Pancreatic Cancer Treatment Approaches

In situations where the cancer is contained within an organ (localized), surgery may be used to remove the cancerous tissue as well as a portion of tissue surrounding the area. In cases where a tumor cannot be removed by surgery (inoperable), other strategies may be considered to help relieve symptoms.

When appropriate, minimally invasive surgical procedures may be used to treat pancreatic cancer. These techniques require only small incisions to accommodate thin, flexible laparoscopic instruments.

Potential benefits of minimally invasive surgeries include:
  • Less blood loss, pain and visible incisions
  • Shorter hospital stays and recovery time
  • Fewer post-operative complications
  • Quicker return to normal activities

In addition to traditional surgical techniques, City of Hope  surgeons are highly skilled in robotic-assisted surgery, using the most advanced da Vinci S Surgical System. This system can achieve excellent results in complex lung operations . A surgeon directs and controls the movements of a specially designed robot, equipped with a camera and miniature surgical tools. At the same time, a sophisticated computerized imaging system provides real-time three-dimensional views of the surgical area, with better visualization than can be achieved with the surgeon’s eye alone.
Surgical Procedures


  • Pancreaticoduodenectomy (Whipple procedure)
    This procedure involves removing the head of the pancreas along with the bile duct and the upper part of the intestine. During the surgery, the bile system, intestine and pancreas are reconstructed with tissue from the intestine. A portion of the pancreas is preserved to produce digestive juices and insulin.
  • Total pancreatectomy
    This operation removes the pancreas, part of the stomach and small intestine, the common bile duct, gallbladder, spleen and nearby lymph nodes. A restricted diet, supplemental digestive enzymes and insulin will be necessary for patients who undergo this procedure.
  • Distal pancreatectomy
    Tumors of the tail of the pancreas are often removed by performing a procedure known as a distal pancreatectomy. This may include removal of the spleen, which is located near the tail of the pancreas.
  • Central pancreatectomy
    Tumors of the main body of the pancreas can be treated using a central pancreatectomy, a complex operation that allows the removal of the tumor while preserving most of the pancreas. This minimizes the risk of developing diabetes and problems digesting food.

Palliative Surgery Options
In some cases, surgical removal of a tumor is not recommended. This includes cases in which a pancreatic cancer has spread beyond the pancreas itself, and where tumors are affecting the blood flow to the liver or intestine. In such cases, the following procedures, called “palliative surgery,” are not curative but may be considered to relieve symptoms:
  • Surgical biliary bypass: If a tumor is blocking the bile system and causing bile to build up in the liver, a biliary bypass may be performed. The gallbladder or bile duct is attached to the small intestine to bypass the blocked area, which helps to relieve the buildup of bile and accompanying jaundice.
  • Stent placement: If a tumor is blocking the bile duct, a stent may be inserted to drain the bile that has built up in the area. The stent may bypass the blockage and drain the bile into the small intestine, or it may drain outside the body. Stents can be placed during surgery or percutaneous transhepatic cholangiography, or in an endoscopic procedure.
  • Gastric bypass: If a tumor is blocking the flow of food from the stomach, the stomach may be reattached to the small intestine, to make it easier to eat normally.

Radiation therapy uses high-energy X-rays and other types of radiation to kill cancer cells. City of Hope was the first in the western U.S. to provide treatment for pancreatic cancer using the Helical TomoTherapy System. This innovative system couples three-dimensional imaging with innovative intensity-modulated radiation therapy to target the tumor with extreme precision. The system not only provides more effective and potentially curative treatment, it reduces unwanted exposure of normal tissues and reduces potential complications.


Chemotherapy drugs destroy cancer cells by interfering with their growth and multiplication. Some chemotherapies involve an infusion of drugs into a vein or central line. City of Hope actively conducts research into finding more effective drug treatments for pancreatic cancer.

Pain Management

Pain can occur when the tumor presses on nerves or other organs near the pancreas. When pain medicine is not enough, treatments may be given to reduce pain coming from nerves in the abdomen. Medicine may be injected into the area around affected nerves, or nerves can be cut to block the transmission of pain signals. Radiation therapy may also be used with or without chemotherapy to shrink tumors, which can help relieve pain.

Nutrition Management

Surgery to remove the pancreas may interfere with the production of pancreatic enzymes that help to digest food. As a result, patients may have problems digesting and absorbing nutrients into the body. To prevent malnutrition, medicines may be prescribed to replace these enzymes