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Treatment

Luke Schoeniger, MD

Therapy is based on the type of tumor, location, gene classification, and prognosis. It’s also critical to know the stages of pancreatic cancer. Staging occurs during diagnosis, and ranges from early-stage disease to stage IV pancreatic cancer, which means the cancer cells have already spread to distant sites in the body. The stage of disease impacts pancreatic cancer survival rates. 

Some patients' cases are discussed at Wilmot’s multidisciplinary tumor board  a conference that is attended by all different specialties that might be required for your care.

Five types of treatment are commonly used for pancreatic cancer: surgery, radiation, chemotherapy, targeted drugs, and ablation.

Surgery

Being eligible for surgery is important for surviving pancreatic cancer. Surgical options include the Whipple procedure, in which the surgeon removes the head of the pancreas as well as the gall bladder, and parts of the stomach and small intestine. Other possible surgeries might involve removing the entire organ or other parts of it. If the cancer has already spread outside of the pancreas, palliative surgery may be an option to relieve symptoms.

Radiation

Radiation therapy uses energy from radiation beams, radio isotopes, or charged particles to target tumors and to eradicate cancer cells. Radiation is sometimes used to treat exocrine tumors either before or after surgery, or in cases where the tumor has grown beyond the pancreas. For people with advanced pancreatic cancer, radiation can also be used to relieve symptoms. Neuroendocrine tumors usually don't respond to radiation.

Chemotherapy

This is the use of drugs or combinations of drugs — given intravenously or as pills — to destroy cancer cells. For pancreatic cancer, chemotherapy can be used at any stage and sometimes in combination with radiation (called chemoradiation therapy) to control the cancer. Chemotherapy is not usually helpful in treating neuroendocrine tumors of the pancreas.

Targeted therapy

These are newer drugs designed to target specific gene changes that result in pancreatic cancer. They target cancer cells without harming normal cells, and tend to have fewer side effects compared to chemotherapy. Many newer drugs are continually being tested.

Targeted drugs are also used to treat neuroendocrine tumors, including Sutent, which attacks blood vessel growth, and Afinitor, which blocks a protein known as mTOR. Another drug class, called somatostatin analogs, can be used to treat pancreatic endocrine tumors.

Some patients with pancreatic cancer have significant pain and digestive issues. Medications and other therapies can be used to relieve these problems.

Side effects

Many cancer treatments cause side effects such as hair loss or fatigue, but not everyone experiences side effects the same way.

The American Cancer Society also offers a free online class to help patients manage the side effects of their illness.

Wilmot's Cancer Control & Survivorship Program is one of the oldest and most highly regarded research programs in the country to investigate the management of side effects.