Pancreatic Cancer Treatments

About Pancreatic Cancer

At Penn Medicine, patients with pancreatic cancer receive their care from a multidisciplinary team of nationally recognized experts in the diagnosis, treatment and research of gastrointestinal cancer.

Pancreatic cancer is cancer that develops within the pancreas, the gland about six inches long that is responsible for making hormones, including the enzymes responsible for the digestion of food and control of blood sugar.

Pancreatic cancer develops when cells within the pancreas begin to grow out of control. It may spread, or metastasize, to nearby lymph nodes and organs such as the liver and lungs.

The pancreas has three sections:

  • Head: Part of the pancreas adjacent to the small bowel and liver ducts
  • Body: Middle of the pancreas
  • Tail: End of the pancreas near the spleen

About 90 percent or more of pancreatic cancer develops in the head of the pancreas.

Penn Medicine's multidisciplinary approach to cancer diagnosis and treatment provides better outcomes and gives patients access to the most advanced treatment, surgical techniques and clinical trials.

Because navigating a new cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them simplify entry into Penn and make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

Read more About Pancreatic Cancer

Diagnosing Pancreatic Cancer

An accurate cancer diagnosis from trusted cancer specialists is the first step in getting personalized treatment options to treat pancreatic cancer.

Patients who choose Penn's Abramson Cancer Center, benefit from a multidisciplinary team of cancer specialists including gastroenterologists, radiologists, pathologists and surgeons who work together to provide both a diagnosis and treatment plan individualized for each patient with pancreatic cancer.

Cancer specialists at Penn Medicine are highly experienced in using the most advanced techniques for diagnosing pancreatic cancer and are actively researching better and more precise ways to detect pancreatic cancer.

Because an accurate diagnosis is an important step in planning cancer treatment, it's important patients know that when they come to Penn Medicine, they are taking an important step in getting the best cancer treatment.

Navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right person. Penn Medicine's contact center has experienced cancer nurses available and ready to guide patients in finding the cancer specialist right for them.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

Read more Diagnosing Pancreatic Cancer

Pancreatic Cancer Treatments

Following the diagnosis and staging of pancreatic cancer, cancer specialists at Penn Medicine's Abramson Cancer Center develop a personalized treatment plan. Penn's treatment options for pancreatic cancer include:

  • Surgery
    • Whipple procedure
    • Pylorus-sparing Whipple
    • Total pancreatectomy
    • Distal pancreatectomy
    • Enucleation (for certain rare types of cancer)
  • Palliative surgery
    • Surgical biliary drainage
    • Endoscopic stent placement for bilary drainage
    • Endonsocoic stent placement for gastric outlet obstuction
    • Surgical gastrojejunostomy
  • Radiation therapy
    • Three-dimensional conformal radiation therapy
    • Intensity-modulated radiation therapy (IMRT)
    • Proton therapy
    • Volumetric-modulated arc therapy (VMAT)
  • Chemotherapy and biologic therapies
    • Photodynamic Therapy (PDT)
  • Clinical trials
  • Other treatments
    • Integrative medicine and wellness
    • Palliative care
    • Penn Home Care and Hospice

Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the correct cancer specialist.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN.


Surgery for Pancreatic Cancer

Surgery for pancreatic cancer offers the only possibility for a cure. Surgeons at Penn Medicine perform the highest volume of pancreatic procedures in the Philadelphia region, and are among the top 10 in the United States. The surgical expertise and experience of Penn’s cancer specialists combined with its multidisciplinary clinical care is backed by leading-edge research that is applied to patients, and can be leveraged in developing new treatments for patients.

Whipple procedure

A Whipple procedure, or pancreatic duodenectomy, is a common procedure in which the gallbladder, common bile duct, part of the duodenum, and the head of the pancreas are removed. Portions of the body and tail pancreas are left to continue to produce bile and digestive enzymes. Studies have confirmed that low complication rates for the procedure are linked to the experience of the surgeon and the multidisciplinary team caring for the patient after surgery.

Pylorus-sparing Whipple procedure

The pylorus sparing Whipple is a modified version of the conventional Whipple where the bottom portion of the stomach or pylorus is not removed.

Total pancreatectomy

Removal of the whole pancreas, part of the stomach, part of the small intestine, the common bile duct, gallbladder, spleen and nearby lymph nodes.

Distal pancreatectomy

Surgeons remove the body and the tail of the pancreas.

Enucleation

A pancreas sparing procedure, during enucleation just the tumor is removed leaving the pancreas in place.

Palliative Surgery for Pancreatic Cancer

If pancreatic cancer has distant spread or cannot be removed, the following procedures may be done to relieve symptoms. These types of procedures do not have cure cancer.

Surgical biliary drainage

If a tumor is blocking the bile duct, a biliary drainage procedure may be performed. In this procedure, the gallbladder or bile duct is drained and may be rerouted directly to the small intestine to create a new pathway around the blockage.

