Pancreatic Cancer Treatment

Pancreatic cancer begins in the tissues of the pancreas. Located in the upper abdomen behind the stomach, the pancreas is a mixed (heterocrine) gland that plays an important role in both digestion and blood sugar regulation. Most pancreatic tumors originate in the exocrine cells, which produce enzymes that aid digestion, although some arise in the endocrine cells responsible for hormone production. While the precise cause is unclear, known risk factors include smoking, chronic pancreatitis, obesity, certain genetic mutations and a family history of pancreatic cancer.

Warning signs of pancreatic cancer may include abdominal pain, jaundice, unexplained weight loss, loss of appetite and fatigue. Often, these symptoms develop gradually, making early detection challenging.

Treatment for pancreatic cancer can vary depending on the type and stage of the tumor and the patient’s overall health. Options may include surgery, chemotherapy, radiation therapy and targeted therapy, which are often combined for heightened effectiveness. Advances in precision medicine and clinical trials continue to provide new sources of hope for many patients.

Surgery for pancreatic cancer

Surgery is the primary treatment for removable (resectable) pancreatic tumors, particularly when the cancer is detected early and confined to the pancreas. The goal is to remove the tumor in its entirety, which can potentially lead to a cure. The types of pancreatic cancer surgery include:

• Whipple procedure – Also known as a pancreaticoduodenectomy, the Whipple procedure is the most common surgical approach to removing tumors from the widest part of the pancreas. A surgeon will excise the head of the pancreas, part of the small intestine (duodenum), the gallbladder, part of the bile duct and possibly a portion of the stomach. The surgeon will then reconnect the remaining digestive organs to restore normal digestive function.
• Distal pancreatectomy – To remove tumors from the body or tail of the pancreas, a surgeon will excise the affected portion of the pancreas and often the spleen, leaving the head of the pancreas intact.
• Total pancreatectomy – In rare cases, a surgeon will remove the entire pancreas along with parts of the stomach, small intestine, bile duct, gallbladder and possibly the spleen. While this surgical approach can effectively treat pancreatic cancer, the patient will require lifelong insulin and enzyme replacement therapy.
• Bypass surgery – If a pancreatic tumor cannot be removed, a biliary bypass or gastric bypass may be considered to relieve symptoms caused by a bile duct or intestinal blockage.

Surgery for pancreatic cancer is complex and requires a careful pre-operative evaluation to determine if the patient is a suitable candidate. Factors such as the size, location and spread of the tumor and the patient’s overall health are crucial in decision-making. Recovery generally involves close monitoring, and some patients may require additional treatment, such as chemotherapy or radiation therapy, to address any remaining microscopic cancer cells and reduce the risk of recurrence. Advances in surgical techniques and post-operative care are continually improving outcomes and quality of life for pancreatic cancer patients.

Chemotherapy for pancreatic cancer

A cornerstone of pancreatic cancer treatment, chemotherapy may be used alone or in combination with other therapies, such as surgery and radiation treatment, for heightened effectiveness. Chemo is a systemic treatment that uses powerful cancer-fighting drugs to target and destroy rapidly dividing cells throughout the body.

When administered before surgery, chemotherapy can shrink the tumor, making it easier to remove and increasing the likelihood of a successful surgical outcome. When administered after surgery, it can help eliminate any residual microscopic cancer cells to reduce the risk of recurrence. Chemotherapy can also be used as the primary treatment for pancreatic cancer that has spread beyond the pancreas, which can help to slow the growth of the tumor and alleviate its symptoms.

Because chemotherapy targets rapidly dividing cells indiscriminately, it can affect both cancerous and noncancerous cells. Specifically, healthy cells that naturally divide at a rapid pace—including hair follicle cells, cells lining the digestive tract and blood cells produced in the bone marrow—are susceptible to damage from chemotherapy. This can lead to side effects, such as hair loss, nausea, vomiting, fatigue, low blood cell counts and recurrent infections due to a weakened immune system. Supportive care measures, including anti-nausea medications and nutritional guidance, can help a patient manage the side effects of chemotherapy.

Radiation therapy for pancreatic cancer

Radiation therapy uses high-energy beams, such as X-rays or protons, to precisely target and destroy cancer cells. It is a versatile treatment for pancreatic cancer, often used in conjunction with surgery and chemotherapy for maximum effectiveness.

When delivered before surgery, radiation therapy can shrink a tumor, making it easier to remove and potentially increasing the success of the surgical outcome. When delivered after surgery, it can target any remaining cancer cells, reducing the risk of recurrence. In cases where surgery is not possible, radiation therapy can help control pancreatic cancer progression and potentially alleviate pain and other symptoms caused by the tumor pressing on nearby organs or nerves.

