Pancreaticoduodenectomy (Whipple procedure):
Removal of the head of the pancreas. A standard pancreaticoduodenectomy also removes part of the stomach, the lower half of the bile duct, the duodenum (first part of the small intestine) a small part of the jejunum (second part of the small intestine) and lymph nodes near the pancreas. The gallbladder and part of the common bile duct are removed and the remaining bile duct is attached to the small intestine so that bile from the liver continues to enter the small intestine. If 10 percent to 20 percent of the pancreatic tissue remains, the patient will produce enough insulin and digestive enzyme for proper metabolism. If less tissue remains, insulin supplements are often needed.

During surgery a small feeding tube (a jejunostomy tube or j-tube) is often inserted into the small intestine. High-calorie liquid will be passed directly into the intestine through this tube to supplement the diet. The additional calories from this supplement can help speed a patient's recovery. Tube feeding continues until a person can eat enough to maintain his or her weight. A second tube (a gastrostomy tube or g-tube) is often inserted into the stomach to help prevent nausea and vomiting after surgery.

Because a section of the stomach and small intestine will be removed during the surgery, the body has to "re-learn" how to digest food, which can take from six to eight weeks.

Total pancreatectomy:
Removal of the entire pancreas and the spleen. This surgery is sometimes used to treat exocrine cancers of the pancreas.

Distal pancreatectomy:
This operation removes only the tail or the tail and another portion of the pancreas. The spleen is often removed as well. This procedure is used almost exclusively with islet cell tumors found in the tail and body of the pancreas.

Palliative procedures
If cancer of the pancreas has spread too far to be completely removed by surgery, treatment will focus on relieving or preventing symptoms. This is known as palliative treatment.

Pain and digestive problems develop when insufficient bile reaches the intestines, which is the result of blockages caused by cancer in the head of the pancreas. This leads to the build-up of bile-related products in the bloodstream. There are two treatment strategies for relief of bile duct blockage. The first is surgery to reroute the bile from the common bile duct directly into the small intestine, bypassing the blockage in the head of the pancreas. The other is a procedure in which the doctor looks at the bile duct through an endoscope (lighted tube with a tiny camera attached) that has been passed down the patient's throat, through the esophagus, the stomach and into the small intestine. He or she will pass a stent (a small, expandable length of tubing) through the endoscope, which is inserted into the bile duct to keep it open.

Radiation therapy
Radiation therapy consists of using high-energy X-rays many times more powerful than a normal chest X-ray to destroy the ability of cells to grow and divide. External radiation aims X-ray beams directly at the cancerous tumor from the outside of the body. The treatment is typically administered by a radiation oncologist for 45 minutes, five days a week for a period of two to six weeks. Radiation therapy is often combined with chemotherapy when pancreatic cancer has spread and cannot be removed by surgery. Side effects of radiation therapy may include changes in skin tone resembling sunburn that last six to 12 months, stomach upset, diarrhea or tiredness.

Chemotherapy:
Chemotherapy involves the use of anti-cancer drugs, taken orally or intravenously. These drugs destroy cancer cells by interfering with their growth or by preventing them from reproducing. Fluorouracil (5-FU) has been used most often to treat cancer of the pancreas. However, recent studies have found gemcitabine to be more effective in treating metastatic cancer of the pancreas. Studies are underway to improve the effectiveness of these drugs.

Chemotherapy drugs kill cancer cells, but at the same time damage normal, healthy cells, causing side effects such as hair loss, sores in the mouth, nausea, vomiting, chills, sore throat and loss of appetite. There are treatments for some of the side effects, such as antiemetic drugs to reduce or prevent nausea and vomiting. Most of these side effects disappear at the completion of the chemotherapy.

Treatment by Stage
Resectable
Surgery will be used if imaging studies indicate a reasonable chance of completely removing the cancer. Surgery is the only treatment that offers a cure for pancreatic cancer. Most often a pancreaticoduodenectomy will be used, usually preceded or followed by radiation therapy and chemotherapy. The average survival time for patients with resectable cancer of the pancreas who have been treated with surgery, radiation and standard chemotherapy is 20 months.

Locally advanced
These cancers of the pancreas have spread too far to be completely removed during surgery. Studies indicate that the lifespan of the patient is not increased by partially removing the cancer surgically. The standard treatments are chemotherapy with gemcitabine or radiation and chemotherapy with 5-FU. The average survival time for patients with locally advanced cancer of the pancreas who have been treated with standard chemotherapy or radiation and chemotherapy is 10 months.

Metastatic
These cancers have already spread through the lymphatic system and it is not possible to remove them surgically. The main treatment is chemotherapy with gemcitabine or 5-FU. Patients with metastatic cancer of the pancreas may want to participate in clinical trials of new chemotherapeutic combinations. The average survival time for patients with metastatic cancer of the pancreas who have been treated with chemotherapy is about five to seven months.