Types of treatment for pancreatic cancer

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
• Your age 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 surgery to remove pancreatic cancer is major. 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 then the cancer would come back. 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. Most often, a tube (stent) can be put in to relieve jaundice. But sometimes an operation is needed to get round a blockage in the digestive system that is caused by the cancer.

Pancreatic cancer can occasionally block the very top of your small bowel (your duodenum). Your surgeon may suggest surgery to go round the blockage and keep your digestive system working. There is more about this in the section on surgery to relieve symptoms of pancreatic cancer.

A stent is a medical word for a small tube. Doctors can use stents to relieve blockages. Many people with pancreatic cancer are troubled with jaundice. This is particularly likely if you have a cancer of the head of the pancreas. The cancer blocks the bile duct or duodenum so that bile is unable to drain away normally into the digestive system. Jaundice causes a number of symptoms and can make you feel very ill. The stent allows the bile to drain and so relieves your symptoms.

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 perform these procedures 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.

For advanced pancreatic cancer, NICE (the National Institute for Health and Clinical Excellence) 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 a drug called gemcitabine for advanced pancreatic cancer. You may be offered GemCap chemotherapy, which is gemcitabine combined with capecitabine. They 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, you may be asked 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 of CancerHelp UK.

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, such as pain.

Sometimes doctors try a combination of radiotherapy and chemotherapy to treat cancers that cannot be removed with surgery.

You may have radiotherapy in advanced pancreatic cancer. It can help to control pain by shrinking a tumour that is pressing on a nerve, for example.

There is more about radiotherapy to treat pancreatic cancer in this section of CancerHelp UK.