The types of radiation therapy for pancreatic cancer include:

• External beam radiation therapy (EBRT) – An external machine (linear accelerator) generates and directs precise X-ray beams at a tumor. Techniques such as intensity-modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) allow for highly targeted treatment of a well-defined tumor using narrow beams of high-dose radiation, sparing surrounding healthy tissues.
• Magnetic resonance imaging (MRI)-guided adaptive radiation therapy (MRI-linac) – Engineered to enhance the precision of EBRT, MRI-linac integrates MRI with a linear accelerator in a single, advanced system. Using real-time, high-definition imaging, this system continually tracks tumor movement and dynamically adjusts the radiation beam to help ensure accurate targeting.
• Proton therapy – Using protons instead of X-rays to destroy cancerous cells, proton therapy is highly accurate, potentially minimizing exposure to nearby organs.

Radiation therapy for pancreatic cancer may cause side effects, such as fatigue, skin irritation, nausea, diarrhea and loss of appetite. Usually, these effects are temporary and can be managed with supportive care. A radiation oncologist will tailor the treatment plan to maximize treatment effectiveness while minimizing side effects.

Immunotherapy for pancreatic cancer

An emerging treatment option for pancreatic cancer, immunotherapy works by harnessing the natural power of the body’s immune system to detect and attack tumor cells. While it has shown significant success in treating several other types of cancer, its role in pancreatic cancer treatment is still evolving due to the unique challenges posed by these tumors. Specifically, pancreatic cancer cells often create an immunosuppressive tumor environment, making it difficult for the immune system to recognize and destroy them. Immunotherapy aims to overcome this roadblock by boosting the body’s immune response or removing the mechanisms that allow cancer cells to evade detection.

The types of immunotherapy for pancreatic cancer include:

• Checkpoint inhibitors – Drugs such as pembrolizumab (Keytruda) and nivolumab (Opdivo) can block certain proteins (PD-1 or PD-L1) that cancer cells use to evade immune attacks. While checkpoint inhibitors have proven effective for some cancers, their success in treating pancreatic cancer has been limited thus far. Typically, this treatment is reserved for patients with specific biomarkers, such as microsatellite instability-high (MSI-H) or mismatch repair deficiency (dMMR).
• Cancer vaccines – Vaccines such as the GVAX pancreas vaccine can stimulate the immune system to seek out and destroy pancreatic cancer cells by introducing tumor-specific antigens into the body. Personalized pancreatic cancer vaccines are tailor-made for each patient to target the specific genetic and molecular profile of a tumor.
• Adoptive cell transfers – This novel treatment approach involves modifying the patient’s immune cells (T-cells) to better recognize and attack pancreatic cancer.
• CAR T-cell therapy – A type of adoptive cell transfer, CAR T-cell therapy involves harvesting the patient’s T-cells and modifying them in a special laboratory to enhance their cancer-fighting abilities. The modified T-cells are then infused into the patient’s bloodstream.
• Immune modulators – Oncolytic virus therapy involves introducing a genetically modified virus into the body to preferentially infect and destroy pancreatic cancer cells. Cytokine therapy uses proteins such as interleukins and interferons to boost the ability of the immune system to fight pancreatic cancer.

The dense stroma surrounding pancreatic tumors and their ability to suppress immune activity have made it challenging to achieve widespread success with immunotherapy. Through ongoing research and clinical trials, scientists are exploring ways to overcome these barriers, including combining immunotherapy with chemotherapy, radiation therapy or targeted therapy for enhanced effectiveness. While still an area of active investigation, immunotherapy represents a promising frontier in pancreatic cancer care, with the potential to significantly improve outcomes and quality of life for some patients.

Frequently asked questions (FAQs) about pancreatic cancer treatment

The following FAQs-related articles provide additional information about pancreatic cancer treatment:

• What are the side effects of pancreatic cancer treatment?
• What is the difference between resectable and unresectable pancreatic cancer?
• Can pancreatic cancer be cured with chemo?

Benefit from world-class care at Moffitt Cancer Center

Moffitt is widely recognized for performing landmark pancreatic cancer research, which has led to the discovery of novel risk assessment and diagnostic techniques as well as groundbreaking chemotherapy drugs, surgical techniques and other treatment options, such as endoscopy, molecular therapy and immunotherapy. Through our robust portfolio of clinical trials, our patients have opportunities to be among the first to benefit from promising new therapies that are not yet available in other settings.

Moffitt also offers a variety of supportive care services, including nerve blocks and pain pumps that can be used if a pancreatic tumor painfully presses on a nearby nerve or organ. Additionally, because pancreatic cancer surgery can sometimes interfere with the body’s production of vital pancreatic enzymes, many patients benefit from personalized nutrition therapy from a licensed dietitian.

If you would like to learn more about pancreatic cancer treatment, you can request an appointment with a specialist in the Gastrointestinal Oncology Program at Moffitt by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.

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