Treatments & Tests
Tests to ask your doctor about
What is biomarker testing?
Every pancreatic tumour is different and knowing the biological characteristics of your tumour can help to determine the best treatment options for you. PanKind encourages you to ask your doctor about biomarker testing also called genomic or molecular profiling.
Whilst biomarker testing may not affect your treatment options initially, it may provide more options in the future as research continues and innovative medicines are available through clinical trials and special access schemes.
What is genetic testing for inherited mutations?
About 10% of pancreatic cancers have an inherited genetic cause. You may have a family history of cancer or pancreatic cancer, or you may have been born with inherited genetic mutations with no family history of cancer. Genetic testing can identify inherited mutations and help you and your care team make treatment decision and inform you and your family of risk.
If you are diagnosed with pancreatic cancer, PanKind encourages you to speak with your doctor and a genetic counsellor about whether genetic testing is appropriate for you.
Treatment for pancreatic cancer
Many years of treating people with cancer and testing different treatments in clinical trials has helped doctors know what is likely to work for a particular type and stage of cancer. Your specialist doctors will advise you about the best treatment for the stage, grade and type of pancreatic cancer you have. Their suggestions will take into account your overall health, how far the cancer may have spread and what you want. As the treatment plan is so individual, you may meet other people with pancreatic cancer with a similar story, who are receiving different treatment to you. Feel free to talk to your medical team about why your treatments have been recommended for you.
Treatment for pancreatic cancer may include one or a combination of the following:
- endoscopic treatments (e.g. stents and bypass surgery to relieve pain and blockages)
- other treatments (e.g. targeted therapy, immunotherapy)
- clinical trials
- supportive care
The most common treatment for early stage pancreatic cancer is surgery, with chemotherapy and/or radiotherapy before and/or after the surgery.
Treatment for more advanced cancer is aimed at relieving symptoms such as pain and digestive problems.
It is important you discuss treatment options with your doctor and ask about the treatments that are selected in cancer centres that treat high volumes of patients each year. Your GP may be able to help you frame your questions to your specialist or find out this information on your behalf.
Chemotherapy uses anti-cancer drugs to destroy cancer cells. The aim is to kill the cancer cells while doing the least possible damage to normal cells. The drugs work by stopping cancer cells from growing and reproducing.
Your doctor may recommend chemotherapy for several reasons including:
- before surgery (neo-adjuvant chemotherapy) to try to shrink the tumour, which will make it easier to remove with clear margins
- after surgery for early stage cancer to get rid of any cancer cells left behind as well as trying to stop the cancer coming back (known as adjuvant chemotherapy)
- for advanced (metastatic) pancreatic cancer if the cancer has spread to other organs in the body, to help control the growth of the disease and maintain quality of life.
Radiation therapy (also called ‘radiotherapy’) treats cancer by using radiation to destroy cancer cells. Radiation can be targeted to where the cancer is in the body. Special techniques are used to minimise dose (and hence harm) to surrounding normal body tissues.
Not everyone who has pancreatic cancer will have radiotherapy. However, research is showing that radiotherapy before surgery may help shrink the cancer. In certain cases, radiotherapy may also be given after surgery to help stop the cancer coming back, but this is rarely done. Radiotherapy is also commonly used as a palliative treatment to help control symptoms such as pain from either the pancreatic cancer or from metastases elsewhere.
Other treatments (immunotherapy/targeted therapies)
Immunotherapy uses substances to help stimulate an immune response in the body to help fight the cancer. Most immunotherapy drugs for pancreatic cancer are given in clinical trials (discussed below). They are not yet standard treatments for pancreatic cancer as their benefits have not been proven. They are usually given with other treatments such as chemotherapy.
Clinical trials are the most accurate way to determine the effectiveness of promising new treatments or new ways of combining cancer treatments. Your doctor may suggest that you take part in a clinical trial. It is important you understand the reasons for the trial and what it means for you. Clinical trials are beneficial because you will:
- have access to a potentially helpful treatment that isn’t yet available as standard treatment
- get regular support and follow-up with specialist doctors and nurses who are experts in their field
- be contributing to research that may help save lives in the future
- feel you are taking an active role in your treatment and care.
