Treating Pancreatic Cancer Based on Disease Extent
Treating Pancreatic Cancer, Based on Extent of the Cancer
This information is about treating exocrine pancreatic cancer, the most common type of pancreatic cancer. See Pancreatic Neuroendocrine Tumor (NET) for information about how that type is typically treated.
Most of the time, pancreatic cancer is treated based on its stage – how far it has spread in the body. But other factors, such as your overall health, can also affect treatment options. Talk to your doctor if you have any questions about the treatment plan he or she recommends.
It can be hard to stage pancreatic cancer accurately using imaging tests. Doctors do their best to figure out before treatment if there is a good chance the cancer is resectable – that is, if it can be removed completely. But sometimes cancers turn out to have spread farther than was first thought.
Other times, immunotherapy given alone may also be an option.
Surgery might be done after chemo or chemoradiation, if imaging shows the cancer has become smaller and can be removed completely by surgery.
Treating metastatic (widespread) cancer
Pancreatic cancers often first spread within the abdomen (belly) and to the liver. They can also spread to the lungs, bone, brain, and other organs.
These cancers have spread too much to be removed by surgery. Even when imaging tests show that the spread is only to one other part of the body, it is often assumed that small groups of cancer cells (too small to be seen on imaging tests) have already reached other organs of the body.
Chemotherapy is typically the main treatment for these cancers. It can sometimes shrink or slow the growth of these cancers for a time and might help people live longer, but it is not expected to cure the cancer.
Gemcitabine is one of the drugs used most often. It can be used alone (especially for people in poor health), or it can be combined with other drugs like albumin-bound paclitaxel (Abraxane), capecitabine (Xeloda), or the targeted drug erlotinib (Tarceva).
Another option, especially for people who are otherwise in good health, is a combination of chemo drugs called FOLFIRINOX. This consists of 4 drugs: 5-FU, leucovorin, irinotecan (Camptosar), and oxaliplatin (Eloxatin). This treatment might help people live longer than getting gemcitabine alone, but it can also have more severe side effects.
In certain cases, immunotherapy or targeted therapy may be options for people whose cancer cells have certain gene changes.
Other treatments might also be used to help prevent or relieve symptoms from these cancers. For example, radiation therapy or some type of nerve block might be used to help relieve cancer pain, or a stent might be placed during an endoscopy to help keep the bile duct open.
Because the treatments now available don’t work well for many people, you may want to think about taking part in a clinical trial of new drugs or combinations of drugs.
Treating pancreatic cancer that progresses or recurs
If cancer continues to grow during treatment (progresses) or comes back (recurs), your treatment options will depend on:
Where and how much the cancer has spread
What treatments you have already had
Your health and desire for more treatment
It’s important that you understand the goal of any further treatment, as well as the likelihood of benefits and risks.
When pancreatic cancer recurs, it most often shows up first in the liver, but it may also spread to the lungs, bone, or other organs. This is usually treated with chemotherapy if you are healthy enough to get it. If you have had chemo before and it kept the cancer away for some time, the same chemo might be helpful again. Otherwise, different chemo drugs might be tried, sometimes along with targeted therapy. Immunotherapy may also be helpful in some cases of recurrent pancreatic cancer. Other treatments such as radiation therapy or stent placement might be used to help prevent or relieve symptoms from the cancer.
If the cancer progresses while you are getting chemotherapy, another type of chemotherapy might be tried if you are healthy enough.
At some point, it might become clear that standard treatments are no longer controlling the cancer. If you want to continue getting treatment, you might think about taking part in a clinical trial of a newer pancreatic cancer treatment. While these are not always the best option for every person, they may benefit you, as well as future patients.
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