Treatment and Care

Treatment Decisions

Once the stage of your cancer has been determined, doctors can make their recommendations for your care. At this point, you will have to make a decision about what types of treatment are right for you, including palliative care in some cases. While surgery is the best chance at prolonging survival, other types of treatment may be directed at maximizing quality of life. Another important consideration before making treatment decisions is that of a second opinion. No two patients are exactly alike, and the seriousness of the diagnosis of pancreatic cancer alone warrants consideration of a second opinion.

Choosing a Medical Center

Many factors may go into the decision of where to get your care. Treatment centers that care for a large number of patients with pancreatic cancer have been proven to have better patient outcomes. Another important clue that a center is experienced in pancreatic cancer is the presence of a Multidisciplinary Clinic dedicated to pancreatic cancer. These teams of doctors are usually comprised of all the specialists who will be involved in all aspects of your care. A typical team may consist of a surgical oncologist, a medical oncologist, a radiation oncologist, a gastroenterologist, as well as nurse practitioners from each discipline, social workers, and therapists.

Surgery

Surgery to remove the tumor is essential for curing pancreatic cancer. It is offered to patients when doctors believe they can remove the entire tumor. There are three major types of operations: a pancreaticoduodenectomy, a total pancreatectomy, or a distal pancreatectomy.

The first, also known as a Whipple procedure, is an operation to remove the head of the pancreas; in addition, the surgeon must remove most of the duodenum (the first part of the small intestine), part of the bile duct, the gallbladder, and the lymph nodes in the area of the pancreas. These parts are then “reconnected” in order to restore continuity of the bile system and digestive tract.

A total pancreatectomy is an operation to remove the entire pancreas and the spleen. As a result of all the pancreas cells being removed, the cells that produce insulin are also removed. Therefore, the patient will become diabetic and require insulin injections from that point forward.

A distal pancreatectomy is an operation to remove the body and tail end of the pancreas; the spleen is usually removed as well.

While each of these operations has a slightly different side effect profile, any operation which removes part of the pancreas is considered a major operation. These procedures typically take several hours to perform and several weeks to recover from. Complications are not unusual either. However, patient outcomes have improved considerably over the past few decades, and several studies have shown that having your operation at a high-volume surgical center decreases your chances of having a major complication.

Common complications after surgery to remove a tumor include problems with digestion, a leak from any one of the connections made during the surgery, bleeding, or infection.

Surgery can also be palliative, meaning that the goal is not cure of the tumor, but instead, relief of symptoms such as jaundice, nausea/vomiting, or pain. A bypass operation can be performed, meaning that a blockage caused by the tumor may be bypassed in order to alleviate symptoms. These operations may help improve quality of life.

Radiation Therapy

Radiation oncologists specialize in treating tumors using high-energy X-ray beams focused on the tumor. This radiation kills tumor cells, thereby shrinking the tumor. External beam radiation is the type of radiation therapy typically employed in pancreatic cancer. Common side effects of radiation therapy are nausea, vomiting, diarrhea, skin changes, fatigue, and weight loss.

Chemotherapy

Medical oncologists specialize in treating tumors using medications to kill tumor cells. It may be in the form of pills or injections, or infusions through a specialized catheter. It may be given in conjunction with radiation or surgery also. When chemotherapy is used after surgery it is referred to as adjuvant therapy, whereas chemotherapy given before surgery is called neoadjuvant therapy. There are several side effects related to chemotherapy, and they depend upon which specific drugs are being given. They range from hair loss to infection, mouth sores to low blood cell counts, and many others.

Clinical Trials

In addition to these standard treatments for pancreatic cancer, many centers offer patients the opportunity to participate in research trials. These may involve new chemotherapy drugs, new regimens of drugs, vaccines, new types of procedures, or other new methods being tested in the fight against pancreatic cancer. The ultimate goal of all these trials is to find better ways to treat this devastating disease.

Palliative care

Many patients will reach a point when they are no longer looking to treat their cancer, but rather to treat their symptoms. This supportive care is often termed palliative care. The goal of the doctor becomes to help the patient cope with their cancer through the use of medications or minimally invasive procedures. This includes controlling pain, minimizing side effects of the cancer, and maximizing quality of life.