Treatment
Treatment of Pancreatic cancer
Treatment depends entirely on the type of cancer and the stage it has reached by the time of diagnosis. For the common exocrine type of pancreatic cancer treatment is divided into two groups these are:
- Localised disease – these will usually be people with small tumours that have caused jaundice at a very early stage because of their location.
- Advanced disease – 80% of people will be in this group and they will be having palliative treatment.
Treatment of localised (early stage) Pancreatic Cancer
This type of cancer can be removed by surgery and the aim of treatment is to cure the cancer. Five year survival in this group is 18-24%.
Surgical operations to remove the pancreas include:
- Whipple operation – pancreaticoduodenectomy
- Total pancreatectomy
- Distal pancreatectomy
These are all major abdominal operations; recovery time is at least three months. Complications of this type of surgery are common and quite severe e.g. pancreatic fistula; this might prolong recovery time to a year. Common enduring problems for someone after this type of surgery include diabetes mellitus (because the insulin producing islet cells are removed with the pancreas) and pancreatic insufficiency – this term means the digestive enzymes normally produced by the pancreas are not there to enable digestion. Pancreatic enzyme supplements containing digestive enzymes (e.g. ‘Creon’) need to be taken with each meal to avoid severe malnutrition and weight loss. See diabetes guidance for information on the treatment of diabetes.
Endoscopy may be used to relieve jaundice prior to surgery.
Chemotherapy may be given after surgery as ‘adjuvant’ therapy or used as a treatment by itself with radiotherapy in people who are not fit enough to survive major surgery. The drugs likely to be used are gemcitabine and 5-fluorouracil. It is not clear what treatment is best and people in this situation may be taking part in clinical trials.
Radiotherapy is likely to be used in combination with chemotherapy treatment for those who are not fit for surgery. Treatment is given over 25 sessions.
Treatment of advanced Pancreatic Cancer
Advanced pancreatic cancer is not curable at all; treatments are palliative and aimed at reducing symptoms, improving quality of life and prolonging life expectancy. Only a few people diagnosed with advanced pancreatic cancer will still be alive a year later.
Chemotherapy using gemcitabine is effective at reducing symptoms and may prolong life for up to a few months. It is often given together with capecitabine tablets.
Radiotherapy may be used for reducing the pain associated with this condition and is often given over 5 sessions.
Nerve blocks - severe gnawing pain is a common feature of this condition and a nerve block may significantly reduce it. Nerve blocks are one-off procedures that destroy nerves to prevent pain signals travelling to the brain. The nerves can be cut during short surgical operations or deadened by injecting alcohol or phenol around the nerve under x-ray control. Names of some of these blocks include:
- Coeliac plexus nerve block
- Sympathectomy
- Splanchnicectomy
- Thoracoscopic sympathectomy
Surgery – palliative surgery may be used to relieve blockages of the bile duct and the stomach – so called ‘gastric outflow obstruction’. This type of operation does not remove the cancer but re-plumbs the bowel so that the bowel contents can get past the blockages caused by the growing tumour. This is called bypass surgery and the names of some of these operations are listed below:
- Gastrojejunostomy, joining the stomach to the small bowel lower down because pancreatic cancer tends to block stomach outflow into the small bowel
- Choledocho or cholecystojejunostomy – joining the bile duct or gallbladder onto the small bowel to relieve jaundice
- Entero-enterostomy – joining two pieces of small bowel together
- Triple bypass - an operation involving all three bypass operations above
Recovery times from these operations take several weeks and improve symptoms of jaundice (yellow skin and itching) and gastric outflow obstruction (bloating and vomiting). They do not improve survival and people who have had these operations are still terminally ill.
Treatment of hormone producing tumours of the Pancreas
These tumours are likely to present at an early stage because obvious symptoms of abnormal levels hormone production happen whilst the tumour is still small. The majority of them can be cured by surgery and it is less likely in this situation that the whole pancreas needs to be removed. This means enduring problems such as diabetes mellitus and pancreatic insufficiency will be less common, however severe complications of surgery such as pancreatic fistula delaying recovery for up to a year are just as likely to be a problem for this group.
Amended November 2008
