Types of treatment for pancreatic cancer
This page gives you an overview of the different treatments doctors use for cancer of the pancreas, and when they use them. You can find the following information
Types of treatment for pancreatic cancer
The type of treatment you need for pancreatic cancer depends on the stage of the cancer, the type of pancreatic cancer you have, your general health and level of fitness.
Surgery and stents
If it is possible to remove your cancer and you are fit enough to cope with major surgery, then your surgeon will offer you an operation.
Even if your cancer cannot be removed, surgery can help to relieve symptoms. Most often, a small tube (stent) can be put in to relieve symptoms such as jaundice. Jaundice is common in pancreatic cancer, and its symptoms can make you feel very ill. Occasionally, your surgeon may suggest surgery to get round a blockage in your duodenum and keep your digestive system working.
Chemotherapy and radiotherapy
Chemotherapy after surgery can help lower the risk of the cancer coming back. Chemotherapy is now recommended as a first treatment for advanced pancreatic cancer. But you need to be well enough to cope with the side effects of this treatment.
Radiotherapy is used less often than surgery and chemotherapy to treat pancreatic cancer. Your specialist may suggest radiotherapy to try to shrink your tumour, to help relieve symptoms such as pain. Sometimes doctors may try a combination of radiotherapy and chemotherapy to treat cancers that cannot be removed with surgery.
You can view and print the quick guides for all the pages in the treating pancreatic cancer section.
The type of treatment you need for cancer of the pancreas depends on
- The stage of the cancer
- The type of pancreatic cancer you have
- Your general health and level of fitness
The stage of your cancer means how advanced it is or how widely it has spread. Cancer of the pancreas is very difficult to treat. Many of these cancers are not diagnosed until the cancer is quite advanced and so may not be curable. As with many types of cancer, the earlier the cancer is diagnosed, the easier it is to get it under control and possibly cure it.
Some types of pancreatic cancer are less likely to come back after surgery. They are not as fast growing and so less likely to spread than other types. Cystic tumours and some endocrine pancreatic cancers are more likely to be curable with surgery.
Your general health and fitness matter because an operation to remove pancreatic cancer is major surgery. You need to be fit enough to get through it. Age is one factor in fitness, but obviously people vary a lot. Your doctor will not make a decision based only on your age.
You will be looked after by a multidisciplinary team. The team is made up of various health professionals who work together to plan how best to manage your treatment and care. The team includes specialist surgeons, doctors who specialise in chemotherapy and radiotherapy (oncologists), specialist nurses, psychologists, dieticians and other health professionals. They will discuss with you the possible treatments you could have and how they may affect you.
When you are diagnosed with pancreatic cancer, your specialist will do tests to see if it is likely to be possible to remove your cancer. If it is, your surgeon will offer you an operation. Surgery to remove cancer of the pancreas involves long and complicated operations. So if it is possible to try to remove your cancer, you must also be fit enough to undergo the operation. There is more about this and what the operations involve in the section on surgery to try to cure pancreatic cancer.
If your cancer has spread, then an operation to try to remove it will not cure you. You would undergo very major surgery and still have cancer. Unless your surgeon can remove all the cancer, there is no point in going through this. Even if it is possible to try to remove the cancer, there is no guarantee that it won't come back. Cancer cells may have broken away before your operation. These would be too small to see on scans. But they can grow into another tumour later. Your specialist may suggest chemotherapy after your surgery to try to stop the cancer from coming back, or slow it down.
Surgery can also relieve symptoms. In most people, pancreatic cancer is diagnosed too late for an operation to remove it. But in some cases you may need an operation to get round a blockage in your bile duct or duodenum. This helps to relieve symptoms such as jaundice or sickness. There is more about this in the section on surgery to relieve symptoms of pancreatic cancer.
However, you are now more likely to have a tube (stent) put in to your bile duct or duodenum to relieve symptoms, rather than surgery.
A stent is a medical word for a small tube. Doctors use stents to relieve blockages. Jaundice is caused by cancer blocking your bile duct. Many people with pancreatic cancer are troubled with jaundice. This is particularly likely if you have a cancer of the head of the pancreas. If cancer blocks the very top of your small bowel (duodenum), you can feel very sick. This is because food and drink cannot pass from your stomach into the bowel in the normal way.
Your doctor puts a stent into the blocked bile duct or duodenum to keep it open. This isn't an operation as such. It is most often done during an endoscopy. Or the stent can be placed through the skin with local anaesthetic. The doctor guides the stent into position using X-ray. The doctors that put stents in are usually specialists in performing procedures with X-ray (radiologists) or endoscopy (endoscopists) rather than surgeons.
The ESPAC-1 trial showed that the chemotherapy drug 5-FU, after surgery, can help lower the risk of the cancer coming back in the future, or at least delay it. Another trial, ESPAC-3, compared 5-FU with gemcitabine after surgery. This showed that both drugs work equally well. As gemcitabine generally has fewer side effects than 5-FU, doctors are increasingly using it as standard treatment after surgery.
For advanced pancreatic cancer, the National Institute for Health and Clinical Excellence (NICE) recommends that chemotherapy should be considered as the first treatment, either on its own or with radiotherapy. But you have to be strong enough to cope with the treatment. NICE recommend gemcitabine for advanced pancreatic cancer. Your doctor may offer you GemCap chemotherapy, which is gemcitabine combined with capecitabine. NICE do not recommend chemotherapy for anyone who is so ill that they need considerable help with day to day living and frequent medical care. They think the side effects will outweigh the benefits in that situation. In other words, the treatment is likely to make you more ill, not less.
If your doctor suggests chemotherapy, they may ask you to take part in a clinical trial so that doctors can continue to learn more about treating this disease. There is more about chemotherapy for pancreatic cancer in this section.
Radiotherapy is used much less than surgery or chemotherapy to treat pancreatic cancer. But you may be offered it in some circumstances. Your specialist may suggest radiotherapy to try to shrink your tumour. You may have this treatment instead of surgery to relieve symptoms.
Sometimes doctors try a combination of radiotherapy and chemotherapy to treat locally advanced cancers that cannot be removed with surgery. In trials, doctors are also looking at radiotherapy and chemotherapy before surgery for early pancreatic cancer.
There is more about radiotherapy to treat pancreatic cancer in this section.
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