Chemotherapy is a treatment using substances that spread through the blood to kill or slow cancer cells. Some people with pancreatic cancer receive chemotherapy before or after surgery. Chemotherapy can also be used to treat metastatic pancreatic cancer. The goal of chemotherapy in this case is to improve the quality of life and reduce symptoms.
How does chemotherapy work?
Chemotherapy is a treatment with cytostatics (cytos = cell, statis = standstill). These are drugs that kill cancer cells or inhibit their division. These drugs spread throughout the body through the bloodstream and can reach cancer cells at almost any location. Chemotherapy is particularly suitable for treating malignant tumors because cancer cells are characterized by accelerated cell division, often combined with a damaged cell repair mechanism. This makes them much more sensitive to cytostatics than normal, healthy cells. Unfortunately, chemotherapy also kills healthy cells. Therefore, you are likely to experience side effects.
To determine the effectiveness of the chemotherapy, a CT scan will be performed, and your blood will be tested. Your fitness to continue will also be determined in consultation with you. If necessary and possible, adjustments will be made to the amount of chemotherapy you receive, how often you receive it, or the composition of the chemotherapy. Sometimes a less potent drug will be switched, or you and your doctor will decide together that it’s best to stop.
Types of chemotherapy for pancreatic cancer
The most commonly used chemotherapy is FOLFIRINOX. This is a combination of four different agents: folinic acid, fluorouracil, irinotecan and oxaliplatin. However, treatment with FOLFIRINOX is an intensive treatment suitable only for fit patients. If you are less fit, you will receive a less intensive chemotherapy regimen. This can be achieved by adjusting the amount or composition of FOLFIRINOX, or by gemcitabine + nab-paclitaxel, a drug with fewer side effects.
Administration of chemotherapy
Chemotherapy treatment is a course of treatment according to a fixed schedule. You receive medication for a period of time, followed by a period where the treatment stops. Treatment often consists of a series of chemotherapy treatments, usually twelve, administered every two weeks. The chemo is administered through an IV. This is either a PICC line inserted into a blood vessel in the arm or a Port-a-cath placed under the skin.
You will receive anti-nausea medication during chemo. You may experience a painful, tingling sensation in your arm. A warm cloth over your arm will help. Shortly after chemo, you may experience a strange feeling in your throat. This will disappear on its own.
Chemotherapy before surgery
If you have pancreatic cancer, you may receive chemotherapy before surgery to remove the tumor. Chemotherapy shrinks the tumor, making it easier for the doctor to remove it ‘radically’, meaning completely. The surgeon will discuss with you whether chemotherapy before surgery might be beneficial. Chemotherapy before surgery is also called ‘neoadjuvant treatment’. Sometimes this chemotherapy is combined with radiation therapy.
Your doctor will tell you if you are eligible for chemotherapy (+/- radiation) before surgery. The stage of your pancreatic cancer matters at this stage. Chemotherapy before surgery is standard for people with borderline resectable pancreatic cancer, where the tumor has also grown into a major blood vessel. For resectable pancreatic cancer, where the tumor appears to be entirely removable and has not, or only minimally, grown into major blood vessels, chemotherapy before surgery is not common, but it is sometimes available as part of a trial.
If you are in good condition, you will likely receive FOLFIRINOX. If you are not in good health, you will receive a less intensive chemotherapy regimen, such as gemcitabine + nab-paclitaxel.
Chemotherapy after surgery
You will usually also receive chemotherapy after pancreatic cancer surgery. The doctor uses chemotherapy to destroy any remaining cancer cells. Sometimes chemotherapy is given both before and after surgery.
The video below explains chemotherapy treatment before or after surgery for pancreatic cancer.
Video chemotherapy before or after surgery for pancreatic cancer
The video ‘chemotherapy before or after surgery for pancreatic cancer’ is only available in Dutch. That is why we made a video transcript in English.
Chemotherapy for metastatic pancreatic cancer
Chemotherapy can be a treatment for metastatic pancreatic cancer. This treatment focuses primarily on slowing the progression of the disease and/or reducing or preventing cancer-related symptoms, such as pain.
If your condition is suitable, your doctor will discuss the various chemotherapy options with you. While patients were previously treated with the chemotherapy drug gemcitabine as a standard treatment, research has shown that survival after treatment with FOLFIRINOX for metastatic pancreatic cancer is significantly better than with gemcitabine (11.1 and 6.8 months survival, respectively). In addition to the improved effect of FOLFIRINOX on life prognosis of patients with metastatic pancreatic cancer, it has been shown that 10 to 20% of patients can still undergo surgery after the treatment.
If FOLFIRINOX is too strong, the amount or composition can be adjusted, or a switch can be made to the combination of gemcitabine + nab paclitaxel.
Watch the video below explaining chemotherapy treatment for metastatic pancreatic cancer.
Video chemotherapy for metastatic pancreatic cancer
The video ‘chemotherapy for metastatic pancreatic cancer’ is only available in Dutch. That is why we made a video transcript in English.
Side effects of chemotherapy for pancreatic cancer
Whether you experience side effects depends, among other things, on the types and amounts of cytostatics you receive. Ask your doctor about the possible side effects of chemotherapy.
Side effects may include:
- sore mouth.
- different taste.
- nausea.
- decreased appetite.
- diarrhea.
- blockage.
- feeling tired.
- a flu-like symptoms.
- pain in muscles and joints.
- shortness of breath.
- more proneness to infections.
- bleeding.
- anemia.
- skin problems.
- hair loss.
- a ‘chemo brain’.
- cholinergic syndrome.
- tingling or pain in your hands or feet (neuropathy).
- heart problems.
If you experience these symptoms, discuss them with your doctor. Unnecessary suffering is unnecessary: doctors often have solutions, such as medication.
Sometimes, however, the side effects are so severe that the doctor adjusts the treatment. For example, by lowering the medication dose or extending the rest period between treatments.
You may want to stop chemotherapy yourself, or your doctor may suggest it. When making a decision, it’s good to consider what’s important to you and to discuss this with your loved ones and your doctor.
If you experience the following symptoms, you should contact your doctor immediately:
- fever (above 38 °C).
- nosebleed that won’t go away.
- bruises, not the result of falling.
- a wound that continues bleeding.
- blood in the stool or urine.
- shortness of breath or coughing.
- pressure on the chest.
- lack of ability to eat or drink properly.
Chemotherapy and sexuality
Many people wonder if they can safely have sex while undergoing chemotherapy. If you are undergoing chemotherapy, this is not an obstacle to sexual contact. These treatments are not harmful to your partner. However, personal hygiene is important in the first few days after chemotherapy.