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Pancreatic cancer

Treatment for early pancreatic cancer

This section gives an overview of treatments used for early-stage adenocarcinomas and other exocrine tumours of the pancreas, generally referred to as early pancreatic cancer.

The treatment options described in this section will be suitable for only 15–20% of people with pancreatic cancer, as most people are diagnosed at a later stage. See information on the treatment of advanced pancreatic cancer or treatment options for pancreatic NETs.

Surgery to remove the cancer, in combination with chemotherapy and possibly radiation therapy, is generally the most effective treatment for early pancreatic cancer. It is important to have the surgery done by a surgeon who specialises in pancreatic cancer. Your medical team will discuss the best treatment for you based on the stage of the tumour (the site, size and if it has spread), your general health and your preferences.

Cancer care pathways

For an overview of what to expect during all stages of your cancer care, read or download the What To Expect guide for pancreatic cancer (also available in Arabic, Chinese, Greek, Hindi, Italian, Tagalog and Vietnamese – see details on the site). The What To Expect guide is a short guide to what is recommended for the best cancer care across Australia, from diagnosis to treatment and beyond.

Treatments before or after surgery

Your surgeon may recommend you see other specialists for treatments before surgery to shrink the tumour, or after surgery to destroy any remaining cancer cells. These treatments are known as neoadjuvant (before) and adjuvant (after) therapies and may include:

Phil's story

"Two years ago, I had a couple of episodes of severe stomach pain a few months apart. I ended up seeing a surgeon and had blood tests, x-rays, CT scans and a PET scan. I got the news that it was pancreatic cancer about a week later.

"I'd played and coached top level sport and thought I was bulletproof, so the diagnosis really rocked me. I'll never forget that drive home, it was the quietest one I'd ever had.

"The surgeon worked with a medical oncologist and radiation oncologist to plan the treatment. They hit me with everything they had. I had 18 chemotherapy sessions, then a month's break, 26 radiation sessions, then some weeks off, and then had surgery.

"We'd hoped I might only lose part of the pancreas, but they had to take all of it as well as the spleen and gall bladder. I spent 12 days in hospital, then went home for recovery. I had four months off work all up.

"I pushed myself to keep walking every day to stay strong before and after the operation. The walking also takes your mind off things, it's better than sitting at home feeling sorry for yourself.

"I had to make some slight changes to my diet, and avoid milk and red meat for a while. Now I can have lean meat, but I always have lots of fruit and vegies. Because I no longer have a pancreas, I'm diabetic and need to inject insulin three times a day and take pancreatic enzymes before meals. The diabetes has been easy to manage, no problems at all.

"I don't take things for granted with my health now. My diet was good before but it's even better now, and I make sure I walk every day. I was 113 kg before the operation, and now I'm just on 80 kg and I feel great."

Tell your cancer story.

Surgery for early pancreatic cancer

Surgical removal (resection) of the tumour is the most common treatment for people with early-stage disease who are in good health. Before the surgery, your treatment team may recommend that you have chemotherapy, with or without radiation therapy, to shrink the tumour. This is known as neoadjuvant therapy.

The aim of surgery for early pancreatic cancer is to remove all the tumour from the pancreas as well as the surrounding tissue. The type of surgery you have will depend on the size of the tumour and where it is located. All surgery has risks and potential complications, so your surgeon will weigh these up against the benefits, taking into account your general health and your preferences.

Surgeries for early pancreatic cancer include:

Whipple procedure

This treats tumours in the head of the pancreas. Also known as pancreaticoduodenectomy, it is the most common surgery for pancreatic tumours. See below for more information about this operation.

Distal pancreatectomy

This removes tumours in the tail or body of the pancreas and often also removes the spleen.

Total pancreatectomy

This removes the entire pancreas and spleen. This may be the best option if the cancer is large, or in multiple places in the pancreas.

Before and after a Whipple procedure

The Whipple procedure (pancreaticoduodenectomy) is a major operation that is done by a specialised pancreatic or hepato-pancreato-biliary (HPB) surgeon.

The surgeon removes the part of the pancreas with the cancer (usually the head); the first part of the small bowel (duodenum); part of the stomach; the gall bladder; and part of the bile duct.

Then the surgeon reconnects the remaining part of the pancreas, bile duct and stomach (or duodenum) to different sections of the small bowel to keep the digestive tract working. This allows food, pancreatic juices and bile to continue to flow into the small bowel for the next stage of digestion. Most people need to adjust their diet after a Whipple procedure.

Before a whipple procedure

After whipple procedure

A Whipple procedure is extensive surgery and usually lasts 5–8 hours. As your surgeon will explain, there is a chance of serious complications, such as major bleeding or blood clots.

Most patients stay in hospital for 1–2 weeks afterwards, and full recovery takes at least 8–12 weeks. See tips on managing dietary issues after a Whipple procedure.

Distal pancreatectomy

The surgeon removes only the tail of the pancreas, or the tail and a portion of the body of the pancreas. The spleen is usually removed as well. The spleen helps the body fight infections, so if it is removed you are at higher risk of some bacterial infections. Your doctor may recommend vaccinations before and after this surgery.

Total pancreatectomy

When cancer is large, or multiple tumours are found, the entire pancreas and spleen may be removed, along with the gall bladder, common bile duct, part of the stomach and small bowel, and nearby lymph nodes. This is called a total pancreatectomy.