Endoscopic stent placement

If the tumor is blocking the bile duct, a stent may be placed during endoscopic retrograde cholangiopancreatography (ERCP) to drain bile that has backed-up in the liver.

Gastric drainage

Gastric surgery may be used if a tumor is blocking the flow of food from the stomach. This procedure alters the digestive track by creating an alternative drainage route from the stomach.

Endoscopic stent placement for gastric outlet obstruction

If the tumor is blocking the bile duct, a stent may be placed to drain bile that has backed-up in the liver.

Surgical gastrojejunostomy

Surgeons create an opening in the stomach to connect it to the upper portion of the small bowel, or small intestine, so that a tube placed in the opening delivers medications and nutritional liquids directly into the stomach.

Radiation Therapy for Pancreatic Cancer

Radiation oncologists at Penn Medicine are recognized for techniques that target radiation precisely to the disease site while sparing nearby tissue. As national leaders in radiation therapy, they are experts in the use of the latest therapies to treat cancer.

Proton therapy at Penn Medicine is now being used to treat upper gastrointestinal cancers and recurrent tumors in the digestive tract. Penn Medicine is one of the only facilities in the country treating gastrointestinal cancers in this way.

Radiation therapy uses high-energy radiation to kill cancer cells. A radiation therapy schedule usually consists of a specific number of treatments given over an extended period of time. In many cases, radiation therapy is capable of killing all of the cancer cells. Radiation oncologists at Penn Medicine use both internal and external forms of radiation therapy to treat cancer.

Three-dimensional conformal radiation therapy

Imaging technology used by radiation oncologists at Penn Medicine help shape the radiation treatment beam to the shape of the tumor. Conformal radiation therapy gives doctors more control when treating tumors.

Special computers use CT imaging scans to create 3-D maps of the location of the cancer in the body. The system permits the delivery of radiation from several directions, and the beams can then be shaped, or conformed, to match the shape of the cancer. Conformal radiation therapy limits radiation exposure to nearby healthy tissue as well as the tissue in the beam's path.

Intensity-modulated radiation treatment (IMRT)

This advanced type of radiotherapy uses a computer-controlled device, called a linear accelerator, to deliver precise doses of radiation to tumors or specific areas within the tumors. Radiation therapy, including IMRT, stops cancer cells from dividing and growing, thus slowing or stopping tumor growth. In many cases, radiation therapy is capable of killing all of the cancer cells.

Using 4-D computed tomography (CT) images along with computerized dose calculations, IMRT allows for the radiation dose to conform more precisely to the shape of the tumor by controlling, or modulating, the intensity of the radiation beam while tracking any movement of the tumor. The therapy allows higher radiation doses to be delivered to areas within the tumor while minimizing the dose to the surrounding area.

Volumetric-modulated Arc Therapy (VMAT)

Volumetric modulated arc therapy (VMAT) is a type of specialized intensity modulated radiation therapy, or IMRT. VMAT delivers radiation by rotating the radiation machine, through one or more arcs while radiation is continuously delivered.

VMAT allows Penn radiation oncologists to treat complex cancers while minimizing exposure to surrounding healthy tissue. VMAT shortens radiation delivery time, and offers patient more comfort because it does not require patients to lie completely still for long periods of time.

Penn radiation oncologists use RapidArcâ„¢ radiotherapy technology to treat hard to reach tumors.

Proton therapy

Penn Medicine is the only health care facility in the country that is using proton therapy to treat recurrent gastrointestinal tumors and tumors in the upper digestive tract in clinical trials.

Penn Medicine's Roberts Proton Therapy Center is the largest and most advanced facility in the world for this precise form of cancer radiation. Patients have access to one of the most sophisticated weapons against cancer, seamlessly integrated with the full range of oncology services available at the Abramson Cancer Center. Proton therapy is external beam radiotherapy in which protons are directed at a tumor.

The radiation dose that is given through protons is very precise, and limits the exposure of normal tissues. This allows the radiation dose delivered to the tumor to be increased beyond conventional radiation. The result is a better chance for curing cancer with fewer harmful side effects.

Proton therapy, like all forms of radiation therapy, works by aiming the energized particles, in this case protons, onto the target tumor. The particles damage the DNA of cells, ultimately causing their death. Unlike X-rays, protons can be manipulated to release most of their energy only when they reach their target. With more energy reaching the cancerous cells, more damage is administered by each burst of radiation.

Chemotherapy and Biologic Therapies for Pancreatic Cancer

Cancer specialists at Penn Medicine specialize in a team approach to treatment with interdisciplinary care and innovative approaches that use chemotherapy to target tumors prior to and after surgery. Medical oncologists, cancer specialists who treat patients with chemotherapy, are part of a multidisciplinary cancer treatment team that approaches cancer care by treating the whole patient with personalized medicine. New biologics and immunoimodulatory therapies are undergoing trials at Penn.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy is usually delivered intravenously through a catheter, or orally by pill.

