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What to Know About Inoperable Pancreatic Cancer

Medically Reviewed by Melinda Ratini, DO, MS on June 26, 2020

When your doctor talks to you about treatment for pancreatic cancer, they may tell you that your condition is "inoperable." That means surgery isn't an option for you, usually because the tumor is too large to remove or your cancer has already spread to other parts of your body. But there are other treatments you can try.

Surgery can cure pancreatic cancer, but only if your surgeon is able to remove the whole tumor. Most people get a diagnosis after the cancer has spread beyond the pancreas.

If your doctor says you have inoperable pancreatic cancer, it's OK to get a second opinion. Some surgeons may have more success at removing larger tumors. Look for one who does a lot of pancreatic cancer surgeries -- more than 15 each year.

If you can't have surgery, your doctor will recommend one of these other treatments:

Chemotherapy

Chemotherapy, or chemo, uses strong medicine to kill cancer cells all over your body. This makes it a good treatment for cancer that has spread.

Chemotherapy on its own won't cure your cancer, but it might help you live longer. It's often the first treatment you'll get if your cancer is inoperable.

Chemotherapy, radiation, or a combination of the two treatments before surgery can sometimes shrink an inoperable tumor and make it small enough for your surgeon to remove.

You may take two or more chemo drugs together. Sometimes doctors give chemotherapy along with other treatments, like radiation or targeted therapy.

Combining medicines helps the treatment work better, but it can bring on more chemotherapy side effects, such as:

Your doctor has ways to help you manage these and other side effects.

Radiation Therapy

This treatment uses high-energy X-rays to kill cancer cells. Radiation therapy treats cancer and eases symptoms like pain.

Radiation treatment can cause side effects such as:

Chemoradiation combines chemotherapy with radiation. Getting the two treatments together may shrink your cancer more, but it can also increase the side effects.

Targeted Therapy

Targeted therapy blocks certain genes or proteins that your cancer needs to grow. Your doctor will test your tumor to see if one of these targeted therapy drugs might work against it:

Side effects depend on which of these drugs you take, but they can include:

  • Nausea and vomiting
  • Diarrhea or constipation
  • Dizziness
  • Tiredness
  • Appetite loss

Immunotherapy

Immunotherapy boosts the body's immune system -- your defense against germs -- to help you fight cancer. Your doctor may suggest "immune checkpoint inhibitors," a type of immunotherapy that treats pancreatic cancer. These drugs turn off the brakes on your immune system so that it can find and kill cancer cells.

If your cancer has gene mutations called "mismatch repair (MMR)" or "microsatellite instability (MSI-H)," the drug pembrolizumab (Keytruda) may help. It works by blocking the protein PD-1 to help your immune system attack your cancer.

Side effects of this treatment can include:

Palliative Therapy

Palliative therapy doesn't stop your cancer from growing, but it can ease your cancer symptoms to help you feel better. You may get medicines and other treatments to relieve pain, relax you, improve your energy or appetite, and support you emotionally.

You get palliative therapy along with your other treatments.

Sometimes surgery is part of palliative care. If your cancer grows so much that it blocks part of your intestine, surgery can open up a route around the blockage.

Clinical Trials

Clinical trials are studies where researchers test new cancer treatments or combinations of treatments. If you join one of these, it could give you a chance to try a new treatment before it's available to the public. Ask your doctor if any pancreatic cancer clinical trials might be right for you.

What to Expect

Survival rates give you an idea of how long people with your type of cancer might live after they're diagnosed. The 5-year relative survival rates show how many people with pancreatic cancer are alive 5 years after their diagnosis.

Keep in mind that survival rates are based on information from large groups of people. The numbers are also a few years old. Treatments have likely improved since then.

The 5-year relative survival rate for people whose pancreatic cancer has spread to lymph nodes or nearby tissues is 12%. When the cancer has spread to distant organs, the 5-year relative survival rate is 3%.

Remember, survival rates can't predict how your cancer will act, or how well treatment will work for you. Your doctor can give you a better idea of what you can expect.

WebMD Medical Reference

Sources

SOURCES:

American Cancer Society: "Chemotherapy for Pancreatic Cancer," "Immunotherapy for Pancreatic Cancer," "Radiation Therapy for Pancreatic Cancer," "Surgery for Pancreatic Cancer," "Survival Rates for Pancreatic Cancer," "Targeted Therapy for Pancreatic Cancer," "Treating Pancreatic Cancer, Based on the Extent of the Cancer."

Cancer.Net: "Pancreatic Cancer: Types of Treatment."

MD Anderson Cancer Center: "Blend of imaging, treatments allows removal of 'inoperable' pancreatic cancer."

National Cancer Institute: "Pancreatic Cancer Treatment (Adult) (PDQ) -- Patient Version."

Pancreatic Cancer Action Network: "Clinical Trials," "Treatment by Stage."

Pancreatic Cancer UK: "Who can have surgery to remove pancreatic cancer?"

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