Treating Resectable Pancreatic Cancer

People whose pancreatic cancer is considered resectable may undergo one of three surgeries:

Whipple procedure (pancreaticoduodenectomy): A surgeon removes the head of the pancreas and sometimes the body of the pancreas, parts of the stomach and small intestine, some lymph nodes, the gallbladder, and the common bile duct. The remaining organs are reconnected in a new way to allow digestion. The Whipple procedure is a difficult and complicated surgery. Surgeons and hospitals that do the most operations have the best results.

About half the time, once a surgeon sees inside the abdomen, pancreatic cancer that was thought to be resectable turns out to have spread, and thus be unresectable. The Whipple procedure is not completed in these cases.

Distal pancreatectomy: The tail and/or portion of the body of the pancreas are removed, but not the head. This surgery is uncommon for pancreatic cancer, because most tumors arising outside the head of the pancreas within the body or tail are unresectable.

Total pancreatectomy: The entire pancreas and the spleen are surgically removed. Although once considered useful, this operation is uncommon today.

Chemotherapy or radiation therapy or both can also be used in conjunction with surgery for resectable and unresectable pancreatic cancer in order to:

Shrink pancreatic cancer before surgery, improving the chances of resection (neoadjuvant therapy)

Prevent or delay pancreatic cancer from returning after surgery (adjuvant therapy)

Chemotherapy includes cancer drugs that travel through the whole body. Chemotherapy ("chemo") kills pancreatic cancer cells in the main tumor as well as those that have spread widely. These chemotherapy drugs can be used for pancreatic cancer:

5-fluorouracil (5-FU) or capecitabine (Xeloda)

Gemcitabine (Gemzar)

Both 5-FU and gemcitabine are given into the veins during regular visits to an oncologist (cancer doctor). An oral drug, capecitabine, may be substituted for 5-FU, especially with radiation.

In radiation therapy, a machine beams high-energy X-rays to the pancreas to kill pancreatic cancer cells. Radiation therapy is done during a series of daily treatments, usually over a period of weeks.

Both radiation therapy and chemotherapy damage some normal cells, along with cancer cells. Side effects can include nausea, vomiting, appetite loss, weight loss, and fatigue as well as toxicity to the blood cells. Symptoms usually cease within a few weeks after radiation therapy is complete.