Pancreatic Cancer Treatment

The optimal treatment of pancreatic adenocarcinoma depends on the extent of the disease. The extent of cancer can be divided into the following 3 categories:

• Localized: The cancer is completely confined within the pancreas.
  
• Locally advanced: The cancer has extended from the pancreas to involve nearby blood vessels or organs.
  
• Metastatic: The cancer has spread outside the pancreas to other parts of the body.

Medical Treatment

Based on the results of the surgery, chemotherapy with or without radiation therapy may be offered to reduce the likelihood that the cancer will return (called adjuvant therapy).

Factors that increase the risk that the cancer may return after surgical removal are as follows:

• Tumor present at the edge of the surgical specimen (referred to as a positive margin)
  
• Tumor present within blood vessels or lymph channels
  
• Tumor tracking along nerves
  
• Surrounding lymph nodes containing cancer

Options for adjuvant therapy include the following:

• Chemotherapy and radiation therapy given simultaneously
  
• Chemotherapy alone

No standard recommendation is available for adjuvant therapy, and it remains an area of intense clinical research. Enrolling in a clinical trial should be considered.

For locally advanced pancreatic cancer that cannot be surgically removed safely, a combination of chemotherapy and radiation therapy or chemotherapy alone may be offered. This treatment remains controversial, and various centers have different recommendations based on a number of factors such as size of the disease and symptoms.

Chemotherapy is the cornerstone of treatment of pancreatic cancer that is locally advanced or metastatic. The chemotherapy agent most commonly used in this setting is gemcitabine (see Medications).

At specific intervals while a person is receiving treatment, imaging studies are repeated to help evaluate whether the tumor is getting smaller or bigger. If a time comes when the tumor grows despite chemotherapy, it may indicate that the cancer has become resistant to this particular therapy and an alternative plan needs to be considered.

Medications

The following chemotherapy drugs may be included as part of the treatment regimen depending on the stage of pancreatic cancer:

• Gemcitabine (Gemzar): Gemcitabine is given intravenously once a week for 7 weeks (or until toxicity limits treatment), and then no treatment is given for 1 week. Then, cycles are resumed of gemcitabine once each week for 3 weeks in a row followed by 1 week off. This drug has direct effects on the cancer cells and is usually given alone for the treatment of metastatic pancreatic cancer. Side effects include fatigue, nausea, increased risk of infection because of its effects on the immune system, and anemia.
  
• Fluorouracil (5-FU): Fluorouracil is usually given intravenously as a continuous infusion using a medication pump. This drug has direct effects on the cancer cells and is usually used in combination with radiation therapy because it makes cancer cells more sensitive to the effects of radiation. The side effects include fatigue, diarrhea, mouth sores, and hand-and-foot syndrome (redness, peeling, and pain on the palms of the hands and the soles of the feet).
  
• Capecitabine (Xeloda): Capecitabine is given orally and is converted by the body to a compound similar to 5-FU. Capecitabine has similar effects on the cancer cells as 5-FU and is also generally used in combination with radiation therapy. Side effects are similar to intravenous continuous infusion of 5-FU.