A dear friend was recently diagnosed with pancreatic cancer. He had surgery, but the tumor (located at the head of the pancreas) was not removed. What, if any, treatment options does he have?

Dianne

Cancer can occur anywhere in the pancreas, but it most commonly strikes the "head," which is the part of the gland that sits just below the stomach and to the left of the upper small intestine (duodenum). A tube called the common bile duct also runs through the head of the pancreas.

One of the reasons that pancreatic cancer is so deadly is that it often does not cause symptoms until the disease is very far advanced. Cancers of the body and tail of the pancreas can become very large before causing symptoms. By that time, they have often invaded nearby organs (such as the stomach or spleen) and are no longer curable even with surgery. Cancer of the head of the pancreas typically causes symptoms earlier because of its location. A common symptom is jaundice (a yellow discoloration of the skin) caused by obstruction of the bile duct by the cancer.

The only chance for cure of any pancreatic cancer is surgical removal. For cancers of the pancreatic head, this involves an operation known as the Whipple procedure. This complicated and delicate surgery involves removal of the head of the pancreas, the duodenum, part of the bile duct, the gallbladder and part of the stomach. Even in the best of hands, the chance for surgical cure of the cancer is usually less than 20 percent.

In the many cases in which a cure is not possible, doctors use various means to make the patient as comfortable as possible. In patients in which the bile duct and/or duodenum are blocked by the tumor, surgeons may create bypasses around obstructed areas to provide a better quality of life. Another potential complication in pancreatic cancer is severe pain, presumably because the cancer impinges on nerves located deep within the abdominal cavity. This can be managed both with pain medications and occasionally with nerve blocks administered by pain specialists. Chemotherapy and radiation have been tried in some cases of pancreatic cancer, but they have met with very limited success and have often produced significant side effects.