Pancreatic Cancer Treatments
We Treat Pancreatic Cancer with a Comprehensive Approach
When it comes to treating your pancreas cancer, it’s all hands on deck. Pancreatic cancer can be complicated to treat, requiring a combination of interventions depending on a variety of factors. With a full range of pancreatic cancer treatments, we look to determine the right approach for you. We collaborate with pancreatic care specialists in our Pancreatic Tumor Board, bringing expertise from across the spectrum of medicine to bear on your specific case.
Many of our specialists are part of the MedStar Georgetown Cancer Institute, which combines unmatched medical expertise, the latest therapies, and research. Our research engine is Georgetown Lombardi Comprehensive Cancer Center— the Washington, D.C. region’s only National Cancer Institute (NCI)-designated Comprehensive Cancer Center. It is also the most experienced proton therapy center in the Washington, D.C. area.
Our team will develop a strategy for treatment based on:
- Your cancer’s stage (the size of the tumor, evidence of spread outside of the pancreas, and its impact on nearby blood vessels)
- Whether your tumor is operable
- Whether your cancer is newly diagnosed or has returned
- Your overall health
- Surgery, including minimally invasive procedures
- Targeted therapy
- Clinical trials
- Palliative care and pain management
Surgery for Pancreatic Cancer
Surgery is often the preferred method to treat pancreatic cancer that has not spread or metastasized. It’s also the best way to contain tumors. Too often, doctors see later-stage disease with tumors that have spread to the lungs or liver or tumors that impact essential arteries nearby, making operations especially challenging or even impossible. We’re pioneering new ways to make these tumors operable, including chemotherapy followed by precise radiation. While pancreatic surgeries are the most complex abdominal operations, we have the most experienced team in the area, performing more procedures than any other team.
Your pancreas has three portions: a wider end (the head), a middle section, (the body) and a narrow end (the tail). Our goal in surgery is to remove the tumor completely with the surrounding lymph nodes, while preserving normal functioning of the remaining digestive tract.
Pancreas operations we perform include:
- Distal Pancreatectomy: The tail and body of the pancreas are removed, sometimes along with your spleen (splenectomy) as well, since it shares blood vessels. Minimally invasive options include robotic and laparoscopic surgery.
- Pancreaticoduodenectomy (Whipple Procedure): The head of the pancreas, the gallbladder, part of the small intestine, and the bile duct are removed. In some cases, we may also need to remove part of the stomach. The Whipple Procedure is the most common pancreatic surgery, with the best chance for a cure or long-term disease control. Research shows that this complex operation is best performed by experienced surgeons who regularly treat patients—our volume is higher than the national average. Minimally invasive options include laparoscopic and robotic surgery.
- Total Pancreatectomy: The entire pancreas is removed, as well as part of the stomach, part of the small intestine, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes. The operation is unusual and only done when the cancer has invaded the whole organ and there are no other options.
Minimally Invasive Surgery Options
Whenever possible, we take a minimally invasive approach with our surgeries, making smaller incisions and using special instruments to allow your surgeon to perform complex procedures in confined spaces. Options include laparoscopic surgery, which uses a small camera to guide surgical instruments through small incisions, and robotic surgery, which uses surgeon-directed robotic “hands” to perform complex procedures with unmatched dexterity. While conventional, open surgery is still recommended for some patients, a minimally invasive procedure means:
- Less postoperative pain
- Shorter hospitalization
- Faster recovery
- Less scarring
Our fellowship-trained surgical oncologists perform more of these procedures than any other team in the Washington, D.C. area.
Chemotherapy for Pancreatic Cancer
Depending on your pancreatic cancer, we may introduce chemotherapy in conjunction with other treatments. Often, we give chemotherapy after surgery to kill off any remaining cancer cells. Other times, it is given prior to surgery to make the tumor operable. On occasion, we will give it alone as a treatment for inoperable tumors (with or without radiation, in either case).
We are committed to tailored, personalized therapies. We are studying new chemotherapy combinations, as well as using existing drugs with newer, targeted therapies. Our clinical trials also include:
- Testing tumors for chemotherapy susceptibility
- Shrinking tumors before surgery with chemotherapy and special radiation
Our team includes internationally-renowned research physicians and one of the area’s largest and most experienced groups of medical oncologists specializing in gastrointestinal cancers.
Chemotherapy given after surgery (a typical approach) only benefits 25 percent of those undergoing successful pancreatic operations, but there is currently no way to predict the effectiveness beforehand. That’s why a specialized team of our surgeons, radiation oncologists, and medical oncologists is collaborating on a clinical trial to test the vulnerability of individual tumors before treatment starts.
The goal is to maximize the effectiveness of chemotherapy in appropriate patients, while avoiding unnecessary treatment in the rest.
Radiation for Pancreatic Cancer
Radiation therapy uses high-energy X-rays or other types of radiation to attack tumors. Physicians often try to shrink pancreatic tumors before surgery with radiation and chemotherapy, or combine chemotherapy and radiation after surgery to kill any remaining cancer cells or apply radiation if cancer returns.
