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Pancreatic Cancer Treatments by Stage

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Treating Resectable Pancreatic Cancer continued...

Distal pancreatectomy: The tail and/or body of the pancreas are removed, but not the head. This surgery is uncommon for pancreatic cancer, because most tumors arising outside the head of the pancreas within the body or tail are unresectable.

Total pancreatectomy: The entire pancreas is surgically removed. Although once considered useful, this operation is uncommon today.

Chemotherapy or radiation therapy or both can also be used in conjunction with surgery for resectable and unresectable pancreatic cancer in order to:

  • Shrink pancreatic cancer before surgery, improving the chances of resection (neoadjuvant therapy)
  • Prevent or delay pancreatic cancer from returning after surgery (adjuvant therapy)

Chemotherapy includes cancer drugs that travel through the whole body. Chemotherapy ("chemo") kills pancreatic cancer cells in the main tumor as well as those that have spread widely. These chemotherapy drugs can be used for pancreatic cancer:

Both 5-FU and gemcitabine are given into the veins during regular visits to an oncologist (cancer doctor).  An oral drug, capecitabine, may be substituted for 5-FU, especially with radiation.

In radiation therapy, a machine beams high-energy X-rays to the pancreas to kill pancreatic cancer cells. Radiation therapy is done during a series of daily treatments, usually over a period of weeks.

Both radiation therapy and chemotherapy damage some normal cells, along with cancer cells. Side effects can include nausea, vomiting, appetite loss, weight loss, and fatigue as well as toxicity to the blood cells. Symptoms usually cease within a few weeks after radiation therapy is complete.

Treating Locally Advanced (Unresectable) Pancreatic Cancer

In locally advanced pancreatic cancer, surgery can't remove the entire tumor. Since surgery to remove only part of the pancreatic cancer has been shown not to help, nonsurgical therapies are best.

Treatment consists of chemotherapy with or without radiation therapy. Either 5-FU or gemcitabine can extend life in people with locally advanced pancreatic cancer.

Treating Metastatic Pancreatic Cancer

In metastatic pancreatic cancer, surgery is used only for symptom control, such as for pain, jaundice, or gastric outlet obstruction. Radiation may be used for symptom relief, as well.  

Gemcitabine is the single most active drug for treating metastatic pancreas cancer. A recent study demonstrated that a 4-drug regimen, known as FOLFIRINOX (5-FU/leucovorin/oxaliplatin/irinotecan), is superior to gemcitabine, but it is a therapy reserved for people in fairly good health. Other drug combinations include gemcitabine with erlotinib, gemcitabine with capecitabine, gemcitabine with cisplatin, and gemcitabine with nab-paclitaxel. 

Other drug combinations to treat pancreatic cancer include oxaliplatin with 5-FU, or capecitabine or cisplatin with 5-FU, or capecitabine. 

 

Palliative Treatment for Pancreatic Cancer

As pancreatic cancer progresses, the No. 1 priority of treatment will shift from extending life to alleviating symptoms, especially pain. Numerous treatments can help protect against the discomfort from advanced pancreatic cancer:

  • Procedures like bile duct stents can relieve jaundice, thus reducing  itching and loss of appetite associated with bile obstruction.
  • Opioid analgesics can help relieve pain.
  • Antidepressants and counseling can help treat depression common in advanced pancreatic cancer.
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