Treatment

Treatment for pancreatic cancer depends on the type, location and stage of your cancer (how far it's spread).

Your age, general health and personal preferences will also be taken into consideration when deciding on your treatment plan.

The first aim will be to completely remove the tumour and any other cancerous cells in your body.

If this isn't possible, the focus will be on preventing the tumour growing and causing further harm.

Sometimes it's not possible to get rid of the cancer or slow it down, so treatment will aim to relieve your symptoms and make you as comfortable as possible.

Cancer of the pancreas is very difficult to treat. In its early stages, this type of cancer rarely causes symptoms, so it's often not detected until it's quite advanced. If the tumour is large or has spread, treating or curing the cancer is much harder.

Cancer Research UK has more information about stages of pancreatic cancer .

Discussing your treatment

Deciding what treatment is best for you can be a difficult process. There's a lot to take in, so it's important to talk about the possible alternatives with a family member or friend.

You should also have an in-depthdiscussion with your doctor, who can tell you the pros andcons of the treatments available to you.

If at any stage you don't understand the treatment options being explained to you, make sure you ask your doctor for more details.

There are three main ways that cancer of the pancreas can be treated:

• surgery
• chemotherapy
• radiotherapy Radiotherapy

Some types of pancreatic cancer only require one form of treatment, whereas others may require two or a combination of all three.

Cancer Research UK has more information about types of treatment for pancreatic cancer.

Surgery

Surgery is usually the only way pancreatic cancer can be completely cured. However, as the condition is usually advanced by the time it's diagnosed, surgery is only suitable for around 15-20% of people.

However, this isn't a suitable option if your tumour has wrapped itself around important blood vessels. If your cancer has spread to other areas of the body, surgically removing the tumour won't cure you.

Surgery for pancreatic cancer is usually only an option for people who have a good general level ofhealth. This is because pancreas surgery is often long and complex, and the recovery process can be slow.

Sometimes the risks of surgery can outweigh the potential benefits.

Your doctor will discuss with you whether surgery is a suitable option. There are several possible surgical procedures, which areoutlined below.

Whipple procedure

The Whipple procedure is the most common operation used to treat pancreatic cancer, and involves removing the head of the pancreas.

Your surgeon must also remove the first part of your small intestine (bowel), your gall bladder (which storesbile) and part of your bile duct. Sometimes, part of the stomach also has to be removed.

The end of the bile duct and the remaining part of your pancreas is connected to your small intestine. This allows bile and the hormones and enzymes produced by the pancreas to still be released into your system.

After this type of surgery, about one in three people need to take enzymes to help them digest food.

The Whipple procedure involves long and intensive surgery, but it's easier to recover from than a total pancreatectomy (see below).

Distal pancreatectomy

A distal pancreatectomy involves removing the tail and body of your pancreas.

Your spleen will usually also be removed at the same time. Part of your stomach, bowel, left adrenal gland, left kidney and left diaphragm (the muscle that separates the chest cavity from the abdomen) may also be removed.

Like the Whipple procedure, a distal pancreatectomy is a long and complex operationthat won't be carried outunless your doctor thinks it's necessary.

Total pancreatectomy

During a total pancreatectomy, your entire pancreas will be removed. This is sometimes necessary due to the position of the tumour.

Your surgeon will also remove your:

• bile duct
• gall bladder
• spleen
• part of your small intestine
• part of your stomach (sometimes)
• surrounding lymph nodes (part of the immune system)

After a total pancreatectomy, you'll need to take enzymes to help your digestive system digest food. You'll also have diabetes for the rest of your life because the pancreas produces insulinthe hormone that regulates blood sugar.

Removing your spleen can increase your risk of developing infections and may also affect your blood's ability to clot. This means you'll be on penicillin (or an alternative antibiotic if you're allergic to it) for the rest of your life, and you'll need to have regular vaccinations.

Sometimes, you may need to take tablets for a short period to stop the platelets in your blood sticking to each other. Platelets are a type of bloodcellthat cause your blood to clot (thicken).

Surgery to ease your symptoms

Although surgery may not be a suitable way of removing your tumour, you may be offered it to help ease your symptoms.

This type of surgery won't cure your cancer, but will mean that your condition is easier to manage, and it will make you more comfortable.

To help control jaundice, a stent can be placed in your bile duct using endoscopic retrograde cholangiopancreatography (ERCP). This will help keep the bile duct open and prevent bilirubinthe yellow chemical in bilefrom building up and causing jaundice.

If a stent isn't a suitable option for you, you may need an operation to bypass your blocked bile duct. Your surgeon will cut the bile duct just above the blockage and reconnect it to your intestine, which allows your bile to drain away.

These types of surgery are much less intensive than surgery carried out on the pancreas. The recovery time is much quicker, andpeople find that theirjaundice improves significantly.

Chemotherapy

Chemotherapyis a type of cancer treatment that uses anti-cancer medicines to either kill the cancerous (malignant) cells in your body or stop themmultiplying.

Chemotherapy treatment is often used alongside surgery and radiotherapy (see below) to help ensure that as much of the cancer is treated as possible.

Chemotherapy may be given:

• before surgery to try to shrink the cancer, so there's a greater chance of the surgeon being able to remove all of the cancer
• after surgeryto help reduce the risk of the cancer coming back
• when surgery isn't possible to try to shrink the cancer, slow its growth and relieve your symptoms

Some chemotherapy medicines can be taken orally (by mouth), but some need to be given directly into a vein (intravenously).

Chemotherapy also attacks normal, healthy cells, which is why this type of treatment can have many side effects. The most common side effects include:

• vomiting
• nausea
• mouth sores
• fatigue
• increased risk of infection

These are usually only temporary, and should improve once you've completed your treatment.

The chemotherapy medications can also be used in combination, so your doctor may suggest using one medication or a combination of two or three.

Combining chemotherapy medications can give a better chance of shrinking or controlling the cancer, but increases the chance of side effects. Sometimes, the risks of chemotherapy can outweigh the potential benefits.

Side effects of radiotherapycan include:

• fatigue
• skin rashes
• loss of appetite
• diarrhoea
• nausea or vomiting

These side effects are usually only temporary, and should improve after your treatment has been completed.

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