligible for surgical treatment. Factors such as the stage of the disease, personal health, and the ability to tolerate a major operation – including prolonged anesthesia – must be considered before a patient can undergo surgery.

It is important to discuss the benefits, risks, and potential complications of surgery with an experienced pancreatic surgeon before deciding upon surgery as the preferred course of treatment.

Although improvements in diagnosis, staging, surgical techniques, and postoperative care have led to better outcomes after surgery, pancreatic resection is a demanding operation on both the patient and the surgical team. Recent studies have shown that the outcome from surgery in these complex procedures is dependent on the experience of the hospital and the surgeon performing the operation. Therefore, it is recommended that pancreatic cancer surgery be performed in a centre that is experienced and does a high volume of these complex surgical procedures to ensure the best outcome.

Whipple Procedure

The Whipple procedure is the most commonly performed surgery to remove tumors in the pancreas. In a standard Whipple procedure, the surgeon removes the head of the pancreas, the gallbladder, part of the duodenum(uppermost portion of the small intestine), a small portion of the stomach called the antrum, and the lymph nodes near the head of the pancreas. The surgeon then reconnects the remaining pancreas and digestive organs so that pancreatic digestive enzymes, bile, and stomach contents will flow into the small intestine during digestion. Surgery usually lasts between 6-10 hours.

Total Pancreatectomy

A total pancreatectomy involves the removal of the entire pancreas, as well as the spleen, gallbladder, common bile duct, and portions of the small intestine and stomach. By removing the pancreas, the chance of removing the entire tumor is increased. Unfortunately, a total pancreatectomy leaves the patient unable to produce pancreatic enzymes for digestion and insulin to control blood glucose levels. The patient will be required to take supplemental enzymes and insulin for the remainder of his or her life. Sometimes, an islet cell transplant can be performed to allow the body to continue to produce insulin.

Distal Pancreatectomy

A distal pancreatectomy involves the removal of the bottom half of the pancreas. This procedure is chosen if the tumor is located in the body or tail of the pancreas.

Palliative Intent Surgery

Palliative intent surgery is sometimes recommended to alleviate distressing symptoms. In particular, tumors blocking the bile duct can cause uncomfortable symptoms such as jaundice, itching, nausea, and bowel problems. Common options for these procedures include:

Stent Implant – having a small plastic tube (called a stent) fitted inside the bile duct helps to open up the duct and help to improve symptoms.

Biliary Bypass – another method to relieve the blockage of the bile duct is to cut the duct above the blockage and rejoin it to the intestine. After the surgery, bile will bypass all or part of your bile duct and drain into the intestine.

Chemotherapy travels through the bloodstream, allowing for effectiveness against circulating metastatic cancer cells and established distant metastatic lesions. However, this is also responsible for the harm caused to the normal, healthy cells in the body. Chemotherapy is given to patients for a variety of reasons. These include:

Chemotherapy Options

When considering chemotherapy as a treatment option, it is important to discuss with your physician the pros and cons of each drug. While one drug may prove effective in a specific subset of patients, it may not necessarily be recommended for treatment of every patient with pancreatic cancer. Furthermore, the side effect profile of each drug may prove to be more or less tolerable based on each patient’s individual preferences. These are all important considerations to discuss with your physician.

Commonly used chemotherapeutic agents include, but are not limited to, the following:

Gemcitabine (Gemzar®)

Gemcitabine is the most commonly used drug to treat pancreatic cancer. It is usually given by intravenous infusion (through a drip) along with anti-sickness drugs. Intravenous infusions are given through a thin, short tube put into a vein in your arm each time you have treatment. Alternatively, you may have a central line, a portacath, or a PICC line inserted just before your treatment starts. These are tubes that give the drugs directly into a large vein in your chest and will stay in place as long as you need treatment.

Nab-Paclitaxel (Abraxane®)

Abraxane® prevents the breakdown of gemcitabine to enhance its effects. By using Abraxane® in conjunction with gemcitabine, the amount of gemcitabine entering the tumors is increased, thereby making it much more effective, but also increasing its potential toxicity.

FOLFIRINOX

FOLFIRINOX is a combination chemotherapy for the treatment of metastatic pancreatic cancer. However, FOLFIRINOX is an extremely toxic treatment and not recommended for all patients. Currently, it is only used in patients with stage 4 metastatic pancreatic cancer who have not yet received any chemotherapy.

5-Fluorouracil (5-FU)

5-Fluorouracil (5-FU) is administered intravenously (through a drip). Sometimes a vitamin called folinic acid (leucovorin) is given at the same time as this enhances the effects of 5-FU. The patient is often given anti-sickness drugs (anti-emetics) at the same time to help prevent adverse side effects.

Irinotecan Liposome Injection (Onivyde®)

ONIVYDE® given in combination with 5-FU (fluorouracil) and leucovorin (LV), is a second-line treatment for metastatic pancreatic cancer that has progressed following previous treatment with gemcitabine.