Treatment

Surgery for pancreatic cancer can be very effective, with low risk of complications, and it is the standard treatment for tumors that can be removed, even in older patients. When performed on patients whose cancer hasn't spread, surgery currently offers the only hope for cure.

Surgery is also an important tool for diagnosis of pancreatic cancers. Advanced techniques such as CT angiography (a view of blood vessels enhanced by computed tomographic techniques) improve physicians' ability to determine the extent of disease and devise the most effective treatment plan for each patient.

Research conducted by surgeons at Memorial Sloan-Kettering showed that pancreatic surgery can be performed in elderly patients with good outcomes comparable to those of younger patients. This study demonstrated that chronological age alone should not be the sole determinant when deciding upon surgery in patients over the age of 70. [Ann Surg 222:426,1995]

The most common type of surgery is the Whipple procedure (also known as a pancreatoduodenectomy). This procedure removes the right-most section, or "head," of the pancreas -- and sometimes more of the gland -- as well as the gallbladder, part of the stomach, the lower half of the bile duct, and part of the small intestine. The cut surfaces of the stomach, bile duct, and remaining pancreas are then joined to the small intestine. After this operation, the patient can generally produce adequate amounts of insulin and digestive enzymes.

Other, less commonly used, procedures include total pancreatectomy (in which the whole pancreas is removed, along with the gallbladder, part of the stomach, part of the small intestine, the bile duct, the spleen, and nearby lymph nodes) and distal pancreatectomy (in which the body and tail of the pancreas are removed).

Surgery for pancreatic cancer is a major operation. The surgeon may remove all or part of the pancreas, which may make it hard to digest foods. Nutrition counseling and supportive care are essential elements of comprehensive treatment of pancreatic cancer. Our doctors' expertise and extensive experience in pancreatic cancer surgery has resulted in an extremely low mortality rate compared to that of most hospitals [Ann Surg Oncol 9:847,2002].

One of the largest referral programs in the nation, Memorial Sloan-Kettering is currently undertaking a large study of more than 2,000 operations for pancreatic cancer, including both standard surgeries and laparoscopic procedures, to identify best practices and provide a benchmark for future innovations in surgical technique.

Even after successful surgery, pancreatic cancer can sometimes spread (metastasize), so most treatment plans include additional therapies such as radiation therapy, chemotherapy, and biologic approaches.

Radiation therapy, usually combined with chemotherapy, is often used to treat patients after surgery to prevent recurrence of pancreatic cancer. Radiation therapy is also sometimes used for patients whose cancer is too widespread to be removed surgically. The most common type of radiation therapy used in treating pancreatic cancer is external beam radiation therapy. A new technique for patients who have extensive local spreading of their pancreatic cancer is intraoperative radiation therapy. The surgeon removes the tumor and while still in the operating room, the patient receives a high dose of radiation therapy. Because the radiation therapy is administrated during the surgical procedure, and can be delivered to a precisely defined area around the pancreas, it is possible to use a higher-than-usual dose of radiation while sparing nearby healthy organs (which are temporarily pushed aside during the procedure).

Find a Clinical Trial Find out about new research studies for pancreatic cancer more

For patients with advanced pancreatic cancer whose tumors cannot be removed by surgery, chemotherapy may be employed to reduce the rate of tumor growth. Chemotherapy is also sometimes used in addition to surgery in an effort to slow the spread or prevent the recurrence of pancreatic cancer.

The clinician-scientists in Memorial Sloan-Kettering's Gastrointestinal Oncology Service are looking at new chemotherapeutic agents and new combinations of treatments. These investigational therapies are sometimes offered to eligible patients through the clinical trial process. Some of these research efforts are highlighted below. For up-to-date details about current clinical trials at Memorial Sloan-Kettering Cancer Center, please visit our clinical trial database.

• Vaccines

  Research is under way at Memorial Sloan-Kettering to evaluate pancreatic cancer vaccines as a way to prevent recurrence of the disease. The vaccines are intended to stimulate the patient's immune system. Unlike vaccines that prevent common viral diseases from ever occurring, pancreatic cancer vaccines are designed to prevent recurrence after cancer has appeared.

  One vaccine trial focuses on the common mutations of the K-ras protein that occur in pancreatic cancers. K-ras is a protein that occurs in many cells in the body. This protein, which plays an important role in how cells function and interact with each other, is mutated (altered) in more than 85 percent of patients with pancreatic cancer. The goal of this pancreatic vaccine study is to activate the immune system by developing an immunologic response to the abnormal K-ras protein, and in doing so, ultimately reduce the risk of recurrence.

• Multimodal Therapy

  For patients who will not benefit from surgery because their disease has spread either to the area near the pancreas (known as locally advanced disease) or to distant sites in the body (metastatic disease), there are still treatments being investigated. For locally advanced disease, Memorial Sloan-Kettering doctors are seeking to combine radiation therapy with a chemotherapeutic agent, gemcitabine, to evaluate whether the combination makes the radiation therapy more effective. For patients with metastatic disease, a clinical trial here will assess the effectiveness of two chemotherapeutic agents, gemcitabine and irinotecan. Other agents under study are paclitaxel (in combination with radiation therapy), flavopiridol, and exatecan.

Rehabilitation therapy plays a role in improving the function and quality of life of patients with pancreatic cancer. At Memorial Sloan-Kettering, physical therapists work closely with the medical team to improve patient's mobility, strength, and endurance after surgery or medical treatments. They offer patients valuable techniques to increase mobility without increasing pain and discomfort and teach energy-conserving techniques to help patients decrease the fatigue they may experience during hospitalization and medical treatments. Occupational therapists here educate patients about the changes they may experience during and after treatment and about adaptive equipment and compensatory techniques that can increase their independence during their daily routines. They also evaluate and treat patients' ability to perform basic daily activities such as bathing, dressing, and moving around their environment.

To learn more about the role of rehabilitation services in the care of cancer patients, visit our Rehabilitation section.