Pancreatic Cancer Treatment

Our pancreatic cancer team includes Julie Larson (left), outpatient nurse coordinator, and surgeon Brett Sheppard, M.D.
Our pancreatic cancer team has specialists for every need. They include Julie Larson, outpatient nurse coordinator, and surgeon Brett Sheppard, M.D.

At the OHSU Knight Cancer Institute, you can count on expert doctors and other providers who work as a team. They understand that every patient requires a highly individual approach with treatments in a precise order.

Our care includes:

  • World-class surgeons who make surgery possible for more patients than ever.
  • Compassionate care providers dedicated to helping you live the best and longest life possible.
  • Advanced chemotherapy and radiation therapy, including radiation therapy during surgery when appropriate.
  • Access to clinical trials and the latest discoveries

Read more about our complete care on our main Pancreatic Cancer page. You can also jump to:

Chemotherapy

Radiation therapy

Surgery

Treatment overview

This page is devoted mostly to exocrine pancreatic tumors. See the bottom of the page to read about pancreatic neuroendocrine tumors.

Every patient’s care is different. But whether your tumor can be removed in surgery will guide many decisions. This is important because removing all of the tumor, combined with other treatments, is the only path to a cure.

Your tumor will be described as:

  • Resectable: Removable with surgery.
  • Borderline resectable: Potentially removable with surgery.
  • Unresectable: Not removable with surgery.

You may have chemotherapy or chemoradiation (chemotherapy plus radiation therapy) to shrink your tumor before surgery. This can help make sure it can all be removed. It can also bring some borderline tumors into the resectable category.

If you have surgery, you will probably have additional treatments to kill any remaining cancer cells. This lowers the chances of cancer coming back.

Your care team will develop a treatment plan that may include:

  • Chemotherapy and radiation therapy to slow cancer growth and control symptoms.
  • An endoscopic procedure to place a stent to keep your bile duct open.
  • Palliative care to provide support, and to relieve symptoms and stress.
  • A clinical trial, to try a new therapy to lengthen and improve your life.
Our surgeons, including Kevin Billingsley, M.D., offer the highest level of skill and expertise for pancreatic cancer. Here, Dr. Billingsley is seated on a table in a lab.
Our surgeons, including Kevin Billingsley, M.D., offer the highest level of skill and expertise for pancreatic cancer.

Treatment goals

Dr. Charles Lopez in white coat, smiling
Medical oncologist Charles Lopez, M.D., Ph.D., offers excellent care and research expertise.

There are long-term survivors of pancreatic cancer. For most patients, though, a cure isn’t possible because the cancer has spread too far.

Even so, you may enjoy years or months of meaningful life. You may set goals such as taking a special trip. Maybe you hope to see a child or grandchild marry or graduate.

At the Knight Cancer Institute, your goals become our goals.

Your team will be devoted to extending and improving your life regardless of your long-term outlook.

Chemotherapy

Chemotherapy uses cancer-fighting medications delivered in an IV drip called an infusion. Depending on your regimen (combination of medications), you will probably have an infusion every week or every other week. Each infusion takes several hours.

At the Knight Cancer Institute, our medical oncologists (doctors who oversee chemotherapy and other cancer medications) will:

  • Use the most advanced techniques.
  • Tailor and adjust your regimen to your specific needs.
  • Deliver chemotherapy in a way that offers you the best outcome. They can make sure, for example, that you stay eligible for a promising clinical trial.

When chemotherapy is given

Before surgery (neoadjuvant): Chemotherapy plays an especially important role before pancreatic cancer surgery.

  • It can shrink the tumor, helping make sure it can all be removed with surgery.
  • It can make some borderline tumors resectable.
  • It can attack tiny clusters of cancer cells that doctors can’t see. Often, these clusters have already spread to other body parts at diagnosis. If the clusters remain, surgery won’t help.
  • Delaying surgery gives these clusters time to grow and be detected. This helps avoid putting a patient through major surgery that ultimately won’t help. Doctors can also see if chemotherapy fights your cancer.