Not everyone is eligible for all clinical trials. If your doctor thinks you might be suitable for a certain trial, they will ask you to speak with the trial coordinator/nurse who will explain the trial in detail.
You may want to ask your doctor:
- Are there any clinical trials that could be right for me?
- Which treatments are being tested and why?
- How long will the trial last?
- What are the possible side effects of the new treatment?
- Do I have to go into hospital to be on the trial?
- What is the standard (best existing) treatment for my cancer if I don’t go on the trial?
If you are eligible and decide to join a randomised clinical trial, you will be given either:
- the best existing treatment, or
- a promising new treatment.
You will be allocated at random to receive one of these and you won’t know which one you are taking. You have the right to withdraw from a clinical trial at any time. Doing so will not affect your cancer treatment.
There are four different phases of clinical trials:
- Phase I: Testing of a new drug/treatment for safety on a small group of patients; it involves testing different doses (dose-ranging).
- Phase II: Testing of the drug/treatment on patients to assess its effectiveness and side effects.
- Phase III: Testing of a drug/treatment on patients to assess effectiveness and safety, but with much larger numbers of people than used in phase II trials.
- Phase IV: Studies looking at drugs that have already been approved as standard treatment, but where important questions remain, like looking at safety over long periods of time. These trials involve thousands of people, and often from all around the world.
PanKind encourage you to ask your doctor if there are clinical trials you could consider as part of your treatment plan.
These are therapies used alongside scientifically proven conventional cancer treatment (e.g. chemotherapy, radiotherapy, surgery). There are many different types of complementary therapies, which include:
- body-based therapies such as massage and yoga
- mind–body therapies such as meditation, music therapy and counselling
- herbal treatments such as cannabis
- Chinese medicine practices such as acupuncture
- diet-related therapies.
There is no scientific evidence to prove these therapies can treat or cure any type of cancer. Some of the main reasons people with cancer use complementary therapies are to:
- feel more in control
- improve wellbeing
- relieve side effects such as pain, nausea and vomiting (e.g. acupuncture may help control nausea caused by chemotherapy).
These are positive outcomes, but it is important to remember that it doesn’t mean the therapies have had any physical effect on the cancer (e.g. killing cancer cells or shrinking a tumour).
It is important to let your medical team know about any therapies you are using or thinking of using. Some are known to interact and cause side effects when used together with conventional treatments. If you are going to use complementary therapies, it is very important to find the right therapist. This may be someone who has had experience in working with cancer patients and is willing to communicate with your medical team.
If you are looking into using complementary therapies, it is likely you will come across the term ‘alternative therapies’ as well. Alternative therapies are very different to complementary therapies. They are used instead of conventional treatments. For example, someone may decide to stop having chemotherapy and treat their cancer using a special diet and herbal remedies that haven’t been scientifically proven to treat cancer. Along with being unproven, alternative therapies can be very expensive, have harmful side effects and possibly make your overall health worse.
We don’t recommend using alternative therapies. But if you do, we strongly advise you to discuss this with your doctor before refusing or stopping conventional treatments.
Supportive care also known as palliative care is often provided alongside other cancer treatments with the focus to support you to live as fully and well as possible. A palliative approach to care promotes you to feel well, minimise and manage symptoms from both the cancer and treatments, as well as support your emotional, social, spiritual and psychological (holistic) needs given the diagnosis of a serious illness. Palliative care support may be recommended to you by one of your care team members at any time from diagnosis and PanKind encourages you to talk to your doctor about palliative care early after you are diagnosed with pancreatic cancer. Palliative care services may also occur outside of the hospital which can be very beneficial in supporting you in remaining as well as you can be, independently. The palliative care team are also very important in supporting people at their end of life and help to ensure they and their families are as comfortable as possible.
Thank you to the clinicians, researchers, patients, and carers who have helped us create and review our website information and support resources, we could not have done it without you.