Exocrine tumour treatment

Monday 30 April, 2012

Download PDF Order FREE booklet

On this page: Surgery Whipple's Procedure | Double Bypass Surgery | After an operation | Chemotherapy | Radiotherapy | Palliative treatment | Reviewers


This section gives an overview of treatments used for the most common type of pancreatic cancer: exocrine tumours. This includes adenocarcinoma. Our next section looks at the treatment of pancreatic neuroendocrine tumours (PNETs).

Although continuing research has improved outcomes for many people, pancreatic cancer can be difficult to treat. Surgery in combination with chemotherapy, and possibly radiotherapy, is the most effective treatment.

Your medical team will consider your situation and recommend the best treatment for you. This will depend on:

  • the stage of the tumour (the site, size and if it has spread)
  • your general health
  • what you want.

It can be difficult to make decisions about treatment. For more information read deciding on treatments.

Surgery

Surgical removal of the tumour (resection) is the most effective treatment for people who have early-stage disease.

Surgery is an option if:

  • the cancer hasn't spread beyond the pancreas (stage 1 or 2)
  • the cancer isn't in surrounding major blood vessels
  • you're in reasonably good health, so you could cope physically with a major operation.

Surgery may also be used as palliative treatment to treat symptoms of pancreatic cancer, such as intestinal obstruction or jaundice. Jaundice is a condition in which the skin turns a yellow colour due to a build-up of bile in the blood.

If you have diabetes, it may go away after an operation. Talk to your doctor for more information.

Surgery for pancreatic cancer has risks and possible complications. Before consenting to the operation, talk to your doctor about this.

Whipple's procedure

The most common operation for pancreatic cancer in the head of the pancreas is known as pancreaticoduodenectomy or the Whipple's surgery. It's a major operation that's done by specialised surgeons. Whipple's procedure removes:

  • the part of the pancreas where the cancer is
  • the first part of the small bowel (duodenum)
  • part of the stomach
  • the gall bladder and part of the bile duct.

The surgeon reconnects the remainder of the pancreas, bile duct and stomach to different sections of the small bowel so the digestive tract keeps working. This allows food, pancreatic juices and bile to continue to flow into the small bowel for the next stage of digestion.

whipples procedure before and after

Double bypass surgery

The surgeon may find that the cancer has spread (metastasised) at the time of the operation. This is possible even if you had several scans and tests beforehand. If this happens, the surgeon won't be be able to remove the tumour, but the operation can be done to relieve symptoms, such as jaundice.

Double bypass surgery allows a blockage in the common bile duct and/or the outlet of the stomach to be bypassed. The surgeon connects a piece of your bowel to the bile duct or gall bladder to take the bile around the blockage. This is a medium-sized operation and you will be in hospital for 7 to 10 days.

If you don't have surgery to relieve the jaundice, the most common treatment is stenting.

After an operation

As with all major operations, you'll be given pain relief. When you're in hospital, you'll also have a drip (intravenous infusion) to replace your body's fluids. If you can't eat or drink within a few days, the doctor may insert a temporary feeding tube.

Most people go home within a fortnight of surgery, but if you have complications after surgery, you may need to stay in hospital longer. If you're in pain when you return home, talk to your medical team. They may prescribe pain-killers to make you more comfortable.

Some people who have surgery will need to take tablets known as pancreatic enzymes, which will help to digest fat and proteins.

A small number of people also develop diabetes and may need insulin therapy. See our Nutrition and dietary problems page for more on the dietary issues that may be caused by pancreatic cancer and its treatment.

Barry's story

"I was diagnosed with pancreatic cancer at the age of 49. I was already an insulin-dependent diabetic of some 10 years. In my case, weight loss was the first indication that something was wrong, but the most prominent symptom was persistent itching. It was to the point where I was scratching continuously on my legs, stomach and backside. It was particularly difficult to get to sleep at night.
When the cancer was finally diagnosed, I didn't get any real time at all to process anything. I think I was diagnosed on Thursday and was in hospital having a Whipple's procedure on the following Wednesday.
I had some complications  after surgery and spent two months in hospital. Pain management was essential in the early stages. I remember that I had a sense of not being in control of anything. I didn't really know enough about what was happening to me.
When I returned home, I had difficulty eating and getting my appetite back. One thing that I had particular difficulty with in the early stages was generating saliva. It seemed to be worse at night. I sought out some products from a chemist, which had limited success, but eventually the problem disappeared as my appetite returned to normal. I now take a digestive enzyme supplement."

Chemotherapy

Chemotherapy is the use of anti-cancer drugs, which kill or slow the growth of cancer cells.  

If you have stage 1, 2 or 3 pancreatic cancer, your doctor may suggest that you have chemotherapy combined with radiotherapy. This may be to destroy any cancer cells remaining after surgery. Chemotherapy can also be given to reduce the risk of the cancer coming back after an operation (adjuvant chemotherapy).