After surgery (adjuvant): Chemotherapy after surgery can kill cancer cells circulating nearly anywhere in your body. Studies have shown that chemotherapy after surgery increases chances of long-term survival.

If you’re not having surgery: Chemotherapy can have significant side effects. Even so, research shows that it helps patients with pancreatic cancer live longer and much more comfortably.

Radiation therapy

Radiation therapy uses beams of energy to kill cancer cells. For pancreatic cancer, radiation therapy is external, meaning it is delivered by machines outside your body.

At OHSU, we use advanced image-guided techniques to target your tumor while sparing healthy tissue. This improves control of  the cancer while reducing side effects. We are also among top cancer centers to offer intraoperative radiation therapy (IORT) for pancreatic cancer, when appropriate. 

Types of radiation therapy for pancreatic cancer

This is the most common type. In 3D CRT, computer-assisted scans enable your doctor to shape beams precisely to your tumor. This lets us deliver a higher dose while protecting healthy tissue. It is often combined with chemotherapy. Treatments are five days a week over two to six weeks. 

IMRT is a type of 3D CRT. It delivers precise radiation from many angles around your body. It enables your doctor to vary doses to different parts of your tumor. Parts with more cancer cells can get higher doses, for example. This therapy is often combined with chemotherapy. Treatments are five days a week over two to six weeks. 

This type delivers very high doses to the tumor over fewer treatments. Advanced imaging makes sure the radiation pinpoints your tumor and avoids healthy tissue. Our Novalis Tx machine rotates around you, adjusting to your breathing and movements. Usually, treatments are once a day for less than a week. 

This therapy is given during surgery. It lets us use a high dose precisely targeted at the area that needs treatment. Our advanced Mobetron system delivers radiation to the tumor bed (the tissue around the tumor) right after the tumor is removed. This kills any cancer cells left behind. It also delivers a week to 10 days’ worth of therapy in one dose.

When radiation therapy is given

The surgical teams at the Knight Cancer Institute, pictured here in scrubs and masks, perform dozens of complicated pancreatic surgeries a year.
Our surgical teams do dozens of complicated pancreatic surgeries a year.

Radiation therapy might be given before or after surgery, but not both. Studies show patients do best when it’s one or the other. Radiation during surgery can be combined with pre- or post-surgery radiation.

Before surgery (neoadjuvant): Radiation therapy might be combined with chemotherapy to shrink a tumor before surgery.

During surgery: See IORT above.

After surgery (adjuvant): Radiation therapy can kill any cancer cells left after surgery, improving your chances of longer-term survival.

If you’re not having surgery: You might have radiation therapy to slow the cancer’s growth and to control symptoms.

Surgery

We provide the highest level of surgical care. Our team-based approach makes surgery possible for as many patients as possible.

  • Your care team will make sure you are as healthy as possible for surgery.
  • Your pancreatic surgeons and vascular surgeons will work together to remove cancer and repair blood vessels.
  • When appropriate, we offer minimally invasive (laparoscopic) and robotic-assisted surgery.
  • We also offer complete follow-up services.

Preparation

Proper nutrition and activity in the weeks before surgery can lower your risk of complications and speed your recovery. Before surgery, you will see:

  • A cancer dietitian: A dietitian with expertise in pancreatic cancer will assess your nutrition, appetite, symptoms and activity level. She will help craft a “prehabilitation” plan to improve your nutrition and activity level. If needed, she can start you on enzyme replacement pills to ease digestion.
  • A physical therapist: A physical therapist with cancer expertise will show you exercises to improve your fitness before surgery.
  • A counselor: If needed, you and your family will receive mental health counseling.
  • Our perioperative team: Our perioperative (at the time of surgery) specialists will make sure surgery is as safe for you as possible. They might seek new scans, for example, or have your heart checked.

The Whipple procedure

The most common surgery to remove pancreatic cancer is called the Whipple procedure. It’s named after Allen Whipple, the first American doctor to do it. It’s also called a pancreatoduodenectomy.

