The only possibility to cure the disease is by surgical resection of the tumor. Due to the limited number of patients who are suitable for surgery with a curative intent, the tendency internationally is that these patients are centralized to centers of excellence for diagnosis and treatment by an interdisciplinary team. The teams should consist of highly qualified surgeons, radiologists, anesthesiologists, oncologists, pathologists, and specialized nurses. Today, there is convincing data showing a positive correlation between the number of operated patients and short and long-term results.
Pancreatic cancer has long been considered a chemotherapy resistant tumor form. A large number of studies, including large randomized multi-center studies, have been completed in recent years, but these have generally shown only marginal effects on tumor response and survival.
Preoperative radiation and chemotherapy are not routinely given but only within the framework of controlled studies.
At the time of diagnosis, about 15% of patients have a potentially resectable tumor. For the remaining 85% of the patients, palliative treatment is appropriate. Additionally, most operated patients will have recurrence of the disease. Therefore, nearly all patients will receive treatment for symptom relief.
Treatment of pain and nausea follows general principles, but a few other alternatives are appropriate for pancreatic cancer:
- Celiac plexus neurolysis
- Splanchnic nerve resection – division of the splanchnic nerves, which drive pain impulses from the pancreas, is now performed by a thoracoscopic technique. The procedure is done bilaterally and good initial results have been reported without side effects.
- Radiation treatment – For extensive metastasis and pain which is difficult to treat, it has been well documented that radiation treatment provides good pain relief for some patients. Unfortunately, the effect is delayed for a few weeks.
- Treatment of gastroduodenal stenosis
- Treatment of jaundice