Pancreatic Cancer Treatment

If the patient has been diagnosed with pancreatic cancer, the treatment care team will talk to the patient about their options for treatment. It is essential that the patient carefully think about their treatment options.  They will want to weigh the risks and benefits of each treatment option available.

Depending on the stage and type of the cancer (as well as other factors), the options for treatment for those who have pancreatic cancer can involve surgery, ablation, chemotherapy, radiotherapy, or embolization treatments.  Pain control is also an essential part of the treatment plan for many patients.  Sometimes, the best treatment involves using more than one kind of treatment.

The doctors used in treating pancreatic cancer include the medical oncologist (a doctor who uses chemotherapy to treat the cancer), a radiation oncologist (a doctor who uses radiotherapy to treat the cancer), an endocrinologist (a doctor who treats individuals who have problems with their hormones), and a surgeon (a doctor who uses surgery to treat pancreatic cancer).

There are many different kinds of specialists who might be on the treatment team as well.  They include nutritionists, social workers, psychologists, nurses, nurse practitioners (NPs), and other health professionals.  Not every pancreatic cancer patient will need all of these specialists. 

It’s essential that the patient discuss all of their treatment choices with the patient, including possible side effects of pancreatic cancer treatment as well as their goals with their oncologist.  Some important things to think about include the patient’s feelings about the side effects from therapy, the likelihood that the therapy will cure the cancer, whether or not surgery can resect (remove) the cancer, the extent (stage of the cancer), the patient’s expected life span, and other significant health problems the patient has.

The patient may feel as though they may need to make a treatment decision quickly; however, it is important that the patient has enough time to take in the information they have just learned.  It is also essential that the patient ask questions if there is anything they aren’t sure about. 

If there is time, the patient may want to obtain a second opinion from another oncologist.  The oncologist can give the patient more information and can help them feel more sure about the treatment plan they decided on. The patient’s primary care physician can help the patient choose the individual who is to give the second opinion.

Prior to surgery, the patient should start by seeing their general practitioner or primary care physician if there are any symptoms that suggest the patient might have pancreatic cancer.  The primary care physician will start by recommending procedures and various tests to investigate the patient’s symptoms.  If the doctor decides the patient has pancreatic cancer, they may be referred to a gastroenterologist (a doctor who treats digestive problems), a surgeon who operates on the digestive tract, a radiation oncologist (a doctor who uses radiotherapy to treat the cancer), or an oncologist (a doctor who deals with cancer patients).

Because the appointments can be short and there is a lot to talk about, the patient needs to prepare for the appointment by writing down as many questions as possible and bringing these questions to see the specialist.  It helps if the patient brings along a friend or loved one who can ask any questions the patient may have forgotten about and will remember the answers the specialist told them if the patient didn’t remember what the specialist said.

The patient needs to quit smoking at least two weeks prior to having their pancreatic cancer surgery.  Smoking can slow the healing process and should be stopped even after the procedure.  They should also stop aspirin, nonsteroidal anti-inflammatory medications, and anticoagulants.  These can cause bleeding during the surgery and should be stopped at least two weeks prior to the procedure. 

The patient needs to be mindful of any restrictions placed on them before surgery.  At the time of the patient’s appointment with the oncologist, they need to write down anything they need to do prior to the procedure, such as making dietary restrictions.  They need to write down their symptoms and share them with their oncologist.  If there are any recent life changes or major stressors in the patient’s life they need to write these down in order to discuss them with the physician. 

As is seen with all major surgery, getting better after pancreatic surgery takes a long time.  The patient doesn’t generally recover until long after the procedure is over with.  The recovery can be separated into different stages, each of which has different expectations.   On the other hand, it is essential to remember that each patient’s recovery process is different.  Each patient’s experience is unique.

The patient will spend about 3-10 days in the hospital after pancreatic cancer surgery. While the patient is in the hospital, there will be many people on the healthcare team who will be checking up on the patient on a daily basis.  The in-house hospital team will consist of the patient’s surgeon, nurses, students, and residents.  Most of the time, the patient will be seen by the resident or nurses, who will see the patient several times daily.  The surgeon will see the patient just once per day.

It is normal to have pain after pancreatic cancer surgery.  While the patient is in the hospital, they will be given IV pain medications.  After discharge from the hospital, the patient will go home on oral painkillers.  After they run out, the patient can take over the counter pain relievers. 

After the surgery, the patient will have sutures or staples, and may have special dressings in place, which cover the incisions.  The patient may have surgical drainage tubes in place in order to drain blood and fluid from the abdominal cavity after the surgery.  The cancer team will look at the dressings every day and will make sure they are healing properly. 

The patient may develop a temporary paralysis of the stomach, known as “gastric ileus”.  This means the patient may not be able to eat for several days after the procedure.  While the patient is hospitalized, they may not be able to eat for several days after surgery.  The patient will have IV fluids running in until they are able to drink liquids adequately. 

Pancreatic cancer treatment is done whenever there is documented evidence through imaging techniques and biopsies that the patient has cancerous cells of the pancreas.  The mainstay of treatment is pancreatic cancer surgery, although many patients will receive chemotherapy and possible radiation therapy. 

After the surgery, the patient will be able to leave the hospital after several days.  It may take up to a week before they are able to tolerate ambulation without pain.  Full recovery from pancreatic cancer surgery can take longer than 2 months.  During these months, the patient will have to have follow up appointments with their oncologist to make sure they are healing properly.

At the first postoperative visit, the patient will meet with the oncologist or their assistant in order to make sure they are healing properly.  The pathology report will be shared with the patient and the patient will learn about how the surgery went.  If the patient needs more prescription medications for pain, they will be prescribed at this time.