How it’s done: The surgeon removes the head of the pancreas and sometimes the body. The surgeon may also take out the duodenum (top of the small intestine), the gallbladder, part of the bile duct and part of the stomach. The surgeon reconnects the remaining pancreas, bile duct and small intestine so you can digest food. The surgeon also reattaches the stomach and small intestine to restore your digestive tract.

Medical illustration of Whipple Procedure
Whipple surgery removes part of the pancreas. The surgeon usually removes the duodenum (top of the small intestine), gallbladder and part of the bile duct and stomach as well. The surgeon then reconnects your digestive system.

Why experience matters: This surgery is highly complex. Experienced, skilled surgeons can greatly lower risk. At the Knight Cancer Institute, our surgeons do dozens of these surgeries a year.

Vascular expertise: Our pancreatic surgeons bring in expert vascular surgeons to repair and rebuild blood vessels that have been invaded or surrounded by pancreatic cancer. This makes surgery possible for patients once considered ineligible.

For patients: This surgery is taxing, with a long recovery and a high risk of complications. This is why our team puts so much focus on preparation. It’s also why our doctors, based on their exceptional expertise, sometimes advise against this surgery for certain patients.

Other surgeries

Most pancreatic tumors develop in the head of the pancreas. This surgery is used for cancer in the body or tail.

The body, tail and spleen are removed, sometimes along with part of the stomach and/or an adrenal gland. This surgery is newer than traditional distal pancreatectomy (see below).

One benefit is it removes more lymph nodes that may be affected by cancer.

When a tumor is in the tail, the surgeon can remove it and sometimes part of the body of the pancreas and the spleen. This surgery may be done with laparoscopy, using small incisions and tiny instruments.

Scans usually provide clear results. If not, doctors might do a minimally invasive procedure to confirm the extent of your cancer before deciding next steps. They can make small incisions and use laparoscopic instruments to take a direct look.

Sometimes, the surgeon starts surgery only to find that the cancer is too advanced for removal. Your care team may proceed with the following to ease symptoms:

  • Cutting nerves or injecting alcohol into them to deaden pain.
  • Attaching your small intestine directly to your bile duct, bypassing the pancreas. This prevents cancer from blocking the duct and causing symptoms such as jaundice (yellowing of the skin and eyes) and itching.
  • Attaching your stomach lower on your small intestine. This bypasses a potential cancer blockage in the top of the small intestine. 

This surgery is rarely done for pancreatic cancer. Usually, it’s reserved for precancerous conditions (see “Preventive surgery” below).

In this surgery, your surgeon takes out your pancreas, gallbladder, spleen and nearby lymph nodes. The surgeon also removes parts of your stomach, small intestine and bile duct. 

Some patients develop a condition in the pancreas called intraductal papillary mucinous neoplasm, or IPMN. Because most of these patients will go on to develop pancreatic cancer, surgeons may recommend doing a preventive Whipple, total pancreatectomy or other surgery.

Follow-up care

After surgery, many patients need:

  • Enzyme pills for digestion
  • Insulin shots to control blood sugar

Our cancer dietitians and endocrinologists (doctors who are experts in hormones) can continue your care.

Clinical trials

As Oregon’s only academic health center, OHSU is a leader in researching new ways to prevent, detect, treat and manage pancreatic cancer. We offer clinical trials to test therapies for every stage of illness. Your care team will work to find a trial for you.

Pancreatic neuroendocrine tumors

These tumors are more likely to be resectable and slow-growing. If the tumor can be surgically removed, the only treatment you may need is a surgery called enucleation, to remove the tumor. Chemotherapy and radiation therapy are typically used only for tumors that can’t be removed and that are causing significant symptoms.

Learn more

For patients

Call 503-494-7999 to:

  • Make an appointment
  • Seek a second opinion
  • Ask questions

Location

Parking is free for patients and their visitors.

Center for Health & Healing Building 2
3485 S.W. Bond Ave.
Portland, OR 97239
Map and directions

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