Treatment for pancreatic cancer

A team of specialists meet to talk about the best treatment for you. They are called a multidisciplinary team (MDT).

The MDT look at national treatment guidelines or the latest evidence for the type of cancer you have. If you have any treatment preferences, your doctor will tell them about this.

The MDT will usually include the following professionals:

• Surgeon – a doctor who does operations (surgery).
• Clinical oncologist – a doctor who uses radiotherapy, chemotherapy and other anti-cancer drugs to treat people with cancer.
• Medical oncologist – a doctor who uses chemotherapy and other anti-cancer drugs to treat people with cancer.
• Pathologist – a doctor who looks at cells or body tissue under a microscope to diagnose cancer.
• Radiologist – a doctor who looks at scans and x-rays to diagnose problems.
• Interventional radiologist – a doctor who uses scans and x-rays to give treatments such as ablation or embolisation.
• Endoscopist – a doctor who specialises in doing an endoscopy, EUS or ERCP.
• Clinical nurse specialist (CNS) – a nurse who gives information about cancer, and support during treatment.

Depending on the type of cancer you have, the MDT may also include:

• a dietitian – someone who gives information and advice about food and food supplements
• a physiotherapist – someone who gives advice about exercise and mobility
• an occupational therapist (OT) – someone who gives information, support and aids to help people with tasks such as washing and dressing
• a palliative care doctor or nurse – someone who specialises in symptom control and supportive care.
• a psychologist or counsellor – someone who gives advice about managing feelings and behaviours.

Surgery is the most effective treatment for early-stage pancreatic cancer. It involves removing part of the pancreas or the whole pancreas. For some people, this may cure the cancer. But it is a major operation. It is only suitable for people who are fit enough. You can only have surgery if the cancer is small, does not affect any large blood vessels, and has not already spread.

You might also have chemotherapy or radiotherapy after surgery, to lower the chances of the cancer coming back. This is called adjuvant treatment.

Unresectable cancer is when the tumour has spread into the blood vessels around the pancreas. This usually means surgery is not an option.

Chemotherapy is the main treatment if the cancer has started to spread. You may have it to control the cancer for some time and to relieve symptoms.

Sometimes, you may have chemotherapy and radiotherapy together. This is called chemoradiation. Or, you may be offered radiotherapy on its own. Your doctor can discuss this with you.

Sometimes, chemotherapy or chemoradiation shrinks the tumour more than expected. This is not common, but may mean that it is possible to remove the tumour with surgery.

An operation is unlikely to be helpful if it is not possible to completely remove the cancer. You may have surgery to relieve symptoms. For example, you may have surgery if the cancer is blocking the bile duct or the bowel.

You may need other treatments to help with symptoms. If your pancreas is not working properly, you may need treatment called enzyme replacement therapy to help your body digest fats and proteins.

Irreversible electroporation (IRE)

Sometimes the cancer cannot be removed by surgery following neo-adjuvant treatment because the nearby blood vessels are still affected. Irreversible electroporation (IRE) is a new treatment that

might be used in this situation. A needle is inserted into the pancreas and an electric current is given through it to destroy the tumour. IRE is only available in a few hospitals in the UK. Your doctor or specialist nurse can give you more information.