Pancreatic Cancer Treatments
How we treat pancreatic cancer
In its early stages, pancreatic cancer can be treated effectively with surgery. For patients with advanced pancreatic cancer, surgery can still be useful for relieving pain, restoring function and improving survival rates.
At City of Hope, we have one of the most experienced pancreatic surgery teams in the U.S. Our surgeons have performed thousands of procedures, and we frequently treat patients whose tumors are considered inoperable at other facilities. We also work continuously to improve the effectiveness and reduce complications of pancreatic cancer surgery, and we are at the forefront of developing minimally-invasive procedures.
There are several forms of pancreatic cancer surgery:
- The Whipple Resection: Named for the Columbia University surgeon who developed the procedure, the Whipple operation involves removing the “head” of the pancreas, where many tumors form. In this procedure the surgeon also removes the duodenum (the first piece of the small intestine), part of the bile duct (the tube that drains bile from the liver into the bowel), the surrounding lymph nodes, the gallbladder, and sometimes part of the stomach. City of Hope surgeons have extensive experience in this highly complex operation, performing more than 100 Whipple procedures each year.
- Distal Pancreatectomy: In this procedure the bottom half, or “tail” of the pancreas is removed, usually along with the spleen.
- Total Pancreatectomy: Removing the entire pancreas along with bile duct, gallbladder, nearby lymph nodes and parts of the stomach and small intestine.
When appropriate, these operations can be done with minimally-invasive techniques, which can be as effective as open surgery, but with less pain, reduced loss of blood, faster recovery, shorter hospital stays and a lower risk of complications.
- Laparoscopic Surgery: In laparoscopic surgery, doctors make a tiny incision in the abdomen and insert a thin, lighted tube with a camera at the end, to get a clear picture of the pancreas, and remove tumors using special miniaturized instruments.
- Robotic Surgery: City of Hope is a leader in robotic-assisted surgery, with world-class experts in the da Vinci Surgical System. In this procedure a surgeon directs a specially-designed robot, equipped with a camera and miniature surgical tools. A sophisticated computerized imaging system provides real-time, three-dimensional views far superior to the surgeon’s eye alone. This system provides excellent results in complex and delicate operations, and the small incisions enable faster recovery.
Ablation destroys tumor cells without surgically removing them. In these procedures, the doctor inserts a thin, needle-like probe into the tumor and uses extreme heat or cold to eradicate tumor cells:
- Cryoablation: Very cold gasses pass through the probe to freeze the tumor, killing the cancer cells.
- Radiofrequency Ablation: A high-frequency current heats the tumor and destroys the cancer cells.
- Microwave Ablation: Microwaves transmitted through the probe heat and destroy the abnormal tissue.
- Nanoknife Treatment: A special instrument sends an electrical current through the tumor, destroying cancer cells.
Embolization shrinks tumors by blocking their supporting blood vessels. This can be done either with particles, chemotherapy drugs or radioactive beads injected into the artery feeding the tumors.
Chemotherapy drugs may be given before an operation to try and shrink the tumors — increasing chances of surgical success — or following surgery to kill stray cancer cells and prevent a recurrence. It is also used when tumors can't be removed surgically. Chemotherapy may also be given in combination with radiation therapy to enhance the cancer-fighting effectiveness of both.
For patients who are healthy enough, a combination of several chemotherapy drugs may be administered for maximum cancer-fighting effectiveness. However, patients who are too weak to tolerate combination treatments may be given a single drug. Chemotherapy is often administered in cycles, with a rest periods in between to allow the body to recover.
Targeted therapy drugs work differently than standard chemotherapy by targeting cancer-specific cells and processes. Some of these drugs are designed to stop changes in cells and cell DNA that cause cancer. Others block the signals that cancer cells use to fuel their growth and spread, or they may stimulate the body's immune system to destroy cancer cells from within (known as immunotherapy.)
Newest Drugs and Clinical Trials
At City of Hope, we constantly evaluate new chemotherapy and targeted therapy drugs for treating pancreatic cancer. Patients at City of Hope have access to newly-developed drugs and drug combinations through our clinical trials program.
Typical radiation treatment is applied externally using one or more beams focused on the tumor.
At City of Hope, we've refined our radiation treatments to precisely target tumors and preserve nearby tissue. Image-Guided Radiation Therapy (IGRT) uses sophisticated computer software and 3-D images from CT scans. The newest advance in this area is Helical TomoTherapy, and City of Hope is a leader in its use.
Radiation may be given before surgery, often in combination with chemotherapy, to shrink tumors and help make the surgery more effective. When tumors cannot be removed surgically, radiation may be used to relieve pain and other symptoms.