Pancreatic Cancer Treatment and Survival Rate

November 22, 2024

This page was reviewed under our medical and editorial policy by Laleh Melstrom, M.D., M.S., associate professor of surgery and immuno-oncology, Division of Surgical Oncology, Department of Surgery, City of Hope^® Cancer Center Duarte

In its early stages, pancreatic cancer may 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.

Who Treats Pancreatic Cancer?

A pancreatic cancer patient’s care team may consist of the following doctors and support caregivers:

• Gastroenterologists, experts in diseases that affect the digestive system
• Surgical oncologists, doctors who use surgery to treat cancer
• Radiation oncologists, doctors who use radiation therapy to treat cancer
• Medical oncologists, doctors who use specialized medications and therapies to treat cancer
• Psychologists, experts who help patients manage the emotional impacts of their pancreatic cancer diagnosis
• Social workers, experts who help pancreatic cancer patients access support and services during and after their diagnosis
• Geneticists, experts who examine the genetic makeup of pancreatic cancers

Factors that Affect Treatment Options

Several treatment options are available for pancreatic cancer, but the treatment used may depend on a number of different factors. These include the following.

Tumor grade: A tumor’s grade describes the appearance of the cancer cells when examined under a microscope. Grades range from one to three, with Grade 1 meaning the cells look normal and Grade 3 meaning cells are highly abnormal.

Extent of resection: If a tumor is resectable, it may be surgically removed, and the extent of resection measures how much of the tumor may be removed.

Tumor markers: This measures a substance that may be found in the body when pancreatic cancer is present. The most common pancreatic cancer tumor marker is CA 19-9. Rising or falling CA 19-9 levels may help doctors gauge whether a tumor is growing or shrinking in size, and it is useful for monitoring progress during and after treatment.

Metastasis: If a cancer has spread to other organs of the body, such as the lung or liver, this is known as metastasis. Cancer that has metastasized is generally unable to be fully removed by surgery.

Recurrence: If cancer returns after the initial treatment ends, this is recurrence. Recurrence may occur in the pancreas or in other areas of the body.

Pancreatic Cancer Treatments

Surgery

There are several forms of pancreatic cancer surgery.

Whipple procedure: Named for the Columbia University surgeon who developed the procedure, the Whipple resection 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.

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 are performed with minimally-invasive techniques, which may 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: 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, 3D 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

Ablation destroys tumor cells without surgically removing them. In the procedures below, 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

Embolization shrinks tumors by blocking their supporting blood vessels. This can be accomplished with particles, chemotherapy drugs or radioactive beads injected into the artery feeding the tumors.

Chemotherapy

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 may not be removed surgically. Chemotherapy may also be given in combination with radiation therapy to enhance the cancer-fighting effectiveness of both. This is known as chemoradiation therapy.

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 rest periods in between to allow the body to recover.

Targeted Therapy

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.)

Targeted therapies for pancreatic cancer may include the following.

BRAF inhibitor: A mutation to the BRAF gene, known as BRAF V600E, may cause abnormal cell growth. A BRAF inhibitor may be used in patients who have this mutation. Medications include Mekinist^® (trametinib) and Tafinlar^® (dabrafenib).

NTRK inhibitor: In a small number of pancreatic cancers, the cancer has a mutation in the NTRK gene in which it fuses with a gene on a separate chromosome. Medications for cancers with this mutation type include Vitrakvi^® (larotrectinib) and Rozlytrek^® (entrectinib).

RET inhibitor: Medications to treat cancers with a mutation to the RET gene include Retevmo^® (selpercatinib).

KRAS inhibitor: In rare instances, pancreatic cancer cells may have the KRAS G12C mutation, which occurs in the KRAS gene. KRAS inhibitor options include Lumakras^® (sotorasib) and Krazati^® (adagrasib).

EGFR inhibitor: A type of protein called EGFR is known to fuel cell growth. Tarceva^® (erlotinib) is a targeted medicine that helps to suppress EGFR growth.

PARP inhibitor: Some pancreatic cancers have changes to the BRCA1 or BRCA2 genes. Lynparza^® (olaparib) is a PARP inhibitor medication that makes it hard for cells with BRCA mutations to repair damaged DNA and survive.

PD-1 inhibitor: Checkpoint proteins may be turned off and on to stop or start an immune response in the body. PD-1 is a checkpoint protein that stops the immune system from attacking healthy cells. By blocking PD-1 with medication, the body may be able to produce a more powerful immune response to destroy pancreatic cancer cells. PD-1 inhibitor medications include Jemperli (dostarlimab-gxly) and Keytruda^® (pembrolizumab).

Radiation Therapy

Typical radiation therapy treatment for pancreatic cancer is applied externally using one or more beams focused on the tumor.

Radiation therapy may be given before surgery, often in combination with chemotherapy, to shrink tumors and help make the surgery more effective. When tumors may not be removed surgically, radiation therapy may be used to relieve pain and other symptoms.

However, new advances in targeted radiation therapy are leading to more uses for radiation as a pancreatic cancer treatment. These newer treatments precisely target tumors while leaving healthy tissue alone. They include image-guided radiation therapy (IGRT) and stereotactic body radiation therapy (SBRT).

Pancreatic Cancer Survival Rate

Five-year relative survival rates provide an estimate of how many patients will be alive five years or more after their initial diagnosis.

The combined five-year relative survival rate for all stages of pancreatic cancer is 13%, according to the American Cancer Society. Rates vary by stage.

• Localized (cancer has not spread beyond the pancreas): 44%
• Regional (cancer has spread to nearby lymph nodes or structures): 16%
• Distant (cancer has spread to areas such as lungs, liver or bones): 3%

However, survival rates are unique to each individual and are dependent on many factors, including cancer type and stage, as well as the patient’s overall health and age. As research advances lead to new treatment options, it is likely that pancreatic survival rates will increase over time.

Why is Pancreatic Cancer So Deadly?

Pancreatic cancer often has a poor prognosis, although this is changing over time. This is because it often causes no symptoms in its early stages when it would be easiest to treat.

For this reason, pancreatic cancer is more frequently diagnosed in a more advanced stage, meaning the tumor is already too large to be surgically removed or has already spread to other areas of the body. The cancer may also spread quickly in some patients.

The City of Hope Difference

City of Hope is home to one of the most experienced pancreatic surgery teams in the United States. Our experts 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.

We’ve refined our radiation treatments to precisely target tumors and preserve nearby tissue. Image-Guided Radiation Therapy (IGRT) uses sophisticated computer software and 3D images from CT scans. The newest advance in this area is Helical TomoTherapy^®, and City of Hope is a leader in its use.

At City of Hope, we constantly evaluate new chemotherapy and targeted therapy drugs for treating pancreatic cancer. In addition, City of Hope patients have access to newly-developed drugs and drug combinations through our clinical trials program.