Many people with pancreatic cancer have surgery as the best chance for a cure and long-term cancer management. But not every person is eligible for surgery. Your treatment will be determined by the type of pancreatic cancer you have—exocrine or endocrine—your cancer’s stage, your personal health, and your ability to tolerate a major operation.
Our commitment to our patients and our time-tested surgical expertise results in high success rates. Our surgeons perform specialized operations to remove cancerous tissue while preserving as much healthy tissue as possible.
You may have any combination of surgery, medication treatments, and radiation treatments. You may also be eligible for a clinical trial of new therapies and drugs.
Doctors have made significant progress in pancreatic operations. But the procedures are complex. They can also be difficult for some patients. It’s critical to choose a specialized surgeon and high-volume pancreatic surgery center because studies show that people have fewer operative complications and better outcomes.
Pancreatic cancers are divided into four surgical categories.
The tumor may lie within the pancreas or extend to nearby organs but don’t involve local blood vessels. They can be removed surgically and show no evidence of spread beyond the pancreas.
The tumor is limited to the pancreas but may be close to major blood vessels. Your surgeon can often remove these tumors and reconstruct the vein, but it’s a complicated procedure.
The tumor has invaded nearby blood vessels or organs and can’t be surgically removed. But there’s no evidence of spread to distant parts of the body.
The cancer can’t be removed because it’s spread to distant parts of your body.
Types of Operations
These procedures are common for adenocarcinomas. Operations for neuroendocrine cancer are often less extensive, but it depends on the tumor’s location.
Pancreaticoduodenectomy, also called the Whipple procedure, is the most common operation to treat tumors in the head of the pancreas, where about 75% of pancreatic cancers occur. Allen O. Whipple, former chair of the Columbia University Department of Surgery, developed this procedure in 1935. This procedure takes about four to six hours depending on the tumor’s location and pathology.
- The conventional Whipple procedure removes the head of the pancreas, the duodenum and part of the stomach, the gall bladder, and part of the bile duct. Your surgeon then reconnects the organs to restore flow of ingested food, along with digestive enzymes and bile.
- The pylorus-sparing Whipple procedure does not remove part of your stomach.
Distal pancreatectomy preserves the head of your pancreas and removes the tail and body. Your surgeon may also remove your spleen because it’s so close to the tail. Sometimes doctors perform this procedure laparoscopically, which usually results in faster healing, less blood loss, less pain and pain medication, and smaller scars. This procedure usually takes about two to four hours.
Central pancreatectomy removes a tumor in the neck or body of the pancreas while preserving the healthy head and tail. This highly specialized procedure is performed at only a handful of centers in the US, including the Pancreas Center at New York-Presbyterian Hospital/Columbia University Irving Medical Center. A central pancreatectomy leaves exocrine and endocrine functions intact and usually decreases the patient’s chance of developing insulin-dependent diabetes. This procedure typically takes two to four hours.
Total pancreatectomy is similar to a Whipple procedure. Your surgeon removes your pancreas, part of your stomach, the duodenum, gall bladder, and local lymph nodes. They may also remove your spleen. This procedure is used if cancer cells have invaded most of your pancreas. It makes you an insulin-dependent diabetic for life. It’s not used if a more limited pancreatectomy is possible.
Radiation therapy causes cancer cells to break or die by targeting the DNA with high-energy particles, such as X-rays, gamma rays, electron beams, or protons. Radiation oncology specialists direct these particles to the tumor site from outside of your body to precisely target cancer cells, often sparing nearby tissue. You might hear this called external beam radiation therapy.
Radiation therapy may be prescribed for patients with exocrine tumors, but it is rarely used to treat neuroendocrine tumors.
Like chemotherapy, radiation therapy can be given before surgery, after surgery, or both. Before surgery, the goal is to shrink the tumor making it easier for the surgeon to remove. After surgery, the goal is to destroy any remaining cancer cells.
External Beam Radiation Therapy (EBRT)
External beam radiation therapy (EBRT) is most often used in treating exocrine tumors. Treatments are usually given five continuous days each week for between five and six weeks.
Stereotactic Body Radiation Therapy (SBRT)
Stereotactic body radiation therapy (SBRT) uses internal markers to concentrate a high dose of radiation at the tumor site. Treatments are usually given over two weeks.
Chemoradiation is radiation therapy combined with chemotherapy (medication). You might get this kind of radiation if exocrine tumors are too widespread to be surgically removed. The treatment can control tumor growth before surgery to improve the chances your tumor can be completely removed. You might get this treatment after surgery to help keep cancer from coming back.
Surgery is the only treatment that can cure pancreatic cancer, but we almost always add chemotherapy to achieve ultimate cure. In different situations, the chemotherapy is given before or after surgery.
Chemotherapy uses medications (chemicals) to stop cancer growth and spread and to prevent cancer from recurrin by causing rapidly dividing cancer cells to become damaged and die.
Chemotherapy is “systemic” medicine—it interferes with all fast-dividing cells in your body. This is why it causes side effects like hair loss.
Chemotherapy for pancreatic cancer is given through an IV in our infusion center.
Chemotherapy drugs are designed to kill cancer and are generally given in cycles, with a period of treatment followed by a period of rest.
You might receive chemotherapy as part of your cancer treatment. Your care team will help you make the complex decision of having chemotherapy before or after surgery to make your tumor operable. The decision depends on your cancer’s specific characteristics and the therapy’s chance to maximize survival.
The most commonly used drugs used for treating pancreatic adenocarcinoma are gemcitabine (Gemzar®), nab-paclitaxel (Abraxane), oxaliplatin, irinotecan, docetaxel (Taxotere®), cis-platinum (Platinol®), and 5-fluorouracil (5-FU) or capecitabine. These drugs are sometimes used alone or in combination.
For neuroendocrine tumors, we typically use octreotide, lanreotide, sunitnib, everolimus, or chemotherapy. Locoregional treatments and sometimes liver transplantation are also considered.
You may qualify to participate in a clinical trial, which is a research study to learn more about promising new treatments or supportive care therapies. The hope is to improve the quality of life and survivorship of colorectal cancer patients. Columbia Cancer offers several pancreatic cancer clinical trials. You can talk to your care team about whether a clinical trial is an option for you.
If your cancer has spread and cannot be removed by surgery, our goal is to relieve your symptoms and improve your quality of life. Palliative care can include:
- Stent placement, an endoscopic procedure to physically open a blocked bile duct or intestine. Plastic stents are a short-term solution for people who might have an operation in the future. Metal stents are more permanent.
- Pain management, using morphine (or other medications) or nerve blocks.