Biologic therapy

Biologic therapy, also called targeted therapy, uses the patients' own immune system to target cancer cells. Substances made by the body or in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer, and are delivered orally by pill or intravenously.  This type of cancer treatment is also called immunotherapy.

Clinical Trials for Pancreatic Cancer

Today, more and more people are surviving cancer. Clinical trials benefit patients with access to breakthrough therapies and treatments. Patients at the Penn Medicine have a unique opportunity: to experience these new advances in cancer treatment. These advances in cancer treatment are occurring every day at Penn Medicine, giving patients hope that even greater discoveries lie ahead. Through clinical trials:

  • Diagnosing cancer has become more precise.
  • Radiation and surgical techniques have advanced.
  • Medications are more successful.
  • Combinations of medical, surgical and radiation therapy are improving treatment effectiveness and enhancing outcomes.
  • Strategies to address the late effects of cancer and its treatment are improving quality of life.

Other Treatments for Pancreatic Cancer

In addition to standard treatments and clinical trials, patients at Penn Medicine may wish to add additional therapies and treatments such as massage therapy, acupuncture and art therapy. These therapies do not have curative intent, and are designed to complement standard treatments, not take their place.

Integrative Medicine and Wellness Programs

At Penn Medicine, integrative medicine and wellness services can supplement traditional cancer treatments such as chemotherapy, surgery and radiation therapy. While conventional medicine plays a critical role in eradicating cancer, integrative medicine and wellness programs offer patients and their families ways to enhance the quality of their lives, minimize or reduce the side effects of cancer and cancer treatment, and promote healing and recovery.

Cancer specialists at Penn Medicine are knowledgeable and supportive of complementary cancer treatments. The cancer team works with patients and families to integrate these supportive programs into the overall care plan, while ensuring the safety and health of patients.

The Abramson Cancer Center’s range of integrative supportive services is designed to help patients cope with the cancer experience and improve their overall sense of well-being. These services include social work counseling, nutrition counseling, psychological counseling and spiritual counseling. Services include:

The Cancer Appetite and Rehabilitation Clinic focuses on patients with loss of appetite and weight.

The Supportive Care Clinic helps to manage cancer related symptoms. Integrative support programs include:

The Abramson Cancer Center at Pennsylvania Hospital at Pennsylvania Hospital also offers a variety of supportive care programs for patients and families, from diagnosis through survivorship. These programs are available at no cost to the patients treated at Pennsylvania Hospital, and some are open to patients treated elsewhere. These services include social work counseling, nutrition counseling, psychological counseling and spiritual counseling.

Support groups and educational programs are available at Pennsylvania Hospital throughout the year.

Palliative Care

Palliative care provides medical and non-medical interventions to ease the symptoms of cancer and its treatment. Palliative care includes physical, emotional and spiritual care that can enhance the quality of life for cancer patients.

Palliative care can be used to complement traditional cancer therapies, or to improve quality of life when curative therapies are no longer an option.

Palliative care is an approach to patient care that can be integrated with curative therapies at any point from diagnosis to survivorship or end-of-life care.

Palliative care services include palliative chemotherapy, radiation therapy and surgery as well as psychological counseling, art therapy and support groups for patients and families. The goals of palliative care are to enhance the quality of life for cancer patients and their families, and provide emotional and spiritual support to enhance personal growth.

Palliative care services are offered at the Hospital of the University of Pennsylvania.  Pennsylvania Hospital, and at Penn at Rittenhouse.

Penn Home Care and Hospice Services

Penn Home Care and Hospice Services offer a full range of home health care needs by partnering three top-level home health care services under one roof:

Penn Home Care and Hospice Services offer an array of specialized therapies and medications for patients with cancer and cancer-related conditions.

Oncology Navigation Specialists

Every step of cancer treatment; from a cancer diagnosis, to surgery and treatment to forming a survivorship plan; comes with different needs and issues that should be addressed.

Oncology Navigation Specialists at the Abramson Cancer Center are available to make a patient’s experience as seamless as possible. As experts in navigating complex health care situations, patient support specialists serve as a consistent point of contact and a reliable source for advice, support and direction for patients and families. They can help in a variety of ways including; provide emotional support, identify resources, and ensure access to information, support services, educational programs and community resources.

Learn more about Patient Navigation specialists at the Abramson Cancer Center.

Pancreatic Cancer Survivorship

Survivorship programs at Penn Medicine are a distinct phase of pancreatic cancer care and are designed to help patients' transition from their cancer treatment routine to a post-cancer care lifestyle. There are more than 12 million cancer survivors living and thriving today as a result of advances in cancer treatment. However, cancer treatments can result in physical, emotional and financial complications long after the therapy is complete.

Read more Pancreatic Cancer Survivorship


Suzi F. Garber

Suzi F. Garber, of Reading, PA., a neuroendocrine tumor patient at the Abramson Cancer Center, writes about her experience so that others might benefit from her story and become proactive advocates for themselves and their loved ones.

For ma

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