Armed with the cutting-edge techniques, such as Proton Therapy with HYPERSCAN technology and the CyberKnife system, our experienced radiation oncologists are studying ways to shrink more tumors so more patients can receive surgery. Other clinical trials include a look at using a targeted therapy to make cancerous cells more vulnerable to radiation, increasing treatment effectiveness.
For pancreatic cancers, we have a variety of advanced radiation techniques, many of which we are pioneering. We are leaders in several types of radiation therapy, including:
Intensity-Modulated Radiation Therapy (IMRT)
Our radiation oncologists can change treatment intensity as they go based on tissue type, delivering specific doses to different parts of a tumor and sparing healthy tissue.
Image-Guided Radiation Therapy (IGRT)
Your radiation oncology team uses high-quality imaging to carefully adjust radiation beams and doses to best fit the size, shape, and location of the tumor, preserving surrounding tissue.
CyberKnife is an advanced external radiation technology that delivers precisely targeted, laser-like radiation through image-guidance systems and a robot arm rotating around your body. Because it’s so targeted, we can also combine that radiation more seamlessly with your overall treatment program, including chemotherapy or other systemic treatments, as well as preventing delays to surgery. You’ll benefit from a shorter radiation course and less side effects compared to conventional radiation therapies.
We were one of the first teams in the country to use CyberKnife for both newly diagnosed and recturning pancreatic cancer, and we remain among the most experienced. Learn more about CyberKnife.
Proton Therapy with HYPERSCAN™
Proton therapy with HYPERSCAN™ targets tumors precisely, preserving surrounding tissues with fewer side effects. Proton therapy can be used anywhere in the body, including the pancreas. We’re the first and most experienced team in Washington, D.C., to offer this advanced radiation treatment. In addition, we are the first in the world to offer the most advanced form of Proton Therapy with HYPERSCAN. Learn more about Proton Therapy.
Targeted Therapy for Pancreatic Cancer
Targeted therapy represents a new front in attacking cancer using medications and other substances aimed at specific molecules that cancerous tumors use to grow, progress, and spread. The idea is to target a tumor’s unique characteristics, including genes, proteins, supporting blood vessels, or host tissue, while limiting damage to healthy cells.
Targeted therapies may replace current treatments, or complement them, and we are studying a number of new targets and approaches.
A newer, very promising approach to care called immunotherapy involves stimulating your own immune system to attack your cancer. While not every patient responds to immunotherapy, in some this means less side effects with more efficient results. Our clinical trials are ongoing, granting you access to treatment unavailable elsewhere.
We offer several types of targeted therapies, many of them in clinical trials:
- Growth Factor Inhibitors: These therapies target certain surface molecules—growth factor receptors—on cancer cells that help them grow.
- Anti-Angiogenesis Factors: We block the growth of blood vessels needed by tumors.
- Drugs for Tumor Stroma (Supporting Tissue): Medications attack dense supporting tissue around pancreatic tumors to potentially make them more susceptible to chemotherapy.
- Monoclonal Antibodies: We deliver toxins or radioactive substances directly to cancerous cells by mimicking immune system proteins.
- Checkpoint Inhibitors: We allow T-cells and other components of the immune system to attack cancers and destroy tumors by releasing the normal “brakes” on the body’s immune system.
- Cancer Vaccines: These vaccines are designed to treat, not prevent, pancreatic cancer by boosting the immune system’s response.
Pancreatic Cancer Clinical Trials and Research
We are pleased to offer you access to our cutting-edge clinical trials on pancreatic cancer treatment through Georgetown Lombardi Comprehensive Cancer Center, the only National Cancer Institute (NCI)-designated comprehensive cancer center in the area, and one of only 51 in the nation. Clinical trials are research studies that test new drugs, treatments, or medical procedures to determine their effectiveness and safety.
These research studies help to inform doctors and scientists about new and emerging therapies to treat pancreatic cancer, allowing our physicians to learn what types of cancers respond best to new treatments. Combining expertise in molecular medicine, translational research, and a patient-centered philosophy, we are realizing the dream of individualized curative therapies to provide personalized medical treatment.
Learn more about the current clinical trials for pancreatic cancer treatment.
Palliative Care and Pain Management
While our medical oncologists are trained to help relieve pain during pancreatic treatment and provide other quality of life support, complex or challenging situations are often best handled by our palliative care or pain management team. Ninety to 95 percent of pancreatic cancer pain is controllable with the right help. The team provides physical, psychological, and spiritual comfort through medications, physical therapy, relaxation. and other approaches. We can help with:
- Loss of appetite
Meet the Team
Find a pancreatic cancer expert at MedStar Georgetown to meet your individual treatment needs.
- Louis M. Weiner, MD
- John L. Marshall, MD
- Aiwu Ruth He, MD, PhD
- Thomas M. Fishbein, MD
- Waddah B. Al-Refaie, MD, FACS
- Patrick G. Jackson, MD
Learn more about pancreatic cancer care at MedStar Georgetown:
- Pancreatic Cancer Risk Factors and Screening
- Pancreatic Disease Program at MedStar Georgetown
- Pancreatic Cancer Clinical Trials at Lombardi