Pancreatic Cancer Treatments Surgery

Surgery is the only possible cure for pancreas cancer, but only a small percentage of people with pancreatic tumors meet the criteria for surgical procedures. In order for surgery to be effective, tumors must be “localized,” meaning cancer cells have not spread to other organs.

Unfortunately, because pancreatic cancer tends to exist independent of any noticeable symptoms, this disease is typically diagnosed in later stages. As a result, only about 10 to 15 percent of pancreas tumors are eligible for surgical removal. This makes pancreatic cancer the fifth leading cause of cancer-related death in the United States.

Tumors that can be surgically removed are referred to as resectable, indicating that the diseased tissue can be removed. In these cases, doctors recommend that patients receive radiotherapy and chemotherapy before the operation to shrink the tumor. Similarly, these therapies may be necessary after surgery to kill any remaining cancerous cells.

Patients who undergo surgery to treat their pancreatic cancer are only 15 to 20 percent likely to survive for five years after the procedure.

The Pancreas: Anatomy and Function

The pancreas is a six-inch long gland, wider at one end than at the other. While the widest portion of the pancreas is called the head, as the gland narrows, it is further subdivided into the neck, body and tail. The pancreas is the organ responsible for producing enzymes and hormones (such as insulin and glucagon) that aid digestion.

The Whipple Procedure

The most common surgery used in the treatment of pancreatic cancer is the Whipple procedure, also known as a pancreaticoduodenectomy. This type of surgery is only an option if the tumor is located in the larger part of the pancreas and malignant cells haven’t metastasized (spread) to any other part of the body.

The Whipple procedure entails the removal of the:

  • gallbladder
  • pancreas head
  • pancreas neck
  • regional lymph nodes
  • part of the common bile duct (choledechectomy)
  • part of the small intestine (duodenum)
  • part of the stomach (antrectomy).

Because many of the tissues and organs surrounding these pancreatic tumors are removed, the pancreas is reattached to the remaining part of the small intestine to allow enzymes and digestive juices to pass into the digestive tract.

The Whipple procedure requires between four to seven hours of surgery. After the procedure, the patient is hospitalized for 8 to 10 days. Although the recovery time varies, most patients take about 6 weeks to recover.

Other Types of Surgery for Pancreatic Cancer

If the Whipple procedure isn’t appropriate for a particular tumor, doctors may choose between two other types of surgery:

  • A distal pancreatectomy removes the body and tail of the pancreas, as well as the spleen.
  • A total pancreatectomy, also known as a double Whipple, removes the entire pancreas, portions of the stomach and small intestine, the common bile duct, the gallbladder and surrounding lymph nodes.

Surgical Complications

The removal of a portion of the pancreas is major surgery. Common complications include post-operative infection and bleeding. After the operation many patients feel fatigued, weak and sleepy for two to four weeks.

One in five people experience a temporary inability to empty the stomach during digestion. Symptoms may include nausea, vomiting and a general lack of appetite. This complication usually resolves itself within two to six weeks after surgery.

Another potential side effect of pancreatic cancer surgery is that the removal of parts of vital organs may permanently affect the body’s ability to produce digestive enzymes and hormones. Roughly half of all people undergoing surgery require supplements and medication for proper digestion. Similarly, the pancreas may also be unable to generate insulin, requiring these patients to take insulin injections.

Call your doctor immediately if you experience any of the following after surgery:

  • bleeding around the incision
  • cloudy fluid or foul-smelling discharge around the incision
  • diarrhea
  • high fever
  • redness, swelling or bruising around the incision
  • severe abdominal pain
  • three or more days of constipation
  • vomiting.

Resources

CancerBACUP (updated 2001). Fluorouracil (5FU). Retrieved March 24, 2003, from the CancerBACUP Web site: www.cancerbacup.org.uk/info/fluorouracil.htm.

CancerBACUP. (updated 2001). Gemcitabine (Gemzar). Retrieved March 24, 2003, from the CancerBACUP Web site:www.cancerbacup.org.uk/info/gemcitabine.htm.

Johns Hopkins Pancreas Cancer Web (updated 2003). Medical treatment and research. Retrieved March 24, 2003, from the Johns Hopkins Web site: pathology.jhu.edu/n.web?EP=N