Treating Pancreatic Cancer, Based on Extent of the Cancer
This information is about treating exocrine pancreatic cancer, the most common type of pancreatic cancer. See Pancreatic Neuroendocrine Tumor (NET) for information about how that type is typically treated.
Most of the time, pancreatic cancer is treated based on its stage – how far it has spread in the body. But other factors, such as your overall health, can also affect treatment options. Talk to your doctor if you have any questions about the treatment plan he or she recommends.
It can be hard to stage pancreatic cancer accurately using imaging tests. Doctors do their best to figure out before treatment if there is a good chance the cancer is resectable – that is, if it can be removed completely. But sometimes cancers turn out to have spread farther than was first thought.
Treating resectable cancer
Surgeons usually consider pancreatic cancer to be resectable if it looks like it is still just in the pancreas or doesn’t extend far beyond the pancreas, and has not grown into nearby large blood vessels. A person must also be healthy enough to withstand surgery to remove the cancer, which is a major operation.
If imaging tests show a reasonable chance of removing the cancer completely, surgery is the preferred treatment if possible, as it offers the only realistic chance for cure. Based on where the cancer started, usually either a Whipple procedure (pancreaticoduodenectomy) or a distal pancreatectomy is used.
Sometimes even when a cancer is thought to be resectable, it becomes clear during the surgery that not all of it can be removed. If this happens, continuing the operation might do more harm than good. The surgery might be stopped, or the surgeon might continue with a smaller operation with a goal of relieving or preventing problems such as bile duct blockage.
Adjuvant treatment (treatment after surgery)
Even when the surgeon thinks all of the cancer has been removed, the cancer might still come back. Giving chemotherapy (chemo), either alone or with radiation therapy (chemoradiation), after surgery (known as adjuvant treatment) might help some patients live longer. The chemo drugs most often used are gemcitabine (Gemzar) or 5-FU.
Neoadjuvant treatment (treatment before surgery)
Sometimes, if the tumor is thought to be resectable but is very large, has many nearby large lymph nodes, or is causing significant pain, chemotherapy or chemoradiation may be given before surgery to shrink the tumor (known as neoadjuvant treatment). This may make it easier to remove all the cancer at the time of surgery. Additional chemo may still be recommended after surgery.
Treating borderline resectable cancer
A small number of pancreatic cancers have reached nearby blood vessels but have not grown deeply into them or surrounded them. These cancers might still be removable by surgery, but the odds of removing all of the cancer are lower, so they are considered borderline resectable.
