Treatment of Recurrent Pancreatic Cancer

 


Your doctor might perform palliative surgery (biliary or gastric bypass, or endoscopic stent placement) to relieve or prevent the symptoms of jaundice, pain, nausea, and vomiting caused by blockage of the bile duct or stomach.

  • Biliary bypass - The doctor might do this procedure if cancer is blocking the common bile duct and bile is building up in the gallbladder. The doctor cuts the gallbladder or bile duct and attaches it to the small intestine to create a new pathway around the blocked area.
  • Endoscopic stent placement - The doctor might do this procedure if the tumor is blocking the bile duct. The doctor places a stent (a thin tube) through a catheter to drain bile to the outside of the body or put the stent around the blocked area to drain the bile into the small intestine.
  • Gastric bypass - If the tumor is blocking the flow of food from the stomach, the doctor may attach the stomach directly to the small intestine so that you can continue to eat normally.

If the tumor is blocking the common bile duct and the duodenum (the first part of the small intestine that connects to the stomach), the surgeon can perform a palliative double bypass, which is a combination of a biliary bypass and a gastric bypass.

You might be treated with chemotherapy drugs, such as:

  • Adrucil® or Efudex® (5-fluorouracil or 5-FU) - 5-FU belongs to the group of chemotherapy drugs known as antimetabolites. 5-FU prevents cells from making DNA and RNA, which stops cells from growing. 5-FU is given as a shot in the vein. The dose depends on your size and your blood counts.
  • Camptosar® (irinotecan) - Irinotecan belongs to a group of chemotherapy drugs known as topoisomerase inhibitors. It stops cancer cells from growing. Irinotecan is given by an injection in a vein. The dose depends on your size, your age, whether you have had radiation to your abdomen or pelvis, how well your liver is working, your blood counts, and whether you have any side effects such as diarrhea.
  • Eloxatin® (oxaliplatin) - Oxaliplatin belongs to the group of chemotherapy drugs known as alkylating agents. Oxaliplatin stops cancer cells from growing, which kills them. Oxaliplatin is given by an injection in a vein. The dose depends on your weight, your blood counts, and the side effects of the medicine.
  • Gemzar® (gemcitabine) - Gemcitabine belongs to a group of chemotherapy drugs known as antimetabolites. Gemcitabine prevents cells from making DNA and RNA, which stops cancer cells from growing; this kills the cancer cells. Gemcitabine is given by an injection in a vein. The dose depends on your size, your blood counts, and the cancer being treated.
  • Xeloda® (capecitabine) - Capecitabine belongs to a group of chemotherapy drugs known as antimetabolites. Capecitabine prevents cells from making DNA and RNA, which stops the cells from growing. Capecitabine is converted in your body to the chemotherapy drug 5-fluorouracil (5-FU). Capecitabine is given in pill form. The dose depends upon your size, but sometimes the dose needs to be lowered if you have side effects.

A targeted therapy, such as erlotinib, might be used in addition to chemotherapy. Targeted cancer therapies involve drugs that block the growth and spread of or instead of cancer by interfering with certain molecules involved in the process by which normal cells become cancer cells (tumorigenesis) and tumor growth. By focusing on molecular and cellular changes that only happen in cancer cells, targeted cancer therapies may be more effective and less harmful to normal cells than standard treatments.

  • Tarceva® (erlotinib) - Erlotinib is an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor. It is one of a new group of drugs that targets tiny flaws in the cell’s communication machinery. Erlotinib is given in pill form.

You might feel pain if the tumor presses on nerves or other organs near the pancreas; this pain can be controlled. Pain is easiest to treat at the beginning and it can be an early warning sign that your cancer is growing. For these reasons, it is important to tell your doctor or nurse as soon as you feel any pain. Options for treating pain include:

  • Surgery - The surgeon cuts some of the nerves that carry pain sensations.
  • Nerve block - The doctor injects alcohol into the area around certain nerves in the abdomen to block the feeling of pain.
  • Pain medicine - Morphine or other medications (opioids or narcotics, which are the strongest pain relievers available) can relieve pain. Other types of medicines used to relieve pain that are not opioids include acetaminophen (such as Tylenol) and nonsteroidal antiinflammatory drugs (NSAIDs, such as aspirin). Pain medicines work best when they are given on a regular schedule. They work less well if they are only used when the pain becomes severe.
  • Radiation - High-energy rays can help relieve pain by shrinking the tumor.
     

This content has been reviewed and approved by Myo Thant, MD.

This content was last reviewed August 15, 2010 by Dr. Reshma L. Mahtani.
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