It is possible to live without a pancreas. However, the body will no longer produce insulin, so you will have type 1 diabetes and need regular insulin injections. You will also need to take pancreatic enzyme supplements to help digest certain foods. It is crucial that an endocrinologist is part of your MDT to help guide your adjustment to life without a pancreas.

Surgery to relieve symptoms

During the surgery to remove the cancer, the surgeon may find that the cancer has spread (metastasised) or grown into one or more of the major blood vessels in the area. This may occur even if you had several scans and tests beforehand. If this happens, the surgeon will not be able to remove the tumour. However, the surgeon may be able to perform procedures (such as a double bypass) that will relieve some of the symptoms caused by the cancer.

Surgical techniques

Surgery for early pancreatic cancer may be done using different techniques. Open surgery involves one larger cut in the abdomen. Laparoscopic surgery involves several small cuts in the abdomen. The surgeon inserts the instruments through these cuts and watches a screen to perform the operation. Robotic-assisted surgery uses a robotic device to help the surgeon perform laparoscopic surgery.

Compared to open surgery, laparoscopic surgery and robotic-assisted surgery usually mean a shorter hospital stay, less bleeding, a smaller scar and a faster recovery time. However, open surgery may be the better option in some circumstances.

Talk to your surgeon about what options are available to you and check if there are any extra costs involved.

What to expect after surgery

Pain control

As with all major operations, you will be given pain relief. If you are in pain when you return home, talk to your medical team about prescribing pain medicine.

Drips and tubes

While in hospital, you will have a drip (intravenous infusion) to replace your body's fluids. At first you won't be able to eat or drink (nil by mouth). You'll then be on a liquid diet before gradually returning to normal food. A temporary feeding tube may be placed into the small bowel during the operation. This tube provides extra nutrition until you can eat and drink normally again. The hospital dietitian can help you manage these changes.

Enzyme and insulin replacements

Some people will need to take tablets known as pancreatic enzymes after surgery. These are taken with each meal to help digest fat and protein.

Insulin therapy

Because the pancreas produces insulin, people who have had all or some of it removed often develop diabetes after surgery and may now need regular insulin injections. See tips on coping with diabetes.

Length of hospital stay

Most people go home within two weeks, but if you have complications, you may need to stay in hospital longer. You may also need to stay in a rehabilitation hospital to recover more before going home.

What if the cancer returns?

If the surgeon successfully removes all of the cancer, you'll need regular check-ups to confirm that it hasn't come back. Check-ups will become less frequent if you have no further problems. Between appointments, let your doctor know immediately of health issues.

Unfortunately pancreatic cancer is difficult to treat, and it often does comes back after treatment. This is known as a recurrence. Most of the time, surgery to completely remove the cancer is not an option if you have a recurrence. Your doctors may recommend other types of treatment with the aim of reducing symptoms and improving quality of life. The next section describes some of these treatments. You may also be able to access new treatments by joining a clinical trial.

Key points

  • For early-stage cancer, surgical removal of the tumour (resection) offers the best potential outcome. This is an option for a small number of people with pancreatic cancer.
  • Chemotherapy and/or radiation therapy may be used along with surgery. This is known as neoadjuvant therapy if done before surgery, and adjuvant therapy after surgery.
  • In a total pancreatectomy, the entire pancreas and spleen are removed, along with the gall bladder, common bile duct, part of the stomach and small bowel, and nearby lymph nodes.
  • If the surgeon finds that the cancer has spread, or is unable to remove the tumour, surgery to relieve symptoms may be performed instead.
  • The most common surgery for pancreatic cancer is the Whipple procedure. This removes the gall bladder and parts of the pancreas, small bowel (duodenum), common bile duct and stomach. Full recovery can take 8–12 weeks.
  • A distal pancreatectomy is sometimes used to treat pancreatic cancer found in the tail or body of the pancreas. It removes part of the pancreas and often the spleen as well.
  • Surgery for pancreatic cancer may be done with open surgery, laparoscopic surgery or robotic-assisted surgery. Your surgeon will discuss the options with you.
  • After part or all of the pancreas is removed, you may need to take pancreatic enzymes to digest fat and protein, or have insulin injections to treat diabetes.

Expert content reviewers:

Dr Lorraine Chantrill, Senior Staff Specialist Medical Oncology, The Kinghorn Cancer Centre, St Vincent's Hospital, and Honorary Research Fellow, Garvan Institute of Medical Research, NSW; Jennifer Arena, Pancreatic and Neuroendocrine Cancer Care Coordinator, Northern Sydney Cancer Centre, Royal North Shore Hospital, and Northern Cancer Institute, NSW; Dr Michael Briffa, Southern Adelaide Palliative Services, Flinders Medical Centre, SA; Rachel Corbett, 13 11 20 Consultant, Cancer Council Victoria; A/Prof Nick O'Rourke, The University of Queensland, Chairman of General Surgery, Head of Hepatobiliary Surgery, Royal Brisbane and Women's Hospital, QLD; Steve Pendry, consumer; Caley Schnaid, Accredited Practising Dietitian, Northern Cancer Institute and Wellac Lifestyle, NSW; Deane Standley, Consumer.

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