Pancreatic Cancer Treatment

At the University of Michigan’s Multidisciplinary Pancreatic Cancer Clinic, treatment begins with a personalized plan developed by pancreatic oncologists, surgeons, pathologists and other medical experts.

Multidisciplinary Pancreatic Cancer Clinic tumor board

Pancreatic Cancer Tumor Board

For most patients, the plan uses multiple kinds of treatments, or therapies, in order to control the disease and improve outcomes. The sequence of therapies - chemotherapy, radiation therapy and surgery - is tailored to patients individually and depends on the tumor's location and the extent of disease. Overall health and quality of life also play an important role in treatment decisions.

Eligibility for clinical trials and exciting new innovative therapies are always be considered.

Surgery for pancreatic cancer

When patients are diagnosed with pancreatic cancer, approximately 20% of the tumors are found to be operable or resectable. This percentage is low because the location of the pancreas makes surgery very difficult.

Each case is individual. For some patients, chemotherapy and radiation therapy, or other new agents (given as part of a clinical trial) will be recommended to potentially reduce the size of the tumor and improve the outcome of surgery.

If the tumor is found to be in the head of the pancreas and is operable, the surgical procedure performed is a pancreaticoduodenectomy, also called a Whipple procedure. This surgery involves removing the head of the pancreas, the gallbladder, part of the bile duct, and part of the stomach. Surgery includes re-connecting the remainder of the bile duct, pancreas and stomach to the bowel so these structures can drain properly.

Radiation therapy for pancreatic cancer

Radiation therapy is used in three ways:

to decrease the risk of local recurrence after surgery
to reduce the size of the tumor before surgery (preoperative or neoadjuvant therapy) and
as part of a treatment regimen for patients who have a tumor that is found to be unresectable.

When radiation is used, it is often in combination with chemotherapy, or with other new treatments as part of a clinical trial, which enhances the effectiveness of the radiation. Radiation and chemotherapy together have been found to benefit patients with locally advanced pancreatic cancer.

Chemotherapy for pancreatic cancer

The goals of chemotherapy treatment are to control the cancer, keep it from spreading by slowing the cancer's growth and improve or reduce the symptoms of the disease. Chemotherapy is often used for cancer that is found to be resectable, resected, borderline resectable, locally advanced or metastatic (spread to other organs). These drugs can have an effect on the cancer by stopping the growth of cancer cells or their ability to multiply.

Why / when does a patient see a gastroenterologist?

Pancreatic cancer causes complications and side effects that are best treated by gastroenterologists.

Jaundice is the most common complication of pancreatic cancer. When a mass, or cancer blocks the bile duct, there is a buildup of fluid causing jaundice, which is evident by a yellow appearance of the skin.

A gastroenterologist will place a stent (a very small tube) in the bile duct allowing fluid to drain into the intestine again as it did prior to the blockage by the tumor.

Sometimes, due to prior surgeries or a blockage that can’t be seen using an endoscope, patients receive a PTC, or percutaneous transhepatic cholangiocatheter. This is a stent that is placed through the abdominal wall or skin (percutaneously) and happens in the Radiology. In this case the bile may sometimes drain into a bag on the outside of the body rather than internally.

In the case of family history of pancreatic cancer, or a genetic disorder that predisposes people to pancreatic cancer, there are also surveillance examinations.

Gastroenterologists use endoscopic ultrasound (EUS) for this exam, which involves using an endoscope, which is a lighted, flexible tube, about the thickness of a finger, to examine the pancreas and to create detailed pictures using ultrasound imaging. EUS is the most sensitive test for picking up small cancers.

Request an appointment/referral

To request a first time appointment, please call the Patient Care Center at 800-865-1125. If you would like to refer a patient, please contact our M-Line service: 800-962-3555. For more information, visit our Appointments web page.