At the time of diagnosis, only about 20% of pancreatic tumors can be removed by surgery. The standard procedure is called a pancreaticoduodenectomy (Whipple procedure).
This surgery for pancreatic cancer should be done at centers that perform the procedure frequently. Some studies suggest that surgery is best performed at hospitals that perform at least 9 of these surgeries per year.
When the tumor is confined to the pancreas but cannot be removed, a combination of radiation therapy and chemotherapy may be recommended. When the tumor has spread to other organs (metastasized) such as the liver, chemotherapy alone is usually used. The standard chemotherapy agent is gemcitabine, but other drugs may be used. Gemcitabine provides clinical improvement in approximately 25% of patients.
For patients who have biliary obstruction (blockage of the vessels that transport bile) and the tumor cannot be totally removed, the obstruction must be relieved. There are generally two approaches to this, surgery and placement of a biliary stent (similar to stents placed in the arteries of the heart to relieve blockages) during ERCP.
Management of pain and other symptoms is an important part of the treatment of advanced pancreatic cancer. Hospice can be very helpful to patients for both pain and symptom management and psychological support for the patient and the family during the course of the illness.
|