Treating pancreatic cancer: controlling disease and protecting quality of life
Treatment is tailored to the location and stage of the tumour, the person’s general health and their own wishes. It may aim to remove or control the cancer, extend life and relieve symptoms while preserving quality of life.
Broadly, care includes treatments directed at the tumour itself and treatments that relieve symptoms.
1. Intensive treatment: Tumour removal and control
When pancreatic cancer is still local and there are no metastases, an intensive approach is possible. The aim of this approach is to remove or significantly reduce the tumour to keep the disease under control for as long as possible. The most common approach is a combination of chemotherapy with surgery.
Surgery for pancreatic cancer
Pancreatic surgery is a major procedure, but for suitable patients it can be crucial to long-term disease control and the prevention of complications. The operation depends on the tumour’s location:
- Whipple procedure: This is the most common operation when the tumour is located in the head of the pancreas. It removes part of the pancreas, the duodenum, the gallbladder and part of the bile duct.
- Distal pancreatectomy: If the tumour is in the body or tail of the pancreas, this part is removed, often together with the spleen.
- Total pancreas resection: Sometimes it is necessary to remove the entire pancreas along with the lymph nodes and surrounding organs.
After surgery, a pathologist examines removed lymph nodes for cancer cells. Chemotherapy may be given afterwards as adjuvant treatment. Medicines used alongside or instead of surgery include:
- Chemotherapy: Destroys cancer cells and inhibits growth. Common regimens for pancreatic cancer are Folfirinox or Nab-paclitaxel in combination with Gemcitabine (Nabgem).
- Targeted therapy: Only works on specific tumour characteristics. Olaparib is an example of such therapy, which is currently only used in patients with hereditary pancreatic cancer.
- Immunotherapy: Helps the patient’s immune system recognise and attack cancer cells. Research into this approach is continuing and early findings are promising.
2. Symptom relief and palliative care
Relieving symptoms is an essential part of pancreatic cancer care. Palliative treatment aims to improve quality of life by managing discomfort, pain and other symptoms effectively.
Treatment of specific complaints
- Jaundice: A tumour in the head of the pancreas can block the bile duct. A stent can keep the duct open and relieve jaundice and the associated itching.
- Duodenal obstruction: If the duodenum becomes compressed or blocked, it can cause nausea, vomiting, pain and bloating. Treatment may involve medication, a stent or, in some cases, surgery.
- Fluid in the abdomen (ascites): Advanced cancer can cause fluid to collect in the abdomen. Chemotherapy may reduce it, or it can be drained; sometimes a catheter is fitted for ongoing drainage.
- Pain management: Pain can be treated with analgesics, radiotherapy, chemotherapy or a nerve block targeting the network of nerves in the upper abdomen.