Pancreatic Cancer Medical Therapies

Complete resection is the only effective treatment of pancreatic ductal carcinoma. Regrettably, such curative operations are possible in less than 15 percent of patients and are limited. For those individuals whose cancer is unresectable, symptomatic control should be the primary goal. Radiation therapy ( often accompanied by chemotherapy) to reduce pain, surgical or endoscopic correction of a blocked bile duct, and sufficient amounts of opioid analgesics may all be indicated.

Carcinoma of the pancreas can be treated in several different ways. If possible, the doctor will recommend surgery to remove the tumor. In most cases, the type of operation performed is known as a Whipple Operation. This surgery removes a large part of the pancreas, the duodenum and a portion of the bile duct. The patient may develop diabetes mellitus and need to take insulin. Often patients will need to take pancreatic enzyme supplements to prevent fat and protein malabsorbtion that leads to diarrhea, steillarrhea and weight loss.

In patients who have cancer that is unresectible (unable to operate on), other options are pursued to relieve the symptoms of the cancer. If the bile duct is obstructed by the cancer, jaundice will develop. The jaundice and obstruction may lead to intense itching, poor appetite, diarrhea, weight loss and fever. It is important to alleviate this jaundice. ERCP with stent placement is the most common method. This involves the use of a flexible tube (endoscope) inserted into the intestine. The doctor then places a stent into the bile duct to allow the flow of bile into the intestine. This stent may be made of plastic or stainless steel. Jaundice may also be relieved by puncturing the liver via an incision within the skin on the right side of the abdomen. A tube (stent) can then be inserted. Surgery may be used to bypass the obstruction of the bile duct in some instances.

In the past, chemotherapy has not been effective in the treatment of pancreatic cancer. Recently, a new agent called gemcitabine has been approved by the FDA to help shrink the tumor in pancreatic cancer. As with all chemotherapy there are side effects which include nausea, vomiting, and decreased white blood cell counts.

There are several ways to control pain. In most cases, the doctor prescribes medication to control the pain. However, in some cases pain medication is not enough. The doctor may use other treatments that effect the nerves in the abdomen. The doctor may inject alcohol in to the area around certain nerves to block the feeling of pain. This procedure rarely causes problems and usually provides pain relief. Sometimes, the doctor cuts nerves in the abdomen during surgery to block the feeling of pain. In addition, radiation therapy can help relieve pain by shrinking the tumor.