Potentially curative surgery is used when diagnostic tests suggest that it is possible to remove the entire tumor. Most curative surgery is designed to treat cancers in the head of the pancreas, near the bile duct. Some of these cancers are found early enough because they block the bile duct and cause symptoms.
Only about 10 percent of pancreatic cancers appear to be contained entirely within the pancreas at the time of diagnosis. Attempts to remove the entire cancer may be successful in some patients. But even when there appears to be no spread beyond the pancreas at the time of surgery, cancer cells too few to detect may already have spread to other parts of the body.
There are three procedures used to remove tumors of the pancreas: Pancreaticoduodenectomy is the most commonly used surgery for attempted removal of a pancreatic tumor. Also known as the Whipple procedure, this operation removes:
- Head of the pancreas
- Body of the pancreas (in some patients)
- Part of the stomach
- Duodenum (first part of the small intestine)
- A small portion of the jejunum (second part of the small intestine)
- Lymph nodes near the pancreas
- Part of the common bile duct
This is a major operation that carries a relatively high risk of complications, even with experienced surgeons. About 30 percent to 50 percent of patients will suffer complications, including leakage from the various surgical connections, infections and bleeding. For the most successful outcome, patients must be treated by a specialized surgeon who has performed many of these operations at a cancer center with extensive experience in pancreatic surgery.
Distal Pancreatectomy removes only the tail of the pancreas, or the tail and a portion of the body of the pancreas. The spleen is usually removed as well. This operation is used more often with islet cell tumors.
Total Pancreatectomy, which removes the entire pancreas and the spleen, was once used for tumors in the body or head of the pancreas. However, when the entire pancreas is removed, patients are left without any islet cells, which produce insulin. This means patients will develop hard-to-manage diabetes and be totally dependent on injected insulin. There doesn't appear to be any treatment advantage to removing the whole pancreas.
Patients with potentially resectable (removable) pancreatic tumors may receive chemotherapy before or after surgery. Chemotherapy is often used to treat pancreas cancer that has metastasized. The kind of chemotherapy you receive and the length of your treatment will be determined by your doctor.
Often, patients may receive low doses of chemotherapy along with radiation to increase the effectiveness of the treatment. Patients with resectable pancreas cancer may receive radiation therapy before or after surgery.
New treatments are always being tested in clinical trials and some patients with cancer may want to consider participating in one of these research studies. These studies are meant to help improve current cancer treatments or obtain information on new treatments. Talk to your doctor about the clinical trials that may be right for you.