Early treatment of pancreatic cancer has the best prognosis. However, because pancreatic cancer is difficult to detect, early treatment is rare. Prognosis depends on the following factors:

• The type and stage (extent of spread) of the cancer
• If the tumor can be surgically removed
• Patient’s age and general health
• Response to treatment
• Recent diagnosis or recurrence

Treatment options are evaluated by the patient and the cancer care team, healthcare professionals who work together to diagnose and treat cancer. The primary members of the team include a medical oncologist, surgeon and radiation oncologist.

Surgery is the only method that has potential to cure pancreatic cancer and is performed whenever possible. Most physicians who treat patients with pancreatic cancer will perform surgery only if they suspect all of the cancer can be removed during the operation. Only a small percentage of patients have pancreatic cancer that has been contained to the pancreas when it is discovered.

If a patient is a candidate for surgery, the procedures may include:

• Whipple procedure. The head of the pancreas, duodenum, gallbladder, part of the stomach and the bile duct are removed. The remaining bile duct is attached to the small intestine so that bile can drain into it. Also called pancreatoduodenectomy, this is the most common procedure for resectable (operable) pancreatic cancer. There are several variations of this procedure. Cancer of the ampulla of Vater (area where the bile and pancreatic ducts drain into the small intestine) has a 30 to 50 percent survival rate after five years using this procedure.
  
  
• Total pancreatectomy. The entire pancreas, the common bile duct, gallbladder, spleen, nearby lymph nodes and possibly part of the stomach and part of the small intestine are removed. For both pancreatectomy and the Whipple procedure, the pancreas removal causes diabetes and the patient must then receive insulin daily.
  
  
• Distal pancreatectomy. The tail and sometimes a part of the body of the pancreas are removed. The spleen may also be removed. This form of surgery is used to treat islet cell cancer (endocrine pancreatic cancer).

If the cancer cannot be removed, palliative surgery may be performed to help prevent or reduce the symptoms of cancer that has spread. These procedures include:

• Surgical biliary bypass. A new pathway to the small intestine is created due to a blocked bile duct. This prevents buildup of bile.
  
  
• Endoscopic stent placement. A stent (flexible tube) is placed in the bile duct to drain the bile into the small intestine or outside the body as needed. This is done when the tumor is blocking the bile duct and there is a buildup of bile.
  
  
• Gastric bypass. A procedure that sews the stomach directly to the small intestine to prevent blockage of food where a tumor has grown. This is done if the tumor is blocking food from the stomach to enable the patient to eat normally.

Almost all patients who have had surgery also undergo other treatments to control the effects of metastasis and the symptoms that accompany the spread of the cancer. These may include:

• Chemotherapy. Powerful drug therapy used to kill cancer cells. Chemotherapy can be administered before and/or after surgery. It targets all cells in the body regardless of location because it is a chemical method of attacking cells. Chemotherapy is used for all stages of pancreatic cancer, but has limited beneficial results. Gemcitabine is the drug used most often in treating pancreatic cancer that has metastasized to other parts of the body.
  
  
• Radiation therapy. Use of high energy x-rays to destroy or shrink cancer cells. This treatment may be performed before, after or instead of surgery. Studies have shown that radiation therapy is not as effective as chemotherapy in reaching the cancer cells that spread throughout the body through the bloodstream and the lymphatic system. Research has also indicated that radiation therapy can shorten the patient’s life.  Radiation therapy provided directly to the tumor during surgery is also being studied as a possible treatment for pancreatic cancer. 
  
  
• Biological therapy (also called immunotherapy). Use of biological agents to assist the body in its immunity against the diseased cells.
  
  
• Comfort (palliative) care. Patients may receive treatment to reduce the severity of their symptoms when the cancer itself cannot be successfully treated.

Physicians may recommend that some patients participate in clinical trials. These studies  test experimental treatments and medications that are not in widespread use. Generally, patients in the advanced stages of pancreatic cancer seek to participate in such trials because of the limitations of standard treatments. Clinical trials are conducted for all stages of pancreatic cancer. The patient’s physicians can best determine which clinical trial is appropriate for treatment.