Prior to surgery, additional procedures to decompress obstruction of the bile ducts if present might be undertaken. This can be in the done with a tube inserted into the bile duct via endoscopic (ERCP) access, or with a tube inserted directly through the skin into the liver known as Percutaneous Transhepatic Biliary Drainage (PTBD). The operative procedure depends on the location of the tumour.
Also known as pancreaticoduodenectomy, this operation is undertaken for tumours arising from the head of pancreas. It entails removal of the head of pancreas, together with part of the stomach, the first part of the small intestine as well as the bile duct. In some cases, the stomach may not be removed, and this is known as pylorus preserving pancreaticoduodenectomy (PPPD).
This is done for removal of pancreatic tumours that are located in the neck, body or tail of pancreas. The spleen may also be removed as part of the operation, but it may also be left intact when the nature of the tumour allows it. This operation is often carried out via laparoscopic (keyhole) access. Robotic surgery is also done for this type of surgery. Large tumours with extension beyond the confines of the pancreas may still require conventional open surgery.
These may be administered following surgery to improve the chances of disease free survival and cure. In cases where the cancer has already spread, or is too extensive for surgery, or where the cancer has recurred, chemotherapy and occasionally radiotherapy is offered as a palliative treatment.
Patients who have been operated on for pancreatic cancers will be on surveillance for possible recurrence of the tumour. This is done through scans as well as blood tests for cancer markers. Patients will also be monitored for possible development of deficiency of digestive enzymes or blood sugar regulatory hormones that are produced by the pancreas.