Treatment for Pancreatic Cancer

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Pancreatic Cancer Expertise  |  Treatment Types  |  Pain Management

Treatment Types

Treatment looks different for different people depending on your diagnosis. We tailor your treatment plan to you. Learn more about the treatment types offered at Fred Hutch. 

Surgery

Surgery is the only treatment with the potential to cure cancer that starts in the pancreas — but only if all the cancer can be removed. Taking out only part of the cancer generally does not improve treatment results for patients, and the surgery is complex with a lengthy recovery.

• If imaging studies, such as computed tomography (CT) scans, suggest that surgeons will be able to remove all of your cancer, your team may recommend surgery.
• If surgery is not a good option for you, you have other options, such as chemotherapy and radiation therapy.

Surgery for Fred Hutch patients with pancreatic cancer is performed at UW Medical Center - Montlake by expert surgeons specially trained to do your type of operation.

• Our surgeons participate in the American College of Surgeons National Surgical Quality Improvement Program for pancreatic surgery to track and improve outcomes.
• After your surgery, your care team at UW Medical Center - Montlake follows evidence-based guidelines to enhance your recovery (“early-recovery after surgery” protocols).

The Main Surgeries for Pancreatic Cancer are:

• Whipple procedure (pancreatoduodenectomy)
• Distal pancreatectomy
• Total pancreatectomy

Whipple Procedure

In this complex operation, surgeons remove part of your stomach, part of your small intestine (the duodenum and part of the jejunum), your bile duct that's outside your liver, your gallbladder and the wide end of your pancreas near the center of your abdomen (called the head, neck and uncinate process).

Then they pull your remaining jejunum up and connect your remaining bile duct, pancreas and stomach to it.

• The risk of complications from this operation is significantly lower when it’s performed at an experienced cancer center by a surgeon who does the procedure frequently.^1,2
• The National Comprehensive Cancer Network recommends that pancreatic resections should be done at institutions that perform a large number of them annually (at least 15-20).²
• We have two surgeons at UW Medical Center - Montlake who perform pancreatic resections. They typically perform 70-90 of these procedures each year.

Distal Pancreatectomy

If cancer is in the tail of your pancreas (the narrow end, near your side) and not in the head, your surgeon may remove the tail and body of your pancreas. Whenever possible, our surgeons try to leave your spleen, but they may have to remove it in order to get all the nearby lymph nodes.

Total Pancreatectomy

In some situations, the entire pancreas is removed along with surrounding structures. Your surgeon may recommend this if your tumor is large, it involves almost your whole pancreas or it spans the central area from the neck to the body of the pancreas.

This approach may also be used for people with familial pancreatic cancer. They might have a Whipple procedure or distal pancreatectomy first. Then if follow-up care shows a lesion has developed in their remaining pancreas, the rest of the gland may be removed.

Minimally Invasive Surgery

Our surgeons perform minimally invasive laparoscopic surgery (through small "keyhole" incisions) whenever possible. Benefits can include less pain, less narcotic pain medicine, less time in the hospital, fewer complications and better overall recovery. 

Open surgery (through a longer incision) is necessary in some situations, such as when a pancreatic tumor involves nearby blood vessels.

Robot-Assisted Surgery

Your surgeon may perform laparoscopic surgery using the robotic da Vinci Surgical System. With da Vinci, your surgeon sits at a console and uses hand and foot controls to move robotic arms that hold a laparoscope (camera) and surgical instruments. The console gives your surgeon a 3D view (not a flat view, like on a monitor screen). Da Vinci allows your surgeon to make very precise, complex motions (more than traditional laparoscopic instruments do), and the ideal ergonomics help prevent fatigue during long operations.

¹ Pancreatic Cancer Surgery, American Cancer Society, 2018
² NCCN Guidelines: Pancreatic Adenocarcinoma, National Comprehensive Cancer Network, 2018

Chemotherapy

Usually chemotherapy medicines are given by infusion into a vein. Some are taken by mouth in pill form. 

• For pancreatic cancer, you are likely to have chemotherapy for one of these reasons: 
  • Before surgery to shrink your tumor so it’s easier to remove
  • After surgery to kill remaining cancer cells that couldn’t be seen
  • Instead of surgery if your cancer is too widespread to remove

Your Fred Hutch team will talk with you about the specific drugs we recommend for you, how you’ll receive them, your treatment schedule and what to expect. We’ll also explain how to take the best possible care of yourself during treatment and after, and we’ll connect you with medical and support resources throughout Fred Hutch.

Targeted Therapy

Targeted therapies are newer cancer treatments that work more selectively than standard chemotherapy. They target a gene or protein responsible for allowing cancer to grow, they seek out and damage cancer cells, or they prompt your immune system to attack particular cells (also called immunotherapy). 

For pancreatic cancer, we perform molecular profiling of tumors to try to detect targets that might respond to treatment.

Radiation Therapy

Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells.

For pancreatic cancer, you may have radiation therapy or a combination of radiation and chemotherapy (chemoradiation), before or after surgery or instead of surgery if you cannot have surgery. Chemotherapy medicines can make cancer cells more sensitive to radiation. 

Conventional External-Beam Radiation Therapy (EBRT)

Physicians commonly recommend conventional EBRT for pancreatic cancer.

• A machine called a linear accelerator sends beams of X-ray radiation toward your tumor.
• Some patients have a type of EBRT called stereotactic body radiation therapy (SBRT), which precisely delivers high doses of radiation over just a few treatments.

Learn more about Radiation Therapy

Proton Therapy

In some situations, your physician may recommend proton therapy, a unique form of EBRT that targets protons at your tumor. 

• Proton therapy may significantly limit radiation exposure to surrounding healthy tissue near the pancreas, such as the bowel, liver, kidneys and spinal cord. 
• This may reduce side effects from treatment, particularly when combined with chemotherapy.
• Proton therapy may be especially useful if you have recurrent tumors and had radiation therapy to the same area in the past.

Fred Hutchinson Cancer Center - Proton Therapy is the only proton facility in the Pacific Northwest.

Learn more about Proton Therapy

Intraoperative radiation therapy (IORT)

Another option for some pancreatic tumors is IORT, a fast and effective form of radiation therapy that uses electron-beam radiation during surgery.

• Your surgeon moves normal structures out of the way to expose the target area for this precise, high-dose treatment.
• It takes only a few minutes to deliver and uses only a fraction of the total radiation given over a traditional multi-week course of external-beam radiation. 

UW Medical Center - Montlake is the only hospital in the WAMI region (Washington, Alaska, Montana and Idaho) to offer this treatment. 

Nutrition

Your pancreas aids in digestion and regulates your blood glucose levels, so pancreatic cancer is likely to affect the way your body uses food. 

To anticipate and prevent potential problems or to diagnose and deal with them early, it’s important to meet with a dietitian when you begin cancer treatment. You might also need enzymes, taken in pill form, to help with digestion.

Pancreatic tumors can affect digestion differently depending on their type and location. Your Fred Hutch dietitian will evaluate your needs and create an individualized nutrition plan for you.