pancreatic cancer treatment

Pancreatic Cancer treatments

If you are suffering from pancreatic cancer, your healthcare team will develop a treatment plan just for you. It will be based on your health and specific information about cancer. When your healthcare team decides what treatments you propose for pancreatic cancer, it takes into consideration the size and location of the tumor as well as your overall health.

The stage of cancer, among other things if the tumor is resectable, at the limit of resectability or not resectable (locally advanced or metastatic), determines which treatments can be proposed.

Pancreatic tumors that are resectable can be removed completely by surgery. Stage 1 or 2 tumors are often resectable. They are treated by surgery to remove the pancreas in part or in whole. Chemotherapy may be administered after surgery (adjuvant chemotherapy). If cancer cells are observed in the tissue removed with the tumor during surgery, i.e. the surgical margins are positive, then a radiotherapy or a chemoradiotherapy can be administered.

Pancreatic tumours that are on the borderline of resectability are treated, if possible, in the context of clinical trials. They could be treated before surgery by chemotherapy and chemoradiotherapy (néoadjuvants treatments).

Locally advanced pancreatic tumours (stage 3) are treated by chemotherapy, radiotherapy or chemoradiotherapy. In some cases, surgery is done to relieve the symptoms of advanced cancer, or palliative surgery, but it is not used to try to remove the entire tumor.

Metastatic tumors of the pancreas (stage 4) are treated with chemotherapy, with or without targeted treatment. You may be offered surgery, radiotherapy or both to relieve symptoms and control pain, or palliative treatment.

One or more of the following treatments for pancreatic cancer can be offered.

Surgery
Depending on the stage, size and location of the tumor, you could undergo one of the following types of surgery.

The Whipple operation, also called Pancréatoduodénectomie, is used to remove tumors in the head of the pancreas or in the opening of the pancreatic duct. The head of the pancreas is removed and the duodenum (first segment of the small intestine), the gallbladder, part of the bile canal, the pyloric (lower section of the stomach that is connected to the duodenum) and the lymph nodes located near the Head of the pancreas.

A modified Whipple operation, also called Pancréatoduodénectomie with pyloric retention, can also be done to remove tumors in the head of the pancreas that are not large, or voluminous, and which have not spread to Duodenum or propagated to the lymph nodes surrounding the pyloric. This is a modified version of Whipple's intervention where the pyloric is not removed. Since the modified Whipple operation does not affect the normal functioning of the stomach, possible nutritional problems are avoided after Whipple's operation.

Distal pancreatectomy is used to remove tumors in the body or tail of the pancreas. We remove the tail of the pancreas, or the tail and part of the body of the pancreas, as well as the neighboring lymph nodes. The spleen is removed only if the tumor has spread to the spleen or to the blood vessels feeding the spleen. Distally pancreatectomy is often not used since the cancer that originated in the body or the tail of the pancreas has already spread often when diagnosed.

We make a total pancreatectomy, only if necessary, to completely remove the tumor. It is very difficult to recover from this surgery, so it is not as often used as the Whipple operation or the modified Whipple operation. The total pancreatectomy removes the whole pancreas as well as the duodenum, the pyloric, part of the bile canal, the gallbladder, sometimes the spleen and the neighbouring lymph nodes.

Palliative surgery is used to relieve the symptoms of advanced cancer. The types of surgery possible are the placement of a stent and the surgical bypass. These interventions can help to clear a blockage in the bile canal or duodenum.

Chemotherapy
In chemotherapy, anti-cancer drugs (cytotoxic) are used to destroy cancer cells. Some chemotherapeutic agents are administered alone. But it happens more often than one associates several.

Chemotherapeutic agents often administered to treat pancreatic cancer are among other things:

Gemcitabine (Gemzar)

5-fluorouracil (Adrucil, 5-FU)

NAB-paclitaxel (Abraxane)

FOLFIRINOX – Folinic acid (Leucovorin), Irinotecan (Camptosar), Oxaliplatin (Eloxatin) and 5-fluorouracil

Radiotherapy

In radiotherapy, high energy rays or particles, such as X-rays and gamma rays, are used to destroy cancer cells.

Pancreatic cancer is usually treated by external radiation. A device emits radiation through the skin to the tumor and part of the tissue around it.

Chemoradiotherapy

Chemoradiotherapy combines chemotherapy with radiation therapy. Both are administered during the same period. Some types of chemotherapy make radiation therapy more effective.

If you can not or do not want to receive cancer treatment

You might want to consider care that aims to make you feel better without treating the cancer itself, perhaps because cancer treatments no longer work, it is no longer likely that they will improve your condition or that their side effects are Difficult to tolerate. Other reasons may explain why you may not or don't want to receive cancer treatment.

Talk to the members of your healthcare team. They can help you choose the care and treatment of advanced cancer.

Followed

Follow-up after treatment is an important component of care for people with cancer. You will need to have regular follow-up visits, especially during the first 2-3 years after the treatment. These visits allow the care team to monitor your progress and find out how you are recovering from treatment.

Clinical trials

Some clinical trials of pancreatic cancer are underway in Canada and accept participants. The aim of the clinical trials is to find new methods for the prevention, detection and treatment of cancer. Learn more about clinical trials

Questions to ask about treatment

In order to make the right decisions for you, ask questions about the treatment to your care team.