Pancreatic Cancer

Treatment Options

Choosing the best treatment plan for pancreatic cancer can be challenging and requires the expertise of several different specialists. Even once a plan has been established, it can often change due to test results or other staging procedures.

Making decisions about what type of treatment to choose can be confusing because of all the different options and factors that must be considered. Talk openly with your treatment team and ask specific questions about your options and what side effects you may expect.

The main types of treatment used to treat pancreatic cancer include surgery, radiation therapy, chemotherapy, ablative techniques and targeted therapy. In addition, many doctors encourage patients with advanced stages of pancreatic cancer to participate in a clinical trial for the opportunity to receive cutting-edge treatments.

Each option has health risks and benefits to consider, so openly discuss the details with your doctor to determine the best treatment for your specific diagnosis.

Surgery

Pancreatic cancers are often described as either “resectable,” which means doctors believe the tumor can be completely removed by surgery, or “unresectable,” which means doctors believe the tumor has spread too far or will be too difficult to remove with surgery.

The types of surgery commonly used with the intent to cure resectable pancreatic cancers include:

  • Pancreaticoduodenectomy: Also known as the Whipple procedure, this is the most commonly used surgery to remove a pancreatic tumor located at the head of the pancreas. The surgeon may also remove the gallbladder, nearby lymph nodes and parts of the body of the pancreas, stomach and small intestine. The remaining bile duct is then attached to the small intestine so the digestion process is affected as little as possible.
  • Distal pancreatectomy: This surgery is used to remove tumors in the tail of the pancreas. The surgeon may also remove the spleen and a portion of the body of the pancreas.
  • Total pancreatectomy: This surgery was once used to remove tumors in the head or body of the pancreas. However, it’s now rarely used because it involves removing the entire pancreas, which renders the body unable to produce insulin. This causes people who undergo this procedure to develop diabetes and become dependent on insulin shots.

Some pancreatic cancers may also be classified as “borderline resectable,” which are often treated with chemotherapy and radiation prior to surgery.

In cases of unresectable pancreatic cancer, surgery may still be used as part of a palliative (supportive) care plan to help relieve or prevent symptoms. This is most commonly done when the tumor is blocking the bile duct. Doctors may either surgically reroute the flow of bile from the bile duct directly to the small intestine, bypassing the pancreas completely, or they may insert a stent (small tube made of plastic or metal) into the bile duct to help hold it open.

Chemotherapy

Chemotherapy may be used at various points in the treatment of pancreatic cancer. The drug most commonly used is gemcitabine (Gemzar), used alone or in combination with another medication. Other chemo drugs include albumin-bound paclitaxel (Abraxane), fluorouracil (5-FU), irinotecan (Camptosar), oxaliplatin (Eloxatin), capecitabine (Xeloda), cisplatin and docetaxel (Taxotere). The preferred drug combination for metastatic disease is called FOLFIRINOX, which combines fluorouracil, leucovorin, irinotecan and oxaliplatin. Another combination proven effective in recent studies is gemcitabine plus albumin-bound paclitaxel.

These drugs can be taken orally or injected, and can be used in a variety of different ways:

  • Before surgery: Also called neoadjuvant therapy, chemotherapy may be used before surgery to shrink the tumor to make it easier to remove, or to relieve pain associated with cancer.
  • After surgery: Also called adjuvant therapy, chemotherapy may be used after surgery to kill any remaining cancer cells.
  • With radiation: Also called chemoradiation, chemotherapy may be given in combination with radiation to make treatment more effective.
  • As palliative therapy: Chemotherapy may help relieve pain and other symptoms by shrinking tumors that may be pressing on nerves or blocking blood or bile passageways.

Radiation therapy

Like chemotherapy, radiation may be used as part of the primary treatment of pancreatic cancer as neoadjuvant therapy, adjuvant therapy or palliative therapy. This is a precise treatment that uses strong waves of radiation to kill cancer cells or eliminate cancer-related pain. This is referred to as a local treatment because the radiation beams are directed to the exact spot where cancer is located. Doctors use computer images from body scans to improve the accuracy and precision of this therapy. The type of radiation used for pancreatic cancer is known as external-beam radiation therapy. A machine delivers the radiation beam(s) from outside the body directly to the location of the cancerous tumor(s). Doctors are able to use a higher dose of radiation while affecting the least amount of nearby healthy tissue.

While patients may experience stomach discomfort toward the end of treatment, this is usually not severe and is easily treated. The most common side effects are loss of appetite, diarrhea, nausea and tiredness.