If you have advanced pancreatic cancer – for example, stage 4 disease – chemotherapy may be given as palliative treatment to help slow the spread of cancer and relieve any symptoms you may have.

Chemotherapy is usually given by injecting drugs into a vein (intravenously). You'll usually go to an outpatient oncology day unit, where you'll sit in a chair and be attached to a drip. The drugs are given over 1 to 3 hours. Most people have up to six courses of treatment. After each treatment session, you'll have a break or rest period of 1 to 3 weeks at home. Your medical team will talk to you about how they'll assess if the treatment has worked.

Tell your doctors about any other prescription or over-the-counter medicines you're taking or planning to take, as these may affect how the chemotherapy works in your body.

Side effects

Chemotherapy affects fast-growing cells in the body, such as the cells involved in hair growth or mouth cells.

Some chemotherapy can cause temporary side effects, which may include:

  • fatigue and tiredness
  • nausea and vomiting
  • a low red blood cell count (anaemia), causing weakness and breathlessness
  • a low white blood cell count, causing poor resistance to infection
  • mouth ulcers
  • diarrhoea
  • flu-like symptoms such as fever, headache and muscle soreness
  • poor appetite
  • skin rashes.

The most common side effects are fatigue and nausea, however you may have none or some of the above side effects. Discuss how you're feeling with your medical oncologist, as steps can be taken to reduce or manage your side effects.

For more information about chemotherapy, call Cancer Council on 13 11 20 for a free copy of the Understanding Chemotherapy booklet.

"I found chemo a bit daunting – walking into the room with the chairs lined up. But the nurses were great and talked through it with me so I knew what to expect." Cheryl

Radiotherapy

Radiotherapy treats cancer by using x-rays to kill cancer cells or injure them so they can't multiply. These x-rays can be targeted at cancer sites in your body.

Radiotherapy may be used:

  • to shrink the tumour before removing it with surgery
  • to destroy any cancer cells that may remain after surgery
  • to relieve symptoms such as pain by shrinking the tumour, which may be pushing on a nerve or another organ
  • with chemotherapy to treat tumours that can't be operated on.

Treatment is usually given Monday to Friday, for up to five weeks. It's painless and each session takes a few minutes. Treatment is planned to do as little harm as possible to your normal body tissues.

Side effects

Radiotherapy can cause temporary side effects, which may include:

  • tiredness
  • nausea
  • vomiting
  • diarrhoea
  • poor appetite
  • reddening of the skin.

Talk with your doctor about how to manage these side effects. For example, if you have nausea or vomiting, you can be prescribed anti-nausea medication. You can also call Cancer Council on 13 11 20 to request a free copy of Understanding Radiotherapy.

Palliative treatment

Palliative treatment helps to improve people's quality of life by alleviating symptoms of cancer when a cure may not be possible. It's particularly important for people with advanced cancer, but it can be used during different cancer stages.

Often treatment is concerned with pain relief and stopping the spread of cancer, but it can also involve the management of other physical and emotional symptoms, such as depression. Treatment may include radiotherapy, chemotherapy or other medication.

If pancreatic cancer has spread and it's not possible to treat it with surgery, your doctor may recommend treatment to relieve problems such as:

  • jaundice: caused by narrowing of the bile duct
  • persistent vomiting and weight loss: caused by obstruction in the stomach or small bowel
  • poor digestion: caused by the blockage of the pancreatic duct, which stops the flow of the digestive enzymes required to break down food
  • pain: in the abdomen and middle back.

For more information and resources on palliative treatment or advanced cancer, call Cancer Council on 13 11 20.


Reviewed by: Dr David Chang, Pancreatic and Upper Gastrointestinal Surgeon, Sydney South West Area Health Service and Research Fellow, Pancreatic Cancer Research Group, Garvan Institute of Medical Research, NSW; Professor Andrew Biankin, Head, Pancreatic Cancer Research Group, Garvan Institute of Medical Research, Consultant Hepato-Pancreato-Biliary, Upper GI Surgeon, Sydney South West Area Health Service, NSW, and Clinical Lead, Australian Pancreatic Cancer Genome Initiative; Annie Angle, Oncology Nurse, Cancer Council Victoria; Dr Lorraine Chantrill, Medical Oncologist, Macarthur Cancer Therapy Centre, Campbelltown Hospital, NSW; Leslye Dunn, Consumer; Helen Gooden, Manager, Multimedia Cancer Support Grants, Cancer Council NSW; Barbara Hunter, Consumer; A/Prof Lara Lipton, Medical Oncologist, Cabrini and Royal Melbourne Hospital, VIC; Barry Ranson, Consumer; Meg Rogers, Cancer Nurse Coordinator, Upper Gastrointestinal Service, Advance Practice Nurse, Peter MacCallum Cancer Centre, VIC; Karen Tokutake, Medical Oncology and Haemotology Dietitian, Prince of Wales Hospital, NSW; and Belinda Vangelov, Senior Oncology Dietitian and Clinical Educator, Prince of Wales Hospital, NSW.
Updated: 30 Apr, 2012