Pancreatic Cancer Treatment
Pancreatic cancer is treated based on the stage of the cancer and how far it has spread. The patient’s overall health could also influence the treatment options.
Once diagnosed with pancreatic cancer, it is important to become an educated patient or an educated loved one if your friend or family member was diagnosed. The treatment options for pancreatic cancer continue to grow, which is good news for pancreatic cancer sufferers.
Treatment options for pancreatic cancer include:
- Ablation or embolization.
- Targeted therapy.
Learn specifics about these treatments below.
Potentially curative surgery: Whipple surgery
Early-stage pancreatic cancer may be removed surgically with the goal of curing the patient. The most common surgery is called the Whipple procedure, or pancreaticoduodenectomy. Those who undergo a successful Whipple procedure may have a 5-year survival rate of up to 25 percent. This surgery is only performed when the surgeon thinks all of the caner can be removed.
This operation removes the head of the pancreas, with the body of the pancreas sometimes also being removed. This can also include removal of the gall bladder, the duodenum (small intestine) and part of the stomach. Generally, surgical resection (removal of damaged tissue) is only possible in 20 percent of pancreatic cancer cases. In those cases, the average survival time after surgery is from 15 to 25 months.
Recovery time for patients undergoing a Whipple procedure varies and most require a hospital stay of several days to two weeks. The patient’s diet is also restricted, with no liquid or solid food by mouth during this time.
Two other surgical options exist but are not frequently used due to poor outcomes. Distal pancreatectomy removes the tail of the pancreas and sometimes part of the body. A total pancreatectomy removes the entire pancreas.
Palliative surgery for pancreatic cancer may be done if the cancer is too widespread to be removed completely. This surgery’s focus is to relieve symptoms and prevent complications such as a blocked bile duct or intestine. But this will not cure the cancer.
CyberKnife pancreatic cancer treatment
The CyberKnife Robotic Radiosurgery System can be used in multiple ways when treating pancreatic cancers. These include:
- Prior to surgery to make the tumor operable.
- The primary treatment option.
- After surgery to treat any remaining cancerous cells.
- In combination with chemotherapy.
Since CyberKnife treatment targets tumor cells directly, sparing the surrounding healthy tissues, it may help those who are poor candidates for surgery or when other treatments have failed. The pancreas is surrounded by the stomach, large intestine, gall bladder, spinal cord and a lot of other important organs, so the extraordinarily precise delivery of the CyberKnife is key. Another benefit of Cyberknife is that it is able to precisely target the tumor even while the patient is breathing, which causes the chest and surrounding area to move.
The advantage of CyberKnife treatment over traditional radiation therapy is that CyberKnife takes only one week instead of five weeks (or five treatments instead of 25). In addition, patients treated with CyberKnife have relatively no side effects compared with traditional radiation, which is frequently associated with nausea, vomiting, loss of appetite, weight loss and fatigue.
Multiple studies have shown that CyberKnife may be a good option for pancreatic cancer patients. A 2015 study of 59 patients found that people with locally-advanced pancreatic cancer (LAPC) had excellent clinical efficacy with minimal toxicity.
Another pancreatic cancer treatment study from 2011 looked at 47 LAPC patients who had two rounds of chemotherapy and continued chemotherapy while starting CyberKnife. This study found a high rate of local control with minimal toxicity. A study from 2010 looked at 20 patients with locally advanced (stage II or stage III) pancreatic cancer and found a high rate of local control and minimal toxicology.
Traditional radiation therapy uses X-rays or particles to kill cancer cells. Radiation makes small breaks in the DNA inside cells, this keeps cancer cells from growing and dividing, which causes them to die.
Nearby normal cells can also be affected by radiation. Most radiation treatments are given five days a week for several weeks.
Possible side effects for traditional radiation include:
- Nausea, vomiting and diarrhea.
- Loss of appetite.
- Skin changes including redness, peeling and blistering.
- Weight loss.
- Increased risk of infection.
Chemotherapy, also known as chemo, is a drug, or combination of drugs, that is injected into a vein or taken by mouth to fight cancer. Chemo enters the bloodstream and travels through the whole body. Chemo for pancreatic cancer may be an option at any stage and can be used before surgery, after surgery or for advanced cases when surgery is not an option.
Chemo can also be used along with radiation (including CyberKnife). This can help the radiation work better but can also have more severe side effects.
Possible side effects of chemo include:
- Loss of appetite.
- Mouth sores.
- Nausea and vomiting.
- Diarrhea or constipation.
- Hair loss.
- Increased chance of infection.
- Shortness of breath.
- Bleeding or bruising.
Ablation and embolization
Ablation and embolization treatments for pancreatic cancers are different ways to destroy the cancerous tumor. These options are not common in treating pancreatic cancer but can be used to help treat cancers that have spread to other organs, especially the liver.
These treatments are used to help prevent or relieve symptoms and are unlikely to cure cancers on their own.
Ablative treatments destroy tumors with extreme cold or heat. The types of ablative treatments include:
- Radiofrequency ablations (RFA).
- Microwave thermotherapy.
- Ethanol ablation.
- Cryosurgery (cryotherapy or cryoablation).
Possible side effects of ablation treatments include infection, bleeding inside the body and abdominal pain.
Embolization treatments inject a substance into an artery to block the blood flow to the cancerous cells, causing them to die. This is often used for large tumors. The three main types of embolization are:
- Chemoembolization (trans-arterial chemoembolization or TACE).
- Arterial embolization (trans-arterial embolization or TAE).
Side effects for embolization treatment may include fever, abdominal pain, nausea, blood clots and infection.
Targeted therapy drugs work differently than traditional chemo drugs. The drug used for pancreatic cancer is erlotinib (Tarceva). It targets a protein on cancer cells called EGFG, which helps the cells grow. In advanced cases this drug can be given along with the chemo drug gemcitabine.
Possible side effects include diarrhea, loss of appetite, fatigue and an acne-like rash on the face and neck.
Immunotherapy uses medicines to increase a person’s own immune system to identify and kill cancer cells. By using checkpoint inhibitors, the immune system will not attack the body’s normal cells.
This is a treatment option for people with pancreatic cancer cells that have tested positive for gene changes, such as changes in one of the mismatch repair (MMR) genes, or for those with a high level of microsatellite instability (MSI-H). Both of these conditions are often seen in people with Lynch syndrome, which makes people susceptible to certain types of cancer.
Immunotherapy is also an option for those whose cancer starts to grow again after chemo. This could also be a treatment option for those whose cancer cannot be removed with surgery or has spread to other parts of the body.
The most common treatment is a PD-1 inhibitor drug pembrolizumab (Keytruda). This drug targets PD-1, by blocking this checkpoint protein the drug boosts the immune system’s response toward pancreatic cancer cells and can shrink tumors. The drug is given using an IV every two to three weeks.
Common side effects can include cough, skin rash, itching, fatigue, constipation, diarrhea, decreased appetite and joint pain. In rare cases, the immune system may start attacking other parts of the body causing life-threatening problems.