Treatment

Surgery

• Pancreatic cancer is difficult to diagnose in early stages, and thus by the time a patient approaches a doctor and is diagnosed with pancreatic cancer the disease has usually spread and curative treatment is an option for only a few patients.
• At presentation only 10-15% of patients can be offered surgery. Surgery is the only curative treatment that can remove the cancerous tumor out of the body. But it cannot be considered in patients with advanced stages as the cancer is spread to lymph nodes and other distant organs.
• Surgery is possible only in patients with localised cancer where the major blood vessels, lymph nodes and other distant organs are not affected.
• If only the immediate neighboring tissues and lymph node are affected, surgery can still be an option as the neighboring tissue can be removed during the procedure.
• Surgery (palliative surgery) in advanced stages is done to make the patient comfortable and reduce pain and other complications that may arise because of the cancer.
• The type of surgery depends on the stage and location of cancer. There are three types of curative surgeries that are commonly done to treat pancreatic cancer.


• Pancreatoduodenectomy (Whipple Procedure)
• Distal pancreatectomy
• Total pancreatectomy

Pancreatoduodenectomy (Whipple Procedure)

• In this surgery, duodenum (initial part small intestine), the head of the pancreas, the gall bladder and bile ducts are removed. The remaining pancreas, bile duct, and stomach are then joined to the intestine.
• The remaining bile duct is directly attached to the small intestine so that bile and pancreatic juice flow into it.
• The operation is complicated and technically demanding so the success of the surgery depends on the skill and experience of the surgeon and the post surgical care.
• Outcome of pancreatoduodenectomy is higher in specialty hospitals where a large number of such operations are done.
• Precautions and care are necessary for an early recovery and to prevent complications. Bleeding and infection are the usual complications after surgery. However, leakage of the pancreatic juice from the remnant pancreas is the most difficult to treat complication. This complication can lead to other complications like bleeding etc.

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Distal pancreatectomy

• In this surgery, only the tail or tail and a part of the body of the pancreas are removed. The spleen is also removed in majority of the cases.
• This surgery is an option for tumors located in the tail and body of the pancreas.

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Total Pancreatectomy

• In this surgery, the entire pancreas is removed along with the spleen.
• This type of surgery was done for the tumors of head and body of the pancreas but in the process of removal of the entire pancreas, the islet cells are lost leading to loss of endocrinal function of the pancreas. Such people have poor control on sugar levels and may need to take insulin all life through.
• The pancreatoduodenectomy procedure is now preferred for the exocrine tumors of head or body of pancreas.

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