Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
When you have chemotherapy
You might have chemotherapy after surgery for pancreatic cancer. The chemotherapy helps to lower the risk of the cancer coming back. This is known as adjuvant chemotherapy.
You usually have chemotherapy for about 6 months. You generally start treatment about 2 or 3 months after surgery.
Some people may have chemotherapy before surgery. You may have this if you have a borderline resectable tumour. This means the cancer is right next to a main blood vessel and so it isn’t clear if surgery would be able to remove all of the cancer.
Treatment before surgery to remove pancreatic cancer is called neo adjuvant treatment. You usually have it as part of a clinical trial.
The chemotherapy may shrink the cancer enough to make surgery possible. Sometimes you have radiotherapy with the chemotherapy (chemoradiotherapy).
If your cancer has spread outside the pancreas (advanced cancer) and surgery is not possible, you might have chemotherapy on its own.
If your cancer comes back after treatment or carries on growing during treatment, you might have a different combination of chemotherapy drugs. This is called second line treatment.
Which chemotherapy drugs
For people who are fit, you are most likely to have a drug combination called FOLFIRINOX or gemcitabine with capecitabine (GemCap). FOLFIRINOX is made up of the chemotherapy drugs:
- fluorouracil (5Fu)
If you are not so fit, you might have gemcitabine on its own.
For people with cancer that has spread to another part of the body (advanced pancreatic cancer) another combination you might have is gemcitabine and nab-paclitaxel.
How you have chemotherapy
You have most chemotherapy drugs for pancreatic cancer as liquids into your bloodstream. Capecitabine is a tablet that you swallow.
You usually have the treatment in cycles. You have treatment for a few days or weeks and then a time with no treatment to allow your body to recover.
Chemotherapy into your bloodstream
You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:
- central line
- PICC line
If you don't have a central line
You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.
Taking your chemotherapy tablets
Speak to your pharmacist if you have problems swallowing the tablets.
Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, no more or less.
Talk to your specialist or advice line before you stop taking a cancer drug.
Where you have chemotherapy
You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.
You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.
For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.
Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
Before you start chemotherapy
You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Common chemotherapy side effects include:
- feeling sick
- loss of appetite
- losing weight
- feeling very tired
- a lower resistance to infections
- bleeding and bruising easily
- diarrhoea or constipation
- hair loss
Side effects depend on:
- which drugs you have
- how much of each drug you have
- how you react
Tell your treatment team about any side effects that you have.
Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.
Dietary or herbal supplements and chemotherapy
Let your doctors know if you:
- take any supplements
- have been prescribed anything by alternative or complementary therapy practitioners
It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. They could be harmful.
When you go home
Chemotherapy for pancreatic cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. Your nurse will give you telephone numbers to call if you have any problems at home.
Research into chemotherapy for pancreatic cancer
Researchers are looking at ways to improve treatment for pancreatic cancer. So your doctor might ask you to take part in a clinical trial.