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Pancreatic cancer treatment

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on May 25, 2022.

On this page, we'll explore treatments for pancreatic cancer, including:

After a pancreatic cancer diagnosis, your doctor may offer a variety of treatment options and technologies to target pancreatic tumors. Depending on your needs, your pancreatic cancer treatment plan may involve minimally invasive gastroenterology techniques, chemotherapy, interventional radiology and/or other innovative approaches. The goal of your treatment plan depends on several factors, including the stage, size and location of the tumor, as well as your overall health.

For example, stage 1 and stage 2 tumors are often resectable, meaning they may be completely removed through surgery. The main goal of surgery is to remove all of the cancer cells in the pancreas, leaving only healthy tissue. Most tumors that are stage 3 or stage 4 are unresectable and cannot be removed by surgery. These cancers must be treated with chemotherapy, radiation therapy, or a combination of the two.

It’s important to remember that you must be healthy enough to undergo surgery of any kind. Your doctor will assess your overall health before determining a treatment plan that’s appropriate for you.

Who treats pancreatic cancer?

  • Your cancer treatment team will likely consist of multiple doctors with expertise in specific areas of medicine, including one or more of the following:

Common pancreatic cancer treatments

Chemotherapy

If chemotherapy for pancreatic cancer is part of your treatment plan, your medical oncologist will use a combination of chemotherapy medications customized to your individual needs. Chemotherapy may be used alone, or in combination with other pancreatic cancer treatments like radiation therapy or surgery.

For pancreatic cancer treatment, chemotherapy is often given concurrently with radiation therapy, called chemoradiation.

For pancreatic cancer patients with liver metastasis, doctors sometimes use intra-arterial chemotherapy (IAC). With IAC, chemotherapy is administered directly into tumors in the liver. This allows the chemotherapy drugs to be concentrated within the tumor, destroying cancer cells while reducing exposure to healthy tissues.

Types of chemotherapy for pancreatic cancer

Chemotherapy medication is able to travel through your bloodstream to most areas of your body. Adjuvant chemotherapy is performed after surgery in order to help kill any remaining cancer cells, preventing their spread. Neoadjuvant chemotherapy is done before surgery to help shrink a tumor so that it can be removed more easily, or when a tumor is unresectable.

Chemotherapy drugs may be delivered:

  • Orally, in pill form
  • Intravenously, as an infusion

Sometimes, a larger infusion site is necessary, so doctors use a central venous catheter (CVC). Through these CVC sites, they can administer medication and collect blood samples. If you need chemotherapy infusions, they may take place in your doctor’s office, a chemotherapy clinic or a hospital.

Chemotherapy is given in cycles. For example, you may receive a series of chemotherapy infusions once a week or several days a week for two to three weeks, then have a period of rest. This cycle repeats, usually for three to six months. The exact schedule of your adjuvant or neoadjuvant chemo will be based on your specific situation, and the length of your chemotherapy will depend on how you’re responding to the treatment, as well as on any side effects you’re experiencing.

Side effects of chemotherapy

It’s common to experience side effects when undergoing this type of treatment. Chemotherapy drugs not only destroy cancer cells, but they also kill healthy cells, which may result in bothersome symptoms.

Some may be mild or go away very soon after treatment, while others may be more intense or longer-lasting. Your cancer treatment team will try to prescribe the minimum appropriate dose of chemotherapy so that your side effects are as minimal as possible.

You’re most likely to have one or more of the following side effects with chemotherapy for pancreatic cancer:

  • Nausea
  • Vomiting
  • Diminished appetite
  • Hair loss
  • Diarrhea or constipation
  • Mouth sores

Sometimes, chemotherapy can harm blood-producing cells in your bone marrow, causing:

  • Low white blood cell count, increasing your infection risk
  • Low platelet counts, causing increased bleeding or bruising
  • Low red blood cell count, resulting in fatigue or shortness of breath

Additionally, the chemotherapy drugs cisplatin, oxaliplatin and paclitaxel can cause nerve damage, resulting in peripheral neuropathy, or numbness, tingling or pain in the feet and hands. If you’re taking the drug oxaliplatin, you may experience nerve pain for about a day after your treatment that intensifies when you’re exposed to cold temperatures, including in foods and beverages. Cisplatin can result in kidney damage, but doctors increase IV fluids before administering it to help prevent this from occurring; it may also cause tinnitus or hearing loss.

