Treatment of pancreatic cancer centers first around staging - determining how much of the pancreas is involved and whether the cancer has spread. This may be done using a formal staging/naming system or by categorizing the cancer into resectable (still within the pancreas and can be surgically removed), locally advanced (spread into nearby organs and not resectable), or metastatic (spread to distant organs).
Unfortunately, pancreatic cancer can be categorized as resectable less than 15% of the time. How much surgery should be done depends on where the tumor is, its size, how far it has spread, and the affected person's health. Pancreatic surgery is very difficult. It requires an experienced surgeon, is associated with significant complications, and requires several weeks of recovery time. Procedures include:
- Whipple procedure: the surgeon removes the head of the pancreas and part of the small intestine, bile duct, and stomach.
- Distal pancreatectomy: the body and tail of the pancreas and the spleen are removed.
- Total pancreatectomy: the pancreas, part of the small intestine, some of the stomach, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes are removed.
Radiation and chemotherapy may be used and are often necessary as tiny, undetectable amounts of the tumor have often spread by the time surgery is done. Regrettably, pancreatic cancer does not respond well to current treatments. Gemcitabine and 5-fluorouracil (5-FU) are the most commonly used chemotherapy agents. They may be used alone or in combination with other drugs.
For those with recurring or inoperable pancreatic cancer, palliative (comfort-oriented) care is the primary priority. Radiation, chemotherapy, and surgery may be used to help relieve pain. Surgery may also be done on non-resectable cancers to remove or bypass blockages in the bile duct and to help relieve pain and jaundice. An ERCP procedure may be done with a flexible endoscope to place a stent (plastic or metal tube that can help keep the duct open). Surgery may also be performed to cut nerves to help relieve pain that is resistant to other measures.
People with inoperable pancreatic cancer may want to consider enrollment in clinical trials of new treatments. There are promising areas of research that may offer them additional options.