What is the treatment of pancreatic cancer?
Many years of treating cancer patients and testing treatments in clinical trials has helped doctors know what is likely to work for a particular type and stage of cancer. You will be advised on the best treatment for your cancer. This will depend on the type of cancer you have, where it is and how far it has spread and your general health.
Surgery For Pancreatic Cancer
The main treatment for pancreatic cancer is surgery. Though cancer surgeries are extensive and take longer hours; with advanced medical care, surgeries have become safer and better equipments are now available to perform surgeries. Improved techniques of anaesthesia and post-operative monitoring have significantly contributed to overall safety of surgical procedures for cancers.
If you are found suitable for the surgery, you will be usually admitted one or two days prior to the proposed date of surgery. There may be dietary restrictions and you may be given laxatives to evacuate your bowels prior to surgery. Your blood group will be checked and blood is usually reserved for all major abdominal surgeries.
It is always a good idea to start with deep breathing exercises once you are admitted to the hospital. Your doctor may summon a physiotherapist to assist you with the same. You will have most of your body parts shaved for the surgery. You will be given a consent form for your signature.
The form would have details of the procedure to be performed on you by your treating surgeon. In case you have any doubts you should feel free to ask them to the surgical team.
The surgeries for pancreatic cancers depend on the location of the tumor in the pancreas.
Majority of the pancreas cancer however are in the head region of the pancreas and the operation performed is “Whipple’s surgery”.
“Distal Pancreatectomy” is performed for tumors located in the tail or body portion of the pancreas and the surgery involves removal of the body and tail portion of the pancreas along with the spleen.
This major operation involves removal of:
- part of the pancreas
- part of the first part of the small bowel (duodenum)
- part of the stomach
- part of the gall bladder and part of the bile duct.
The diagram below shows what your surgeon removes
The surgeon reconnects the remainder of the pancreas, bile duct and stomach to different sections of the small bowel so the digestive tract keeps working.
A feeding tube may be placed during the surgery to replenish nutrition to the patient after surgery.
This operation is performed for certain types of pancreatic tumors located in the tail or body portion of the pancreas. This surgery involves removal of only the tail of the pancreas or the tail and a portion of the body of the pancreas. The spleen is usually removed as well.
Sometimes surgery may begin with the hope it will cure the patient, but the surgeon discovers this is not possible. In this case, the surgeon may continue the operation as a palliative / bypass procedure to relieve or prevent symptoms.
Cancers growing in the head of the pancreas can block the common bile duct as it passes through this part of the pancreas. This may cause pain and digestive problems because the bile can’t get into the intestine and patient develops jaundice and vomiting. The bile chemicals will build up in the body
There are 2 options for relieving bile duct blockage.
Surgery can be done to reroute the flow of bile from the common bile duct directly into the small intestine, bypassing the pancreas. Sometimes, the stomach connection to the duodenum (the first part of the small intestine) is rerouted at this time as well. Often, late in the course of pancreatic cancer, the duodenum becomes blocked by cancer, which can cause pain and vomiting that requires surgery. Bypassing the duodenum before this happens can help avoid a second operation.
A second approach to relieving a blocked bile duct does not involve surgery. Instead, a stent (small tube) is placed in the duct to keep it open. This is usually done through an endoscope (a long, flexible tube) while the patient is sedated. The doctor passes the endoscope down the patient’s throat and all the way into the small intestine. The doctor can then insert the stent into the bile duct through the endoscope. The stent helps keep the bile duct open and resists compression from the surrounding cancer.
Drinking and eating after surgery.
After an anaesthetic, the movement of the bowel slows down and usually takes about 72 hours to get back to normal. After about 48-72 hours you will probably be ready to start taking small sips of water, however your doctors will tell you when it is appropriate for you to start drinking some fluids. This will be gradually increased after a couple of days until you are able to eat a light diet.
You will probably be ready to go home in about 10-14 days after your operation and once your stitches have been removed. If deemed appropriate your doctor may send you home with stitches and call you later to remove the stitches. By and large you should be able to climb several flights of stairs after your discharge from the hospital and you will be given diet instructions.
Before you leave hospital you will be given an appointment for a post-operative check-up at the outpatient clinic.
Diet after pancreas surgery.
You will be transferred to the Intensive care unit after the surgery. Your recovery will depend on the magnitude of surgery performed. After the operation, the patient is usually monitored in the ICU for 48 to 72 hrs and the overall hospital stay (if no complications) is usually between 10–14 days.
Your pain and discomfort will be taken care of by the anaesthetic team. You will be given pain-killers and an intravenous infusion (drip) to replace your body’s fluids until you are able to drink and eat again after a few days. You will also have a naso-gastric (NG) tube in place.
This is a thin tube that passes down your nose into your stomach or small intestine and allows any fluids to be removed so that you don’t feel sick. It is usually taken out within 48 hours. Sometimes a small tube (catheter) is put into the bladder to drain your urine into a collecting bag.
After your operation you will be encouraged to start moving about as soon as possible. This is an essential part of your recovery. If you have to stay in bed the nurses will encourage you to do regular leg movements and deep breathing exercises. You will be seen by a physiotherapist who can help you to do the exercises.
At first, even tiny meals may make you feel uncomfortably full. You will need to eat very small amounts very often at first. Then, gradually increase the amounts and then the time between meals. At first, you may find you need to eat every hour or so in order to get enough nutrition.
There is no restriction on the type of food you eat after a pancreas surgery and you should be able to eat all that you did before surgery. Fizzy drinks can make you feel full – it is probably best not to drink with meals at all, as any liquid will fill you up.
Try keeping a food diary if you are having problems you think are related to your diet. Take a small notebook and draw a line down the centre of each page. Write down what you eat and when on the left of the page. Write down any symptoms you get and when on the other side of the page. After a few days, you may be able to spot which foods cause which symptoms.
Some people need to take tablets to help digest fat and proteins, and some people develop diabetes, which may require treatment.