If you experience any side effects with your treatment, be sure to reach out to your doctor. Some medications are available to help lessen symptoms, or your chemotherapy dose may need to be modified.

Gastroenterology

Some gastrointestinal procedures for pancreatic cancer treatment include:

Endoscopic retrograde cholangiopancreatography (ERCP) allows doctors to view the bile ducts in the pancreas in order to remove samples for biopsy, relieve an obstruction of the bile duct, or place a stent into a narrowed duct to keep it open. According to the Pancreatic Cancer Action Network, about 5 percent to 7 percent of patients who undergo ERCP may experience pancreatitis (inflammation of the pancreas) after the procedure, though it’s often mild. Rare complications include:

  • Gastrointestinal bleeding
  • Tearing
  • Infection
  • Allergic reaction to anesthesia used during the procedure

Endoscopic ultrasound allows doctors to view high-quality images of the pancreas. An ultrasound cannot determine whether a suspicious area or mass is cancerous. However, it can help establish whether further cancer diagnostic testing is needed.

Biopsies to test tissue samples can be performed with a needle during an endoscopic ultrasound, using its live images to guide the procedure.

Side effects aren’t typical with this procedure, but they may include:

  • Pancreatitis
  • Gastrointestinal bleeding
  • Tearing
  • Pancreatic cyst infection
  • Allergic reaction to anesthesia used during the procedure

Fiducial markers are placed inside a pancreatic tumor prior to radiation therapy to allow for more precise targeting of the tumors and reduced harm to healthy tissue. The procedure to place the fiducial markers doesn’t typically cause pain, but it may result in bleeding complications and, in rare cases, vascular damage.

Celiac plexus neurolysis blocks the nerves that supply the pancreas to provide pain relief.

Side effects that commonly occur after the procedure include:

  • Hypotension (decreased blood pressure)
  • Pain
  • Swelling
  • Bruising
  • Muscle spasm at the injection site
  • Diarrhea

Rare side effects include:

  • Kidney damage
  • Paralysis
  • Infection
  • Allergic reaction

Interventional radiology

With interventional radiology, doctors may visualize tumors in the pancreas and perform real-time image-guided interventional procedures. Doctors may deliver treatment directly to pancreatic tumors, take biopsies, provide palliative treatment and monitor your response to treatment.

In cases when pancreatic cancer spreads to the liver, one or more of the following treatment procedures may be used:

SIR-Spheres (Y-90): This treatment uses tiny beads called microspheres to deliver radiation directly to tumors in the liver. Measuring one-third the diameter of a human hair, the tiny microspheres are embedded with a radioactive element (Y-90) to help kill cancer cells. The radiation therapy is delivered to a tumor through a catheter a physician guides into the hepatic artery, the liver’s main blood vessel. Once in place, the microspheres are inserted into the catheter, where they can enter the smaller blood vessels supplying the liver tumor and block the flow of blood. Then, the microspheres emit radiation to destroy cancer cells in the tumor, while sparing healthy liver tissue.

Chemoembolization: With this treatment, chemotherapy drugs are delivered directly to a liver tumor. This delivery method reduces side effects, like nausea and vomiting, and enhances the cancer-killing properties of the drugs. During the procedure, chemotherapy is injected through a catheter directly into a liver tumor using image guidance. The chemotherapy drugs are mixed with microspheres, which block the flow of blood to the tumor. Without a blood supply, the tumor no longer has the oxygen and nutrients it needs to grow. Chemoembolization allows high doses of chemotherapy drugs to be targeted directly to the cancerous portion of the liver for a longer period of time, without exposing the entire body to the effect of the drugs.

Side effects of interventional radiology

Although interventional radiology procedures are less likely to cause severe side effects than more invasive treatments, you may still experience them. For example, SIR-Spheres Y-90 can cause pain and tightness in the abdomen, nausea and/or loss of appetite after the procedure. After chemoembolization, it’s normal to experience pain, fever, and nausea or vomiting for up to 48 hours. Your progress will be monitored after an interventional radiology procedure, and supportive therapies may be introduced to manage your side effects.

Radiation therapy for pancreatic cancer

With sophisticated radiation therapy delivery systems and image-guidance technologies, radiation oncologists are better able to target difficult-to-reach tumors in the pancreas. Also, radiation oncologists may direct higher radiation doses at pancreatic cancer cells, while reducing exposure to normal, healthy pancreatic tissue.

