Pancreatic Cancer

Treatment for a recurrence or for metastases

When pancreatic cancer comes back in the area of the pancreas or spreads elsewhere, such as the liver or the lungs, more treatment may be offered. The goal may be to eliminate some of the tumours, to slow the cancer’s growth, to relieve symptoms, and to improve the quality of life (also see ‘Pain management and other palliative care’).
Most people said when their cancer recurred they had received chemotherapy (for details of the drugs used and how they are given see ‘Chemotherapy’). Some of them had it in a clinical trial (see ‘Clinical trials’). The chemotherapy drugs used to treat disease recurrence or spread were not always those that they had had before.
Quite often as with Peter (Interview 43 above), a low blood count postponed chemotherapy treatments. Some drugs, such as gemcitabine, can reduce the production of white blood cells made by the bone marrow. This makes people more prone to infection. These drugs can also reduce the production of platelets, which enable the blood to clot and stop bleeding. They can also reduce the number of red blood cells, making people prone to anaemia (see ‘Side effects of chemotherapy’).
Some people continued with chemotherapy, others had stopped it after a few months because their tumours had shrunk or they were having bad side effects. People whose tumours had shrunk had periods of ‘watchful waiting’ during which the disease was monitored by scans or blood tests for the tumour marker CA19-9, and more treatment was given if necessary. Bob had inoperable cancer. After having gemcitabine and then taking part in a clinical trial he was given fluorouracil (5FU) and mitomycin, which helped to control his pain and brought down the CA19-9 tumour marker. He was expecting to stop this treatment soon.
After David’s (Interview 09) recurrence he took part in a clinical trial which included gemcitabine, capecitabine and erlotinib. He vomited blood and passed blood from his back passage, and the bleeding could have been due to the drugs. As the treatment went on he found it harder to tolerate.
Some people had radiotherapy as well as chemotherapy after a recurrence (see ‘Radiotherapy and chemoradiotherapy’). Audrey, for example, had both at the same time. She understood that radiotherapy would not cure her cancer but hoped that it would keep the symptoms under control. It did stop her pain. David (Interview 09) had radiotherapy after finishing his chemotherapy. Adrian had one session of radiotherapy for the pain from a secondary tumour at the top of his leg. Others had Cyberknife treatment, a form of radiotherapy (see ‘Cyberknife sterotactic ablative radiotherapy (SABR) and its side effects’).
Vicky had a rare type of pancreatic cancer, a neuroendocrine tumour. When it spread to the liver the secondaries were treated with radiofrequency ablation which uses heat to destroy cancer cells. An electrode probe applies an electric current which heats the cancer cells to high temperatures, killing them. This type of treatment is particularly suitable for neuroendocrine cancers that have spread to the liver. Before treatment starts doctors need to make sure that the cancer is well controlled elsewhere in the body.

Helen did not have a neuroendocrine tumour but she had also hoped to have radiofrequency ablation for a tumour in her liver. However, when a CT scan showed that another tumour had appeared in her liver the consultant told her that he needed to make sure that no more tumours were going to appear before he would consider using this treatment. This disappointed and upset Helen. Her consultant told her she could join in the TeloVac trial, and Helen has been having chemotherapy in that trial for the past nine months.  

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Last reviewed September 2018.
Last updated June 2013



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