The treatment of pancreatic cancer generally involves four primary options. Surgery, radiation therapy, chemotherapy, and participation in a clinical trial. Treatment options depend upon many factors at the time of diagnosis including specific type of pancreatic cancer, location and size of the tumor(s), tumor proximity to adjacent blood vessels, and progressive stage of the cancer.
Treatment options are recommended by a team collaboration of experts which includes an oncologist, surgeon and radiologist that rely upon imaging studies, various tests, biopsy and general health of the patient. The team also includes the patient who must make decisions based upon many considerations of recommendations that consider his or her own personal wishes.
Surgery to remove a cancerous tumor(s) is only an option when the cancer is still contained within the pancreas and has not spread to other organs or tissue. However, there are surgical procedures that may be performed after metastasis (spread) to help relieve pain and remove obstructions in the bile and pancreatic ducts.
The type of surgery is determined by the location of the tumor(s) within the pancreas. If the tumor is
in the head of the pancreas, removal of the tumor is known as the “Whipple Procedure”. If in the body or tail of the pancreas, surgery is referred to as a “Distal Pancreatectomy”. If there are multiple or very large tumors, the entire pancreas may be removed via a “Total Pancreatectomy”.
Only surgery is considered a “Curative Treatment” meaning the treatment team believes that it is possible all of the cancer can be removed at its earliest stage when it is most treatable. Only about 9% of diagnosed cases are made at stage 1. Once the cancer has spread, it becomes inoperable and further treatment is considered “Palliative Treatment” which is only focused on extending quality life by reducing symptoms and staving of cancer recurrence.
Radiation therapy uses high-energy, highly targeted x-rays to kill cancer cells. Radiation may be used before or after surgery. Preoperative use intends to shrink the size of a tumor prior to surgery making it easier to remove. After surgery, radiation intends to kill any remaining cancer cells in the pancreas to help prevent recurrence and spreading to other organs. Radiation therapy is similar to a diagnostic x-ray except with substantially higher doses of radiation.
All radiation targets the cancerous tumor carefully applied to avoid damage to surrounding tissue minimizing potential side effects. Multiple treatments are usually required on a daily basis covering a duration of several weeks. Radiation treatment itself is painless and quick. Side effects can include nausea, diarrhea, fatigue, poor appetite, and subsequent weight loss. It can also result in lowered blood counts and increased chances of infection.
Chemotherapy is the use of cancer cell- killing medicines usually administered by injection into veins (intravenous), but certain types are given orally in the form of tablets or capsules. Chemotherapy may be administered before and after surgery. Use before surgery is an attempt to reduce the size of the tumor. After surgery (or if surgery is not an option), its primary purpose is trying to prevent cancer from coming back and/or spreading to other organs.
If the cancer is inoperative, chemo therapy becomes a “palliative treatment” meaning that a cure is not reasonable likely and remaining treatments aims only to slow the growth and spread of the cancer purposed to extend life as long as possible and to control associated symptoms. It is important to note the average 5-year survival rate of all stages of pancreatic cancer is 6 to7%.
If the cancer is still confined to the pancreas at diagnosis, the 5-year survival rate is about 28%. If the cancer has metastasized (spread) to other organs, the 5-year survival rate diminishes significantly to about 2.8%. Unfortunately only about 9% of cases are diagnosed at Stage 1.
Chemotherapy is a systemic treatment where selected drug(s) enters and travels the bloodstream to reach cancerous tumor cells wherever they may hide. Treatment can be rigorous with side effects including nausea, vomiting, extreme fatigue, low blood cell count, and infection. Withstanding the rigors and discomfort of treatment depends upon existing health condition of the patient.
Clinical trials are essentially research studies designed to test and develop new methods to prevent, detect, treat, manage symptoms, and to extend life of late stage pancreatic cancer patients. Through clinical trials medical researchers may discover new and effective treatments that safely perform better than existing treatments. Participation in a new clinical trial contributes to medical discovery that not only may result in increased life extension but advanced knowledge that may leads to early detection methods and an eventual cure. This is a great gift to future patients.
Clinical trials exist at many hospitals and cancer treatment centers and are available for patients at all stages of pancreatic cancer. Every trial has a designated principle investigator that will determine trial protocol and patient eligibility, Successful trial results are submitted to the FDA for its approval for public use. Discuss availability and eligibility with your pancreatic cancer treatment team.