Ablative techniques

When pancreatic cancer has metastasized (spread), the areas of metastasis are sometimes treated with ablative techniques, which can destroy a tumor without surgery. While not often recommended, the different types of ablation used for pancreatic metastases include:

  • Radiofrequency ablation (RFA): This procedure involves inserting a needle-like probe directly into the tumor and sending a high-frequency current through it to heat the tumor and destroy the cancer cells.
  • Microwave thermotherapy: This procedure uses microwave technology to heat tumors and destroy cancer cells.
  • Cryotherapy: Also called cryosurgery or cryoablation, this procedure uses cold gases to freeze the tumor and destroy the cancer cells.

Targeted therapy

The FDA has approved the use of the targeted therapy drug erlotinib (Tarceva) for locally advanced, unresectable or metastatic pancreatic cancer, in combination with gemcitabine. It targets a protein called EGFR to block the growth of the tumor. Recent trial results show targeted therapy may be more effective than chemotherapy as an initial treatment.

Treatment options for pancreatic neuroendocrine tumors (NETs)

NETs are often easier to surgically remove than exocrine pancreatic cancers, especially when caught early, but the following are options for patients with more advanced stages of this rare disease:

  • Chemotherapy – The most common drugs used to treat NETs include fluorouracil, capecitabine, dacarbazine (DTIC-Dome), oxaliplatin, streptozocin (Zanosar) and temozolomide (Temodar). Studies show that combining temozolomide with thalidomide (Thalomid) or capecitabine may be more effective.
  • Targeted therapy – Both sunitinib (Sutent) and everolimus (Afinitor) are oral targeted therapy medications often used to treat NETs.
  • Hormone therapy – This therapy includes drugs that can stop tumor growth and relieve symptoms by preventing cancer cells from releasing hormones into the blood. Medications include octreotide (Sandostatin, Sandostatin LAR) and lanreotide (Somatuline Depot). Hormone therapy may be the first choice for patients with a positive OctreoScan (a test that shows the growth of neuroendocrine tumors).
  • Embolization – During this procedure, the doctor will inject a substance into your artery to block blood flow to the tumor, causing the cells to die. This procedure might be particularly helpful for patients with liver metastases.

Clinical trials

Nearly all of the cancer-fighting drugs and devices currently available exist only because they were thoroughly tested beforehand. These tests, known as clinical trials, are research studies designed to evaluate the safety and effectiveness of new drugs and therapies. Those who participate often have advanced stages of cancer in which surgery isn’t an option. Talk to a member of your health care team to find out if you’re eligible to participate. You can also search for trials yourself by visiting a number of helpful websites (see below).

 

The four p’s medicine gets personal

All cancer types are as different as the patients who have them, which is why doctors are working on personalizing treatment based on the characteristics of each person and his or her disease. Testing for gene mutations and evaluating the molecular structure of cancerous tumors can help doctors tailor the treatment plan to the patient instead of making the patient adapt to a pre-existing treatment plan.

While plenty of progress has already been made in cancer treatment, the future depends less on the current “one size fits all” approach and more on the four P’s:

  1. Predicting. Perform several tests prior to treatment to locate biomarkers that can determine which therapies will work and which ones won’t, and choose accordingly. This allows doctors to predict each patient’s response to treatment so that no one wastes time, money or energy on unsuccessful options.
  2. Preventing. Separate the overall population from those who are at high risk of developing this disease, and have those at risk get tested/screened to find and treat cancer at an earlier stage.
  3. Personalizing. Use information from the patient’s test results, such as predictive biomarkers, to tailor the treatment plan to each individual.
  4. Participation. Empower patients through education about how they can personally improve their health, such as quitting smoking, eating well and exercising their way to a better and longer life.

Some organizations are already offering more comprehensive programs, such as the Pancreatic Cancer Action Network’s "Know Your Tumor" initiative for patients with Stage IV pancreatic adenocarcinoma. The organization provides molecular profiling of your tumor that can help the development of new therapies and procedures for other patients with pancreatic cancer. To learn more call 877-272-6226, email pals@pancan.org, or visit www.pancan.org/section-facing-pancreatic-cancer/know-your-tumor.

 

 

Search for pancreatic cancer cinical trials

If your doctor does not mention a clinical trial as an option for you, ask about this possibility. An increasing number of websites are available where both physicians and patients can find out about clinical trials:

 

 

Previous Next

 



Register Now! Sign Up For Our Free E-Newletter!

Read Inspiring Cancer Survivor Stories

Order Your Guides Here