In treating pancreatic cancer, radiation therapy is often given concurrently with chemotherapy—an approach called chemoradiation.

Types of radiation therapy

Traditional radiation therapy utilizes high-energy X-rays to destroy cancerous cells and stop them from growing. It can be useful in the treatment of certain pancreatic cancers—by shrinking tumors before pancreatic cancer surgery, or destroying remaining cells after a pancreatic cancer resection.

Types of radiation therapy include:

External beam radiation therapy (EBRT): Beams are used to precisely target the tumor, delivering high-energy X-rays only to cancer cells. This helps to preserve healthy surrounding tissue. Treatment length is typically three to six weeks. Another type of EBRT is called intensity-modulated radiation therapy (IMRT). This 3D radiation also targets the tumor or specific areas within the tumor, but treatment with IMRT can take slightly longer than with EBRT.

Stereotactic body radiotherapy (SBRT): This type of radiotherapy uses specialized equipment to deliver targeted high-dose radiation in fewer doses than with EBRT. Doses are administered over the course of days rather than weeks.

Proton beam radiation therapy (PBRT): High-energy protons specifically target the tumor in a way that allows your radiation oncologist to deliver a much higher dose than other types of radiation therapy.

Pancreatic cancer surgery

Surgery involves removing all or part of the pancreas. In some pancreatic cancer cases, the tumor can be safely and completely removed by surgery. The type of surgery for resectable pancreatic tumors depends on the location and size of the tumor.

Removing all or part of the pancreas is called a pancreatectomy. Depending on the size and location of the tumor, the doctor may be able to do the surgery laparoscopically. Laparoscopic surgeries use tiny incisions, which typically helps reduce overall recovery time and the risk of complications.

Some surgical procedures include:

  • Whipple procedure (pancreaticoduodenectomy): As part of this procedure, the surgeon typically removes the head of the pancreas, as well as the duodenum, gallbladder, nearby lymph nodes, and parts of the bile duct and stomach. This procedure may be used if the cancer is limited to the head of the pancreas.
  • Distal (partial) pancreatectomy: If the cancer is limited to the tail of the pancreas or near it, the surgeon will remove the body and the tail of the pancreas. The surgeon may also remove the spleen. 
  • Total pancreatectomy: This procedure involves removing all of the pancreas, plus the bile duct, gallbladder, spleen, as well as portions of the stomach and small intestine. It may be done when cancer has spread to many areas of the pancreas.
  • da Vinci® Surgical System: This robotic surgery system, which includes robot arms and computer graphics, gives the surgeon greater control and precision in the movements of instruments. Like a laparoscopy, it uses tiny incisions for entry. It may be helpful in hard-to-reach areas of the pancreas.

Patients who are diagnosed with early-stage pancreatic cancer do better than those who are diagnosed with more advanced cancer. However, most cases of pancreatic cancer are detected after it has already metastasized, About 20 percent of patients diagnosed with pancreatic cancer are eligible for surgery, according to thee American Society of Clinical Oncology.

Your care team may also recommend other treatments for pancreatic cancer in addition to, or in place of, surgery. For instance, your care team may recommend chemotherapy and/or radiation therapy prior to considering surgery for pancreatic cancer.

Targeted therapy for pancreatic cancer

Targeted therapy is a cancer treatment that uses drugs to track down and attack specific cancer cells or parts of cells that are may affect another cell’s behavior or propel a cancer’s growth. Targets include enzymes, proteins or gene mutations.

Some types of targeted therapy drugs for pancreatic cancer include:

These inhibitors block cell processes that could lead to more cancer growth and allow cancer cells to be identified as separate from healthy cells, and thus attacked.

In some cases, pancreatic cancer is a result of some cells having changes in the BRCA genes (BRCA1 or BRCA2). When this occurs, a targeted therapy drug known as a PARP inhibitor may be offered.

BRCA genes make proteins that help repair damaged DNA in cells. When these genes change (mutate), the DNA may not be repaired correctly, which can lead to the development of cancerous cells. PARP inhibitors block enzymes and prevent cancer cells from repairing their DNA, which causes them to stop growing or die. So PARP inhibitors may help shrink or slow the growth of some advanced pancreatic cancers.

