Pancreatic cancer is cancer that starts in the pancreas, an organ that sits behind your stomach. Your pancreas helps your body digest food and regulate blood sugar.
If your pancreatic cancer is deemed inoperable, it means that doctors can’t remove the cancer surgically. Surgery may not be an option because the cancer has spread to other areas in your body or it’s in a problematic location, such as nearby blood vessels.
According to the National Cancer Institute (NCI), almost 58,000 Americans may receive a pancreatic cancer diagnosis in 2020.
Read on to learn more about three types of inoperable pancreatic cancer and which treatments are available.
Your doctor might say your condition is inoperable if the cancer has metastasized. This means your tumor has spread to other parts of your body, and as a result, it can’t be removed by surgery.
If your cancer has spread to other organs, your doctor might label it as stage 4.
A locally advanced tumor is one that hasn’t spread to other organs but still can’t be removed with surgery. A lot of times, the cancer can’t be taken out because it’s too close to major blood vessels.
Chemotherapy and sometimes radiation therapy may be recommended to help manage your disease. If your disease responds to treatment and does not spread throughout the body, you may be considered for surgical intervention.
If your cancer comes back during or after treatment, it’s known as recurring cancer. Sometimes recurring cancer can’t be operated on because it’s spread to other organs. For instance, when pancreatic cancer recurs, it commonly crops up in the liver first.
Your treatment options will depend on how much your cancer has spread and your overall health.
Pancreatic cancer is often diagnosed when the disease is more advanced because it doesn’t cause symptoms early on. By the time a person notices symptoms, the cancer may have already spread outside the pancreas.
Some tests that can spot pancreatic cancer include:
- Imaging tests. CT scans, MRIs, ultrasounds, and PET scans are all used to help doctors see the cancer inside your body. Some of these tests involve first receiving an injection of an intravenous (IV) contrast, so doctors can see more of what’s going on.
- Endoscopic ultrasound. With this procedure, your doctor will pass a thin tube down your esophagus and into your stomach to take images of your pancreas. Learn more about endoscopy.
- Biopsy. Sometimes your doctor might take a small piece of tissue from your pancreas to examine under a microscope. A biopsy can be performed using a needle or during an endoscopic ultrasound.
- Blood tests. Your doctor might use a blood test to measure liver function, certain hormone levels, or certain proteins, such as cancer antigen (CA) 19-9. Pancreatic tumor cells release CA 19-9. Blood tests aren’t always reliable, however.
These tests can help your doctor determine whether you’re a candidate for surgery. In some cases, the tests won’t reveal cancer that’s spread, and your doctor might find it when they begin to operate on you.
Even though surgery isn’t an option for inoperable pancreatic cancer, there are several available treatments. Some aim to attack the cancer, while others are used to manage your symptoms.
Chemotherapy uses special medications to kill cancer cells, and it can be delivered as an injection or an oral pill. Gemcitabine (Gemzar) is one example of a chemotherapy drug that may be used for pancreatic cancer.
In people with inoperable pancreatic cancer, chemotherapy is typically used to control the growth of cancer and improve their chance for survival. Sometimes, different chemotherapy combinations are given together.
Radiation uses high-energy beams to kill cancer cells. It’s sometimes given along with chemotherapy.
These therapies interfere with cancer cell growth by targeting specific abnormalities within cancer cells.
The Food and Drug Administration (FDA) approved the targeted therapy drug erlotinib (Tarceva) to treat pancreatic cancer.
People with advanced pancreatic cancer may be prescribed erlotinib in combination with gemcitabine (Gemzar, Infugem). Gemcitabine is a traditional chemotherapy drug.
Other targeted therapy drugs that may be used to treat pancreatic cancer include:
- larotrectinib (Vitrakvi)
- entrectinib (Rozlytrek)
- pembrolizumab (Keytruda)
Larotrectinib and entrectinib are FDA approved to treat all solid tumors that are caused by a genetic mutation known as NTRK gene fusion, regardless of the location of the tumors.
Pembrolizumab is FDA approved to treat solid tumors that have certain biomarkers and can’t be removed by surgery. These tumors are known as microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) tumors.
MSI-H and dMMR tumors both have a lot of mutations within their DNA.
Immunotherapy treatments are given to prompt your immune system to fight the cancer in your body. Immunotherapy is also known as biological therapy.
Immunotherapy’s ability to treat pancreatic cancer tumors is being studied, and it can be used alone or in combination with chemotherapy.
The targeted therapy drug pembrolizumab (Keytruda) is also an immunotherapy treatment.
Some procedures can help control specific symptoms. For example, your doctor might recommend inserting a small stent in your body to relieve symptoms of a blocked bile duct, such as jaundice, nausea, or vomiting.
Clinical trials are available to test novel treatments for inoperable pancreatic cancer. Being involved in a clinical trial could give you access to new therapies that you might not otherwise be given.
Talk to your doctor if you think you’d like to participate in a clinical trial. You can also visit ClinicalTrials.gov to search for studies in your area.
When discussing your outlook, your doctor might give you information on 5-year survival rates. This refers to the percentage of people who live at least 5 years after being diagnosed.
According to the National Cancer Institute (NCI), people who have pancreatic cancer that’s metastasized — and who were diagnosed between 2010 and 2016 — have a 5-year survival rate of about 2.9 percent.
People with pancreatic cancer who can have surgery typically live longer than those who don’t. While the best hope for survival is surgical removal of the cancer, it’s not an option for many. That’s why treatments are available to help you manage your symptoms.
It’s important to remember that survival rates are based on population-level data. They won’t tell you what will happen in your specific situation.
As newer ways to detect and treat pancreatic cancer are being discovered, these statistics may change in the future.