Pancreaticoduodenectomy (Whipple procedure): This is the most common operation to remove a cancer of the exocrine pancreas. It is also sometimes used to treat pancreatic NETs.
Video (Whipple): https://www.youtube.com/watch?v=4Zxvm3MSb8k
During this operation, the surgeon removes the head of the pancreas and sometimes the body of the pancreas as well. Nearby structures such as part of the small intestine, part of the bile duct, the gallbladder, lymph nodes near the pancreas, and sometimes part of the stomach are also removed. The remaining bile duct and pancreas are then attached to the small intestine so that bile and digestive enzymes can enter the small intestine. The pieces of the small intestine (or the stomach and small intestine) are then reattached as well so that food can pass through the digestive tract.
In the best of hands, many patients still suffer complications from the surgery. These can include:
- Leaking from the various connections among organs that the surgeon has to make.
- Trouble with the stomach emptying itself after eating.
Other, longer-term complications can include weight loss, trouble digesting some foods, changes in bowel habits, and diabetes in some people.
Distal pancreatectomy: In this operation, the surgeon 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 to treat PNETs found in the tail and body of the pancreas. It is seldom used to treat cancers of the exocrine pancreas because these tumors have usually already spread by the time they are found.
Total pancreatectomy: This operation was once used for tumors in the body or head of the pancreas. It removes the entire pancreas and the spleen. It is now seldom used to treat exocrine cancers of the pancreas because there doesn’t seem to be an advantage in removing the whole pancreas.
It is possible to live without a pancreas. But when the entire pancreas is removed, people are left without any islet cells, the cells that make insulin and other hormones that help maintain blood sugar levels. These people develop diabetes, which can be hard to manage because they are totally dependent on insulin shots. People who have had this surgery also need to take pancreatic enzyme pills to help them digest certain foods.
Many clinical trials are testing new combinations of chemotherapy drugs for pancreatic cancer. Studies have looked to see if combining gemcitabine with other drugs would help patients live longer. For example, adding capecitabine (Xeloda) to gemcitabine seems to help some patients. The combination of gemcitabine, irinotecan, and celecoxib (an arthritis drug) also shows promise.
Other studies are testing the best ways to combine chemotherapy with radiation therapy or newer targeted therapies.
Some current studies are looking at different ways to give radiation to treat exocrine pancreas cancer. These include intraoperative radiation therapy (in which a single large dose of radiation is given to the pancreas in the operating room at the time of surgery) and proton beam radiation (which uses a special type of radiation that might do less damage to nearby normal cells).
As researchers have learned more about what makes pancreatic cancer cells different from normal cells, they have developed newer drugs that should be able exploit these differences by attacking only specific targets. These targeted therapies may provide another option for treating pancreatic cancer. They may prove to be useful along with, or instead of, current treatments. In general, they seem to have fewer side effects than traditional chemo drugs. Looking for new targets to attack on cancers is an active area of research.
Growth factor inhibitors: Many types of cancer cells, including pancreatic cancer cells, have certain molecules on their surface that help them grow. These molecules are called growth factor receptors. One example is epidermal growth factor receptor (EGFR). Several drugs that target EGFR are now being studied. One, known as erlotinib (Tarceva), is already approved for use along with gemcitabine.
Anti-angiogenesis factors: All cancers depend on new blood vessels to nourish their growth. To block the growth of these vessels and thereby starve the tumor, scientists have developed anti-angiogenesis drugs. These are being studied in clinical trials for patients with pancreatic cancer.
Drugs that target the tumor stroma (supporting tissue): Pancreatic cancer does not always respond well to chemotherapy. One reason may be the dense surrounding supportive tissue (stroma) in the tumor. The stroma seems to form a barrier that helps protect the cancer cells from the effects of chemo drugs. Researchers are now looking at drugs that attack the stroma directly to help break it down. This might allow chemo or other drugs to be more effective.
Other targeted therapies: Many drugs targeting other aspects of cancer cells are now being studied for use in pancreatic cancer. Some of these drugs, such as sunitinib (Sutent), have several different targets.