Treatment for early pancreatic cancer

Monday 1 February, 2016

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On this page: Surgery to treat early pancreatic cancer | What to expect after surgery | Neoadjuvant and adjuvant therapies | Key points | Leslye’s story

This section gives an overview of treatments used for early-stage pancreatic cancer, including treatment of early-stage pancreatic NETs. See information on the treatment of locally advanced and metastatic pancreatic cancer.

Surgery to remove the cancer, in combination with chemotherapy, and possibly radiotherapy, is generally the most effective treatment for early-stage pancreatic cancer.

Your medical team will discuss the best treatment for you based on the following factors:

  • the stage of the tumour (the site, size and if it has spread)
  • your general health
  • your preferences
  • for pancreatic NETs, whether the tumour is functioning (hormone producing) or non-functioning.
Travelling for treatment

Some people in rural and regional areas have to travel to attend appointments with specialists. If you need to travel a long way for treatment, ask your doctor what support is available to coordinate your journey. You may also be able to get financial assistance towards the cost of accommodation or travel. To check your eligibility or to apply, speak to your GP, the hospital social worker or travel department, call Cancer Council 13 11 20 or see patient transport factsheet.

Surgery to treat early pancreatic cancer

Surgical removal (resection) of the tumour is usually the most suitable treatment for people with early-stage disease who are in good health. The surgeon will aim to remove all the tumour from the pancreas as well as the surrounding tissue. The type of surgery will depend on the size of the tumour and where it is located.

Surgery for early-stage pancreatic cancer, particularly pancreatic NETs, is potentially beneficial, especially if the tumour is small. However, there are risks and potential complications involved in pancreatic surgery. Your surgeon will weigh up the benefits and impacts of surgery, while taking into account your wants, and your general health.

Surgeries for early-stage pancreatic cancer include:

  • The Whipple procedure, or pancreaticoduodenectomy, which treats tumours in the head of the pancreas. This is the most common resection surgery for exocrine pancreatic tumours.
  • A distal pancreatectomy, which removes tumours in the tail or body of the pancreas. This surgery is more likely an option to treat early-stage pancreatic NETs.

Where the cancer is large, or in multiple places in the pancreas, a total pancreatectomy, may be performed. This involves removal of the entire pancreas and spleen. If the cancer has spread (metastasised) or the surgeon is unable to safely remove the whole tumour, a double bypass may be perfomed.

Whipple procedure

The Whipple procedure (pancreaticoduodenectomy) is a major operation that is done by specialised pancreatic or HPB surgeons. During this procedure the surgeon will remove:

  • the part of the pancreas where the cancer is (usually the head)
  • the first part of the small bowel (duodenum)
  • part of the stomach
  • the gall bladder and part of the bile duct.
Whipple procedure - before the operation

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. The surgery usually lasts 5–8 hours and most patients stay in hospital for 1–2 weeks afterwards. See tips on managing dietary problems after a Whipple procedure.

Whipple procedure - after the operation
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 this surgery.

Total pancreatectomy

When cancer is large, or multiple tumours are found, the entire pancreas and spleen may be removed, along with the gallbladder, bile duct, part of the stomach and small intestine, 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 need to have regular insulin injections. It will also be necessary to take pancreatic enzyme pills to help digest certain foods.

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 that will relieve some of the symptoms caused by the cancer.

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 medication.
  • Drips and tubes
    When you are in hospital, you will have a drip (intravenous infusion) to replace your body’s fluids. At first you will not be able to eat or drink (nil by mouth). You will then be restricted to 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 your ability to eat and drink is fully restored.
  • 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
    A small number of people develop diabetes after surgery and may need insulin therapy. See tips on coping with diabetes.
  • Length of hospital stay
    Most people go home within a fortnight, but if you have complications, you may need to stay in hospital longer.

See information on managing dietary issues that may be caused by pancreatic cancer and its treatment.

Neoadjuvant and adjuvant therapies

Other treatments may be used before surgery to shrink the tumour, or after surgery to destroy any remaining cancer cells. These are known as neoadjuvant (before) and adjuvant (after) therapies.

Your doctor may suggest the following:

  • chemotherapy to kill or slow the growth of cancer cells, either before or after surgery
  • chemotherapy combined with radiotherapy (chemoradiation) after surgery to reduce the chance of the cancer returning.

See more information about chemotherapy and radiotherapy, including management of side effects.

Key points

  • For early-stage cancer, surgical removal of the tumour (resection) offers the best potential outcome. This may not be an option for some patients.
  • The most common surgery for pancreatic cancer is the Whipple procedure. This removes the gall bladder and parts of the pancreas, small bowel, bile duct and stomach.
  • A distal pancreatectomy is sometimes used to treat pancreatic cancer and pancreatic NETs found in the tail and body of the pancreas.
  • In a total pancreatectomy the entire pancreas and spleen is removed, along with the gallbladder, bile duct, part of the stomach and small intestine, 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.
  • After surgery, you may need to take pancreatic enzymes to digest fat and protein, or receive insulin injections to treat diabetes.
  • Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. It can be combined with radiotherapy.
  • Chemotherapy and/or radiotherapy may be used before or after surgery. This is known as neoadjuvant and adjuvant therapy.

Leslye’s story

"My symptoms started with itchy skin. After a few days I was jaundiced and had dark coloured urine and back pain. I thought I had a problem with my gall bladder so I went to Emergency. The doctors did several tests and scans and couldn’t figure out what was wrong, so they put a stent into my gall bladder to prevent it from becoming blocked.

"The stent was changed four times over the course of a year. I had regular scans but no cancer was detected.

"I wasn’t feeling well and I had a bout of pancreatitis, so my surgeon removed my gall bladder and did a biliary bypass. They were then able to see that I had a carcinoid pancreatic neuroendocrine tumour on the head of my pancreas.

"One good thing for me was that I didn’t have to have chemotherapy or radiotherapy.

"I had a Whipple procedure. It was a serious operation and I was in hospital for five weeks.

"During recovery in hospital, I didn’t have a feeding tube – I drank water and built up to other fluids. Over the next six months, I lost a lot of weight because I didn’t eat a great deal.

"I now eat a mostly vegetarian diet with meat 1–2 times per week. I take a digestive enzyme supplement called Creon® with food and increase the dose with a larger meal. I try to eat well most of the time.

"I rarely eat sugary, fatty or dairy foods. I’m able to maintain a healthy weight.

"Since I’ve learned to manage my diet, I was able to go overseas this year on a European river cruise. I was careful with what I ate and I rested a few days when I needed to, but I didn’t have any serious problems."

Reviewed by: A/Prof Vincent Lam, Associate Professor of Surgery, Sydney Medical School & Hepatobiliary, Pancreatic and Transplant Surgeon Westmead Hospital, NSW; Dr Phillip Tran, Radiation Oncologist, Site Director, Sunshine Hospital Radiation Therapy Centre, VIC; Dr Victoria Atkinson, Senior Medical Oncologist, Division of Cancer Services, Princess Alexandra Hospital, QLD; Alison Keay, Upper GI Cancer Nurse Coordinator, WA Cancer & Palliative Care Network, WA; Belinda Steer, Clinical Lead Dietitian, Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, VIC.

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