Treatment to manage pancreatic cancer and symptoms

Pancreatic cancer usually has no symptoms in its early stages, so many people are diagnosed when the cancer is advanced.

If the cancer involves nearby organs or blood vessels (locally advanced – some stage 3 cancers) or has spread to other parts of the body (metastasised – all stage 4 cancers), surgery to remove the cancer may not be possible.

Instead, treatments will focus on shrinking or slowing the growth of the cancer and relieving symptoms without trying to cure the disease. This is called palliative treatment.

Some people think that palliative treatment is only offered at the end of life. However, it can help at any stage of pancreatic cancer. It does not mean giving up hope – rather, it is about managing symptoms and living as fully and comfortably as possible.

Palliative treatment is one aspect of palliative care (see below). Many studies have shown that when palliative care is delivered early it can improve people’s quality of life.

Palliative treatments may include surgery, chemotherapy and radiation therapy, either on their own or in combination.

These treatments may be used to help manage the cancer and relieve some common symptoms of advanced pancreatic cancer, such as:

• jaundice caused by narrowing of the common bile duct
• ongoing vomiting and weight loss caused by a blockage in the stomach or small bowel 
• pain in the abdomen (belly) and middle back.

Many people with advanced pancreatic cancer have digestive problems. For example, a blockage in the pancreatic duct can stop the flow of the digestive enzymes required to break down food.

This can be treated with pancreatic enzyme supplements. See Managing your diet and nutrition for ways to change your diet to help manage some common problems.

Surgery to relieve symptoms

If the tumour is pressing on the common bile duct, it can cause a blockage and prevent bile from passing into the bowel.

Bile builds up in the blood, causing symptoms of jaundice, such as yellowing of the skin and whites of the eyes; itchy skin; reduced appetite, poor digestion and weight loss; dark urine; and pale stools.

If cancer blocks the duodenum (first part of the small bowel), food cannot pass into the bowel and builds up in your stomach, causing nausea and vomiting. Blockages of the common bile duct or duodenum are known as obstructions.

Surgical options for managing obstructions

Inserting a stent

Chemotherapy

Chemotherapy uses drugs to kill or slow the growth of cancer cells. It is used for pancreatic cancer at various stages. If the cancer is at a stage where it can be removed with surgery, chemotherapy is often used before or after the surgery.

When surgery cannot remove the cancer, chemotherapy can be used as a palliative treatment to slow the growth of the cancer and relieve symptoms.

For some stage 3 cancers, chemotherapy may be combined with radiation therapy. This is called chemoradiation.

The chemotherapy drugs are usually given as a liquid through a drip inserted into a vein in the arm (intravenous infusion) or as tablets that you swallow.

To avoid damaging the veins in your arm, it may also be given through a tube implanted into a vein (called a port, catheter, central line or PICC line). This will stay in place until all your chemotherapy treatment is over.

You will usually receive treatment as an outpatient (not admitted to hospital). Typically, you will have several courses of treatment, with rest periods of a few weeks in between.

Your medical oncologist will assess how the treatment is working based on your symptoms and wellbeing, as well as scans and blood tests.

Tell your team about any prescription, over-the-counter or natural medicines you are taking, as these may affect how the chemotherapy works in your body.

Side effects of chemotherapy

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

Radiation therapy

Also known as radiotherapy, radiation therapy uses a controlled dose of radiation to kill cancer cells or injure them so they cannot multiply. The radiation is usually in the form of focused x-ray beams targeted at the cancer.

Treatment is painless and carefully planned to do as little harm as possible to healthy body tissue near the cancer.

• Chemoradiation – For stage 3 cancers that cannot be removed with surgery (locally advanced cancers), radiation therapy may be given with chemotherapy to slow the growth of the cancer. This is called chemoradiation. For cancers that are at a stage where they can be removed by surgery, chemoradiation may also be used before or after the surgery. In chemoradiation, the radiation therapy is delivered over several treatments (called fractions). Each fraction delivers a small dose of radiation that adds up to the total treatment dose. Your doctor will let you know your treatment schedule. Many people have treatment as an outpatient once a day, Monday to Friday, for up to 6 weeks. Each radiation therapy session takes 10–15 minutes. You will lie on a table under a machine called a linear accelerator that delivers radiation to the affected parts of your body. The machine does not touch you, but it may rotate around you to deliver radiation to the area with cancer from different angles. This allows the radiation to target the cancer more precisely and limits the radiation given to surrounding tissues.
• Radiation therapy on its own – Radiation therapy may also be used on its own over shorter periods to relieve symptoms. For example, if a tumour is pressing on a nerve or another organ and causing pain or bleeding, a few doses of radiation therapy may shrink the tumour enough to relieve the symptoms.
• SBRT – Stereotactic body radiation therapy (SBRT) is an emerging treatment for pancreatic cancer. It delivers a higher dose of radiation per treatment session over fewer treatment sessions than usual radiation therapy. SBRT is not standard practice for pancreatic cancer but may be a treatment option as part of a clinical trial at some cancer centres.

Side effects of radiation therapy

Linear accelerator (LINAC)

How palliative care can help

The treatment options described on this page are generally part of palliative treatment.

Palliative treatment is one aspect of palliative care, in which a team of health professionals work together to meet your physical, emotional, cultural, spiritual and social needs.

Specialist palliative care services see people with more complex needs and can also advise other health professionals.

Contacting a specialist palliative care service soon after diagnosis gives them the opportunity to get to know you, your family and your circumstances. You can ask your treating doctor for a referral.

How palliative care works