Treatment Type Details

Surgery

There are three main types of surgery including; pancreaticoduodenectomy, distal pancreatectomy and total pancreatectomy. The type of surgery will depend on the location of the tumour and how much of the pancreas has been affected.

Pancreaticoduodenectomy also known as a ‘Whipple’ procedure is the most common type of surgery to remove a pancreatic cancer. It is a difficult and complex operation that removes the head of the pancreas, gallbladder, part of the bile duct, the lower part of the stomach, the duodenum (first part of the small intestine) and surrounding lymph nodes. The remaining part of the stomach and bile duct are then joined to the small intestine, and the pancreas joined to the stomach or small intestine.

A distal pancreatectomy removes the body and tail of the pancreas and often the spleen. As your spleen helps your body fight infections, you may need vaccines before and after the surgery.

Total pancreatectomy removes the entire pancreas as well as the gallbladder, duodenum, part of the bile duct and sometime part of the stomach and spleen. What is removed is based on the location and size of the tumour.

Stents and bypass surgery

Stents and bypass surgery may be used to help relieve symptoms caused by the tumour blocking parts of the digestive system. If the tumour is pressing against the bile duct, bile may not be able to pass into the bowel causing symptoms such as jaundice, itchy skin, poor digestion and/or weight loss. If the tumour is blocking the duodenum, food may not be able to pass into the bowel causing nausea and vomiting.

A stent is a small plastic or metal tube that can be inserted to keep the bile duct, pancreatic duct or duodenum open to allow bile or food to pass into the bowel. Stents are most commonly inserted using the endoscopic retrograde cholangiopancreatography (ERCP) procedure. When there is a cancer, to prevent blockages and infections, your doctor will usually prefer a metal stent.

Bypass surgery does not remove the tumour but can help relieve symptoms. Sometimes a surgeon will begin an operation such as the Whipple procedure to remove the cancer but find that it has spread. If they can no longer remove the cancer, the surgeon may instead do bypass surgery to help with symptoms. For a blocked bile duct, bypass surgery will connect the bile duct around the blockage to the small intestine. For a blocked duodenum, bypass surgery will connect the stomach to the intestine so that the stomach can empty properly. A bypass surgery may also be considered for any part of the small bowel which may become blocked from spread of a pancreatic cancer around the abdomen. This is usually an urgent situation and your medical team will guide you on whether this operation is safe and recommended.

Each type of surgery has unique benefits, risk and side effects, which your doctor will discuss with you before you undergo any treatment.

Chemotherapy

Chemotherapy uses drugs to destroy the cancer cells by stopping the cancer cells from growing or dividing. Chemotherapy drugs travel via the bloodstream to kill cancer cells throughout the body. It may be given alone or with other treatments such as surgery and, or radiotherapy. One or multiple chemotherapy agents may also be given together. Common chemotherapy agents active in pancreatic cancer include gemcitabline, nab-paclitaxel, 5-fluorouracil, oxaliplatin and irinotecan. Each have potentially unique side effects which your doctor will discuss with you.

Radiation therapy

Radiation therapy (or radiotherapy) usually uses x-rays to damage cancer cells to stop them growing or dividing. The radiation is targeted to the cancer so that the least amount of healthy tissue is affected. Radiation therapy may be used to help shrink the tumour before surgery, destroy cancer cells that may be there after surgery, or help to relieve pain as part of palliative treatment. Increasingly, stereotactic body radiation therapy ‘SBRT’ is being utilised and delivers extremely precise, very intense doses of radiation to cancer cells while minimising damage to healthy tissue.

A new treatment option which has recently been made available to patients in Australia, is MR-guided radiation therapy. Combining a MRI imaging scanner with a linear accelerator, the MR-Linac allows treatment specialists to see tumours and adapt treatment in real time, allowing higher doses of radiation to be delivered to the tumour safely. GenesisCare Australia has a compassionate access program through its Foundation to support patients in accessing this treatment. You can learn more here.

Targeted therapies

Targeted therapies are designed to specifically target various aspects of how cancer cells grow, divide, repair or interact with other cells. An example is a small molecule capable of switching off an abnormal gene in a cancer that is causing it to grow without regulation from the body.  There is a targeted therapy approved by FDA in the USA called oliparib, for the treatment of pancreatic adenocarcinoma with BRCA mutations, however it is not yet available in Australia. PanKind is advocating for expedited approval in Australia.

There may be other targeted therapies being investigated for their safety and potential activity in clinical trials. If you are interested in participating in a clinical trial, learn more about them here and ask your doctor if there are any clinical trials that might be suitable for you.

Immunotherapy

Immunotherapies harness the body’s immune system to seek out and attack cancer cells. Immunotherapy alone has not shown benefit in most people with pancreatic cancer. Investigation into newer immunotherapy agents alone, and in combination with other treatments is continuing in clinical trials

If you are interested in participating in a clinical trial, learn more about them here and ask your doctor if there are any clinical trials that might be suitable for you.

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