Treatment

Pancreatic Cancer Nomogram This tool predicts the chances that a patient will survive pancreatic cancer up to three years after initial surgery more

Surgery for pancreatic cancer can be very effective, with a low risk of complications, and is the standard treatment for tumors that can be removed. When performed on patients with localized disease, surgery currently offers the best opportunity to extend survival. Surgery for pancreatic cancer also is routinely recommended for older patients (over age 70) who qualify for this treatment. Surgical outcomes in older patients are comparable to those of younger patients.

• Whipple Procedure

  The most common type of surgery for pancreatic cancer 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.

• Minimally Invasive Surgery

  Our surgeons have performed over 100 laparoscopic surgical procedures in patients with pancreatic cancer. As in laparoscopic staging, this minimally invasive technique involves inserting a thin, lighted tube called a laparoscope with a camera on its tip through a tiny incision in the patient's abdomen to remove pancreatic cysts, tumors, and all or part of the gland. Our surgeons continue to evaluate the effectiveness of this approach in selected patients and its potential to reduce complications that can arise with traditional, open surgery.

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).

Our surgeons are also working to develop techniques that reduce surgical complications, such as leakage of pancreatic secretions due to injury of the organ from surgery, and eliminate unnecessarily extensive surgery.

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 for pancreatic cancer. For more information, visit the section on After Treatment in this cancer information overview.

Even after successful surgery, pancreatic cancer can sometimes spread, or metastasize, so most treatment plans include additional therapies (known as adjuvant therapies) such as chemotherapy and radiation therapy. Studies suggest that different combinations of surgery, chemotherapy, and radiation therapy may extend survival for some patients, depending on the location and extent of their disease. See sections below on Chemotherapy and Radiation Therapy for information about adjuvant treatment for pancreatic cancer.

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

Chemotherapy is often used in addition to surgery or radiation therapy in an effort to slow tumor growth or prevent the recurrence of pancreatic cancer. Currently, gemcitabine is the standard chemotherapy drug for patients who have had surgery for pancreatic cancer. One study showed that treatment with gemicitabine following surgery significantly extended disease-free survival.

Memorial Sloan-Kettering researchers are investigating a new method, called neoadjuvant therapy, to improve outcomes associated with pancreatic surgery and even reduce the size of more advanced tumors so that they may be surgically removed. This method involves pre-treating surgery patients with the chemotherapy drugs gemcitabine and oxaliplatin. Following surgery, patients receive additional chemotherapy, usually in the form of gemcitabine.

For patients with locally advanced or metastatic pancreatic cancer whose tumors cannot be removed by surgery, chemotherapy may be used to reduce the rate of tumor growth, relieve symptoms, and extend survival. Research has shown that gemcitabine has some benefits for patients with inoperable pancreatic tumors [Burris, et al. J Clin Oncol, 1997], depending on the general health of the patient prior to chemotherapy.

Investigational Approaches

At Memorial Sloan-Kettering, our investigators are constantly evaluating new chemotherapy combinations that may improve the standard of care. These investigational therapies are sometimes offered to eligible patients through the clinical trial process.

For example, new chemotherapy combinations are being evaluated 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). Gemcitabine is currently being studied in combination with several other chemotherapy drugs such as erlotinib, bevacizumab, cisplatin, and oxaliplatin.

Antivascular drugs, which target the blood vessels that support and nourish tumors, are also being studied as a potential treatment for pancreatic cancer. Memorial Sloan-Kettering is studying one such drug, sunitinib, in combination with gemcitabine.

Radiation therapy, usually combined with the chemotherapy drug gemcitabine, 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 advanced to be removed surgically. The most common type of radiation therapy used in treating pancreatic cancer is external beam radiation therapy.

Our doctors are involved in ongoing efforts to decrease the toxicity, or damage, to healthy tissues that may occur during radiation therapy for pancreatic cancer. Intensity-modulated radiation therapy (IMRT) and respiratory gating are two approaches that have potential merit in decreasing toxicity to normal tissue.

IMRT is a type of 3-D radiation therapy that targets tumors with greater precision than conventional radiation therapy. Using highly sophisticated computer software and 3-D images from CT scans, the radiation oncologist can develop an individualized treatment plan that delivers high doses of radiation to cancerous tissue while sparing surrounding organs and reducing the risk of injury to healthy tissues.

Respiratory gating is another type of radiation therapy used at Memorial Sloan-Kettering to treat pancreatic cancer with minimal damage to healthy tissue. Because tumors and organs in the abdomen shift during breathing, precise delivery of radiation therapy to cancerous tissue can be difficult. Respiratory gating entails the delivery of radiation treatment only at certain points during a patient's breathing cycle, when the "mobile" tumors and/or regions of the abdomen are in a specific position. This approach decreases the radiation dose to the surrounding healthy tissues.