Pancreatic Cancer: Standard Therapy

Pancreatic cancer is hard to diagnose early, since the signs and symptoms are not obvious. Because of this, the majority of pancreatic cancers are only found after the disease has reached an advanced stage. Earlier detection may improve as more high-risk people have access to pancreatic cancer screening. 

Doctors base treatment recommendations for pancreatic cancer on several factors, including:

• stage and grade
• type
• location of cancer
• overall health of the patient
• additional testing, including biomarkers and genetic testing for an inherited mutation

Every treatment has potential risks and side effects. Before any new treatment or surgery, make sure your healthcare team tells you what to expect.

This section focuses on treatment for pancreatic exocrine cancer, the most common type. Treatment may include:

Surgery

Surgery is used when results of tests suggest that it is possible to remove all the cancer. Only about 20% of patients with pancreatic cancer are able to have surgery because most pancreatic cancers are first diagnosed when the disease has already spread.

• Whipple procedure (pancreaticoduodenectomy) is the most common operation to remove a cancer in the head of the pancreas.
• Distal pancreatectomy is a surgery that removes only the tail of the pancreas or the tail and a portion of the body of the pancreas.
• Total pancreatectomy surgery removes the entire pancreas, as well as the gallbladder, part of the stomach and small intestine, and the spleen.
• Palliative surgery may be used to relieve symptoms or to prevent certain complications like a blocked bile duct or intestine in instances where the cancer is too widespread to be removed completely. ERCP (Endoscopic Retrograde Cholangiopancreatography is a procedure where the surgeon inserts a tiny scope down the esophagus to the first part of the small intestine, known as the duodenum. The surgeon can use surgical instruments passed through the scope to relieve complications of pancreatic cancer like a blocked bile duct.

Chemotherapy

Chemotherapy uses drugs to help kill cancer cells. These drugs can be injected into a vein or taken orally. Most pancreatic cancers are treated with one or more of the following chemotherapy agents: 

• Gemcitabine (Gemzar)
• 5-fluorouracil (5-FU)
• Oxaliplatin (Eloxatin)
• Albumin-bound paclitaxel (Abraxane)
• Capecitabine (Xeloda)
• Cisplatin
• Irinotecan (Camptosar)
• Liposomal irinotecan (Onyvide)

Radiation therapy

Radiation therapy uses high-energy particles or beams, such as X-rays to destroy cancer cells. You may receive radiation treatments before or after pancreatic cancer surgery, often in combination with chemotherapy such as capecitabine or gemcitabine. In specialized medical centers, radiation therapy may be delivered during surgery (intraoperative radiation).

Radiation treatments are usually performed Monday through Fridays with weekends off for either 2, 3 or 5 weeks depending on the underlying reason for treatment. 

Timing of treatment

• Neoadjuvant treatment is given before surgery to shrink the tumor and help the surgeon remove as much of the cancer as possible. 
• Adjuvant chemotherapy is given after surgery to prevent the cancer from spreading or coming back.
• Maintenance therapy with a PARP inhibitor is given to some people after they complete chemotherapy treatment to keep the cancer from coming back or growing. 
• If the cancer recurs, additional chemotherapy, targeted therapy or immunotherapy may be given, depending on response to initial treatment and tumor biomarker testing.

Treatment side effects

Your healthcare team should explain what you might expect from all treatments, including:

• all of the possible risks and side effects of each treatment.
• which side effects may be serious and how to tell. 
• when and who you should call if you experience a side effect.
• what can be done to treat or alleviate each side effect. 

Make sure you let your healthcare team know if you experience any side effects of your treatment. For more information about possible treatment side effects, see our section on Cancer Treatment by Treatment Type. 

In the News