If you’ve been diagnosed with pancreatic cancer, your doctor will first want to find out what stage cancer you have. Staging helps your doctor design the best treatment course. The stage tells whether the cancer has spread within your body, and if so, where it’s located.
Pancreatic cancer is often diagnosed at a late stage because it tends not to show symptoms early on. Stage 4 pancreatic cancer means the cancer has spread to other organs, typically the liver or the lungs. You can’t cure the cancer at this point, but you still have treatment options.
It’s important to understand what treatments are available to you, so you can make the right decisions.
For stage 4 cancer, your doctor might recommend one or more of the following treatments:
Chemotherapy. This treatment uses drugs that kill cancer cells or stop them from dividing. Chemotherapy is given either by a pill or intravenously through a vein.
Gemcitabine (brand name: Gemzar) is the most commonly used drug for late-stage pancreatic cancer. You may get this drug alone, or combined with other drugs such as albumin-bound paclitaxel (Abraxane), erlotinib (Tarceva), or capecitabine (Xeloda). Chemotherapy may also be given in combination with radiation (this is called chemoradiation), a procedure that kills cancer cells with high-energy rays. Some common side effects are hair loss, fatigue, and increased risk for infection.
Palliative pain treatments. As your tumor grows, it can put pressure on nearby nerves and organs. This can cause pain and discomfort. Your doctor might give you an injection of pain medicine, or cut the nerves that are causing the pain sensation. This treatment doesn’t cure the cancer, but it can make you feel more comfortable.
Palliative surgery. Surgery at this stage can’t remove the cancer, because it has spread too far. However, it can relieve any blockages the tumor has created. There are three kinds of surgery that may be done for stage 4 pancreatic cancer:
- Bypass surgery is an option if the tumor is blocking the common bile duct. The liver normally releases a substance called bile, which helps with digestion. Bile is stored in the gallbladder. It then travels through the common bile duct to the intestines. From there, it’s removed from the body in the stool. When a tumor blocks the small intestine, bile can build up in the body and cause jaundice, which is the yellowing of the skin and eyes. Bypass surgery connects the bile duct or gallbladder directly to the small intestine to get around the blockage; this procedure is known as a choledochojejunostomy.
- A stent is a thin metal tube that’s placed inside the blocked bile duct to open it up so that bile can drain. The bile may drain to the outside of the body, or into the small intestine. A stent can also be used to keep the small intestine open if the cancer is blocking it. You may need to have another surgery to place a new stent after a few months since the tumor can eventually grow and block the stent.
- Gastric bypass is surgery that attaches the stomach directly to the small intestine. It can be used to circumvent a tumor that’s blocking food from leaving your stomach (referred to as gastric outlet obstruction) and reaching your intestine.
The available treatments for stage 4 cancer generally won’t stop your cancer from growing. But don’t give up hope if your doctor says there are no other treatments left to try. Researchers are testing new cancer therapies in clinical trials.
When you enroll in one of these trials, you’ll have a chance to test a new treatment that isn’t yet available to the general public. The study you’re in might eventually lead to a new breakthrough therapy for pancreatic cancer.
Ask your doctor about clinical trials, or look for open trials online.
Getting treatment for a late-stage cancer can be confusing and stressful. If you start to feel overwhelmed, ask your medical team, family, friends, and counselors for help and support.