Immunotherapy for pancreatic cancer

Immunotherapy is a type of cancer treatment that stimulates your immune system to attack cancer cells. Certain types of pancreatic cancers can be treated with immunotherapy by using immune checkpoint inhibitors.

Your care team will confirm through testing if the cancer is positive for certain types of gene mutations, including a high level of microsatellite instability (MSI-H) or alterations in one of the mismatch repair (MMR) genes. With checkpoint inhibitors, cancer cells cannot fool the immune system into believing they are healthy, thus exposing them and triggering the immune system to attack.

Pancreatic cancer treatments by stage

Stage 0 pancreatic cancer

Within stage 0 pancreatic cancer, when the tumors are usually small, treatment options typically include:

Surgical options

Resection: When tumors are small enough, they can usually be entirely removed by surgery. Complete removal of the tumors vastly improves survival rate for this type of cancer. Types of surgical procedures include:

  • Distal pancreatectomy
  • Total pancreatectomy
  • Whipple procedure

Nonsurgical options

In addition to surgery, your care team may also recommend one of these treatment options:

  • Chemotherapy
  • Radiation
  • Targeted therapy
  • Chemoradiation

Stage 1 pancreatic cancer

Within stage 1 pancreatic cancer, treatment options include:

Surgical options

Resection (1A or 1B): Like in stage 0, stage 1A and 1B tumors may still be small enough to be surgically removed, vastly upping survival rate.

Nonsurgical options

As in stage 0, in addition to surgery, your care team may also recommend one of these nonsurgical options:

  • Chemotherapy
  • Radiation
  • Targeted therapy
  • Chemoradiation

Stage 2 pancreatic cancer

Within stage 2 pancreatic cancer, treatment options include:

Surgical options

Resection (2A): Stage 2A tumors may still be small enough to be surgically removed, vastly improving survival rate.

Borderline resectable (2A, 2B; aka locally advanced): In some cases, in stage 2A, as well as in 2B, the cancer may have spread to nearby tissues, organs or a major blood vessel. In this case, the patient would have a neoadjuvant treatment (see nonsurgical options below) to shrink the tumor before having surgery.

Nonsurgical options

If the tumor is locally advanced and has spread into surrounding organs or tissues, it’s possible the surgeon may not be able to remove the entire tumor. To help shrink the tumor in order to remove it, the doctor may use one of nonsurgical options listed below prior to surgery. If the cancer can be surgically removed, the doctor may still recommend one of these nonsurgical options in addition to surgery:

  • Chemotherapy
  • Radiation
  • Targeted therapy

Stage 3 pancreatic cancer

Within stage 3 pancreatic cancer, treatment options include:

Surgical options

Borderline resectable (locally advanced): As with locally advanced stage 2 tumors, the patient would have neoadjuvant treatment (see nonsurgical below) to shrink the tumor before having surgery.

Nonsurgical options

Your doctor may also recommend one of these nonsurgical options:

  • Chemotherapy and radiation
  • Radiation

During this stage, there are also procedures that may ease symptoms and extend quality of life, including:

  • Biliary bypass
  • Endoscopic stent
  • Gastric bypass

Stage 4 pancreatic cancer

Stage 4 pancreatic cancer (or metastatic pancreatic cancer) means the cancer has spread to other organs. As a result, surgery can’t completely remove the cancer. The most common treatment options include chemotherapy and clinical trials, including those studying new immunotherapy approaches.

Some patients, typically with advanced or recurrent cancer, may benefit from immunotherapy or targeted therapy based on the characteristics of the pancreatic cancer cells.

Pancreatic cancer clinical trials

Clinical trials are an important testing ground for measuring the effectiveness and safety of new cancer drugs and treatments before they are granted government approval. As part of our commitment to providing cutting-edge treatments, our doctors may recommend that you enroll in a clinical trial that may offer you access to pancreatic cancer treatment options that would otherwise be unavailable to you.

Over the past few years, immunotherapy and targeted therapy have become more common in clinical trial options for pancreatic cancer treatment.

In many cases, clinical trials are intended for patients with advanced cancer who may have run out of other treatment options. However, patients may qualify for a clinical trial at any stage of their disease and/or treatment if they meet strict and specific criteria. Talk to your doctor about whether a clinical trial is an option for you and ask about the risks and requirements involved.

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