Treatment

Standard of Care for Pancreatic Cancer

1. Surgery (if the cancer is operable)

  • Goal is to completely remove the tumour when possible.

  • Types of surgery:

    • Whipple procedure (pancreaticoduodenectomy): For tumours in the head of the pancreas.

    • Distal pancreatectomy: For tumours in the body or tail of the pancreas.

    • Total pancreatectomy: Removes the entire pancreas (used rarely).

  • After surgery: Chemotherapy (and sometimes radiation) is often given to kill any remaining cancer cells — this is called adjuvant therapy.

2. Chemotherapy

  • Aim is to destroy cancer cells, shrink tumours, and prevent recurrence or spread.

  • Common regimens:

    • FOLFIRINOX (a combination of several drugs) – for patients healthy enough to tolerate it.

    • Gemcitabine, sometimes combined with nab-paclitaxel – used when FOLFIRINOX is too strong.

  • When it’s used:

    • Before surgery (neoadjuvant therapy) to shrink the tumour.

    • After surgery (adjuvant therapy) to reduce recurrence.

    • As the main treatment for advanced or metastatic cancer.

3. Radiation Therapy

  • The goal is to target and kill cancer cells in or near the pancreas.

  • Radiation therapy is used alongside chemotherapy (chemoradiation) for locally advanced cancer that cannot be removed surgically. This may help relieve symptoms such as pain or blockage.

4. Palliative and Supportive Care

  • This may relieve symptoms, improve comfort, and support quality of life and includes pain control, nutrition support, stent placement for bile or digestive blockages, and emotional care. It can be started at any stage of the disease.

AB Health Solutions provides access to tests that allow for targeted treatment

Targeted Treatment

Personalised Medicine Targeting tumours

  • These therapies are targeted to attack the specific genetic changes in cancer cells.

  • Examples:

    • Olaparib for patients with BRCA1 or BRCA2 gene mutations.

    • Larotrectinib or entrectinib for rare NTRK gene fusions.

  • Genetic testing of the tumour (and sometimes blood) is required to identify patients who may benefit.

Immunotherapy

  • Goal: To help the immune system recognise and fight cancer.

  • Example:

    • Pembrolizumab for tumours with MSI-high or mismatch repair deficiency (dMMR) — rare in pancreatic cancer but important to test for.