Treatment overview for pancreatic cancer
The type of treatment you are offered depends on the stage of your cancer, its size, and your general health.
Planning your treatment
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The treatment will be planned by a team of specialist doctors and other healthcare professionals. This is known as a multidisciplinary team (MDT), and may include:
a surgeon who specialises in treating pancreatic cancer
oncologists – doctors who treat cancer with chemotherapy and radiotherapy
a pathologist – a doctor who specialises in analysing tissue samples (biopsies) for signs of diseases
a radiologist – a doctor who analyses x-rays and scans
a specialist nurse who specialises in caring for people with pancreatic cancer and who can give information and support.
The MDT may also include other healthcare professionals, such as:
an occupational therapist
a psychologist or counsellor.
Surgery, chemotherapy and radiotherapy may all be used to treat pancreatic cancer. An important part of the care of people with pancreatic cancer is using treatments to control symptoms and make you feel more comfortable. This is known as supportive care. Research is going on to find more effective treatments for pancreatic cancer and you may be invited to take part in a clinical trial of a new drug or treatment.
Treatment by stage of cancer
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The most effective treatment for early-stage pancreatic cancer is surgery to remove part, or all, of the pancreas. This may cure the cancer for some people but it is a major operation. It is only suitable for people who are fit enough to have the surgery and who have cancers that are small and haven’t spread. Chemotherapy may be used after the operation to try to reduce the chances of the cancer coming back.
Chemotherapy may be used to control the cancer for some time and to relieve symptoms. Sometimes chemotherapy and radiotherapy are given together. This is called chemoradiation. If the cancer is blocking the bile duct or the bowel, surgery or stents may be used to relieve symptoms. Very occasionally it’s possible to operate to try to remove stage 3 cancers. However this is rare.
Metastatic or advanced cancer
One of the main aims of treatment is to reduce symptoms so that you feel as well as possible. This is called supportive care. Chemotherapy may be given to shrink the cancer and relieve symptoms. It can also help some people to live for longer. Stents may be used to relieve jaundice or other symptoms caused by a blocked bile duct or bowel. Radiotherapy, painkillers and nerve blocks may be used on their own or in combination to control any pain.
The benefits and disadvantages of treatment
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Many people are frightened at the idea of having cancer treatments, particularly because of the side effects that can occur. However, these can usually be controlled with medicines. Treatment can be given for different reasons and the potential benefits will vary depending on your individual situation.
If the cancer has spread to other parts of the body, treatment may only be able to control it, improving symptoms and quality of life. However, for some people in this situation the treatment will have no effect on the cancer and they will get the side effects without any of the benefit.
If you’ve been offered treatment that aims to cure the cancer, deciding whether to accept it may not be difficult. However, if a cure is not possible and the purpose of treatment is to control the cancer for a period of time, it may be more difficult to decide whether to go ahead.
Making decisions about treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether you wish to have treatment. If you choose not to have it, you can still be given supportive (palliative) care with medicines to control any symptoms.
Before you have any treatment, your doctor will explain its aims. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should be given full information about:
the type and extent of the treatment
its advantages and disadvantages
any significant risks or side effects
what will happen if you don’t have treatment.
If you don’t understand what you’ve been told, let the staff know straight away, so they can explain again. Some cancer treatments are complex, so it’s not unusual to need repeated explanations.
It’s a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion. You may also find it useful to write a list of questions before your appointment.
People sometimes feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.
You can always ask for more time if you feel that you can’t make a decision when your treatment is first explained to you.
You are also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.
Your multidisciplinary team (MDT) uses national treatment guidelines to decide the most suitable treatment for you.
Even so, you may want another medical or surgical opinion. If you feel it will be helpful, you can ask either your specialist or GP to refer you to another specialist for a second opinion. Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information. If you do go for a second opinion, it may be a good idea to take a relative or friend with you, and have a list of questions ready, so that you can make sure your concerns are covered during the discussion.