Pancreatic Cancer

Treatment

The pancreas is a comma-shaped organ about six inches long that is situated horizontally behind the stomach. The pancreatic duct joins the lower end of the bile duct and both ducts drain into the small intestine. The pancreas secretes enzymes that aid digestion and the production of insulin. Insulin regulates sugar metabolism. The pancreas connects through the bile ducts to the small intestine.

Surgery

At Mayo Clinic, surgeons typically recommend surgery for tumors contained in the pancreas. The specific operation depends upon whether the tumor is located in the head, neck, body or tail of the pancreas. In general, tumors located in the head and neck area of the pancreas are managed with the Whipple resection, whereas those in the body and tail are managed with distal pancreatectomy. Occasionally, a total pancreatectomy is required, though it is used less commonly. Occasionally, portal vein removal may be possible.

Radiation Therapy

Radiation therapy is usually recommended for patients who have localized pancreatic cancers that cannot be removed. It is also generally recommended either following surgical removal of the pancreatic tumor or before an attempt at removal. High-dose radiation can be directed toward the pancreas to destroy cancer cells and reduce a tumor's size. Most commonly, radiation is delivered from a source outside of the body, usually with high-energy linear accelerators. Sometimes radiation therapy may be delivered with electrons during surgery. Mayo Clinic radiation oncologists have developed 3-D conformal techniques that deliver radiation to the area of the pancreas cancer and lymph node sites at risk while protecting important organs such as the kidneys, spinal cord and liver.

Sometimes radiation therapy may be delivered with electrons during surgery in a process called intraoperative radiation therapy (IORT). IORT may be an option for patients whose cancer appears to be borderline resectable or unresectable based on images of the tumor. In such instances, the physician team may determine that the external radiation plus chemotherapy component of treatment should be given before surgery to remove the cancer. At the time of subsequent surgery (usually 4-6 weeks after completion of combined chemoradiation), IORT can be delivered to a site of narrow resection margins or to unresectable cancer, as needed.

Specialists typically use radiation in combination with other therapies such as chemotherapy. Clinical trials investigating the best combinations of drugs with radiation therapy are available. Clinical trials may offer the best treatment options for some patients.

Chemotherapy

Chemotherapy can be administered orally or through a vein into the bloodstream. Oncologists usually recommend chemotherapy to treat pancreatic cancer that has spread to other parts of the body. It can be combined with other therapies, and physicians usually recommend it for patients who receive radiation therapy. Chemotherapy is given during radiation to enhance the local effects of radiation, and additional cycles of chemotherapy are given after the combined chemoradiation in an attempt to prevent the cancer from spreading elsewhere in the body.