Surgery may be used alone or in combination with radiation therapy and chemotherapy. The surgeon may remove all or part of the pancreas. The extent of surgery depends on the location and size of the tumor, the stage of the disease and the patient’s general health.
- Whipple Procedure If the tumor is in the head (the widest part of the pancreas), the surgeon removes the head of the pancreas and part of the small intestine, bile duct and stomach. The doctor then reconnects the digestive tract and biliary system. The surgeon may also remove other nearby tissues.
- Pancreatectomy A surgical procedure in which the surgeon removes the tail and body of the pancreas, as well as the spleen. In a total pancreatectomy, the surgeon removes the entire pancreas, part of the small intestine, a portion of the stomach, the common bile duct, the gallbladder, the spleen and nearby lymph nodes.
Sometimes before one of the above procedures, the surgeon may choose to start with a laparoscopy, in which several small holes are made in the abdomen while a patient is under anesthesia, through which a camera can can be passed. This allows the surgeon to assess whether the cancer has spread to other areas within the abdominal cavity, in which case undertaking the full operation to remove the primary tumor would not be beneficial.
If the tumor is blocking the common bile duct or small intestine, placement of a stent (a tiny tube that helps keep the blocked area open and can be either metal or plastic) can be performed to relieve the blockage using nonsurgical approaches, such as endoscope cholangiopancreatography (ERCP) or endoscopy. In some instances, the patient may need surgery to create a bypass, even if the tumor itself cannot be completely removed. A bypass allows fluids to flow through the digestive tract. It can help relieve jaundice and pain resulting from a blockage.
Radiation therapy uses high-energy rays to kill cancer cells. A large machine directs radiation at the abdomen. Radiation therapy may be given alone, with surgery, with chemotherapy or both. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. Radiation therapy is also called local therapy. This method affects cancer cells only in the treated area.
Chemotherapy is the use of drugs to kill cancer cells. Doctors also give chemotherapy to help reduce pain and other problems caused by pancreatic cancer. It may be given alone, with radiation or with surgery and radiation. Systemic chemotherapy uses drugs to target cancer cells throughout the body. It can be given orally or by injection, and can be done as an outpatient treatment at the hospital, doctor’s office or at home.