Making treatment decisions about metastatic pancreatic cancer

Pancreatic cancer is cancer that begins in the cells of the pancreas, a large organ located behind the stomach. Most of the pancreas is made up of exocrine cells, which produce and release digestive enzymes. Most pancreatic cancers are adenocarcinomas, which occur when exocrine cells mutate, multiply in an uncontrolled way, and form tumors.

Metastatic pancreatic cancer occurs when these cancerous cells spread beyond the pancreas to other areas of the body, such as the lymph nodes, liver, or the lining of the abdominal cavity.

Metastatic pancreatic cancer is considered incurable, but treatment can help relieve symptoms and help a person live longer.

Treatment for metastatic pancreatic cancer

There are many different types of cancer treatments available—and the number of treatments available and the types of treatments available continue to expand. But cancer therapies can be categorized into two broad categories. One is local therapies, which treat specific tumors in specific locations in the body. Examples of localized therapies include surgery to remove tumors and radiation therapy to shrink or destroy tumors.

Systemic therapy is the second category. Systemic therapies are cancer treatments that act on cancer cells throughout the body, including tumors in locations outside the pancreas and micrometastases, small clusters of cancer cells that are still too small to be detected by imaging tests. Examples include chemotherapy, targeted therapies, and immunotherapy.

Because metastatic pancreatic cancer has spread to other areas of the body outside the pancreas, it cannot be treated with surgery. Treatment will involve systemic therapies. Chemotherapy is the main treatment, and several drugs may be taken in combination with each other.

Treatment may also include therapies to address specific symptoms being caused by pancreatic cancer, such as pain or blocked bile ducts.

It’s important to remember that metastatic pancreatic cancer is a different experience for every person. Different treatment options will be better for different people, and everyone with metastatic pancreatic cancer should work with their healthcare team to decide on a treatment plan.

Working with your healthcare team

It’s important to advocate for yourself and what you want when making treatment decisions. Work with your healthcare team to understand the goals, the benefits, the side effects, and the day-to-day impact of different treatment approaches.

Ask these questions about your treatment goals:

• What are the most important things I should know about my diagnosis?
• What treatment approach do you recommend?
• Why do you recommend this approach?
• What are the goals of this treatment approach?
• What are our next steps in treatment?
• Are there other providers or specialists you recommend I work with?

Ask these questions when starting a therapy:

• How does this therapy work?
• How is the therapy taken and how often?
• How will you know if the therapy is working?
• What side effects can this treatment cause?
• What can be done to manage side effects during treatment?
• What treatment options are available if this therapy doesn’t work?
• Should I consider participating in a clinical trial?

Ask these questions about support and quality of life:

• What can be done to manage pain, discomfort, fatigue, digestive problems, and/or other symptoms?
• What can I do to take care of my mental and emotional health?
• What can I do to keep myself as healthy as possible? What should I avoid?
• Who can I talk to if I need help or support during treatment?
• What will treatment cost? Who can I talk to if I am concerned about the cost of treatment?

If you have questions about your diagnosis, your treatment, and your quality of life while living with metastatic pancreatic cancer, your healthcare providers will be your best source of information.