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Treatment of pancreatic cancer centres 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 categorising the cancer into resectable (within the pancreas and can be surgically removed), locally advanced (spread into nearby organs and not removable), or metastatic (spread to distant organs).
Unfortunately resection (removal) is possible less than 15% of the time. How much surgery is done depends on where the tumour is, its size, how far it has spread, and the patient'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 also may be used and are often necessary as tiny, undetectable amounts of the tumour have often spread by the time surgery is done. Unfortunately, pancreatic cancer does not respond well to current treatments. However, new chemotherapy agents, such as gemcitabine, are showing promise and advances in molecular pathology are also providing a foundation for the development of new chemotherapeutic and biological agents that appear to be promising.
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 also may be done on non-resectable cancers to remove or bypass blockages in the bile duct and to help relieve pain and jaundice. A procedure may be done with a flexible endoscope to place a stent (plastic or metal tube that can help keep the duct open). Surgery also may be performed to cut nerves to help relieve pain that is resistant to other measures.
Patients with inoperable pancreatic cancer also may want to consider enrolment in clinical trials of new treatments. There are promising areas of research that may offer patients additional options.
Last Review Date: March 6, 2017