Pancreatic Cancer

Potentially curative surgery

Surgery is the treatment of choice for pancreatic cancer, but can only be used if the cancer is small and hasn’t spread. It is the only treatment that can cure pancreatic cancer, but only 15-20% of patients are suitable for such surgery (NHS Choices 2014).
Doctors had told some people that they were suitable candidates for surgery which might lead to a cure. Most felt lucky that surgery was possible and were convinced that surgery was the only option. However, a few people took a little while to decide to have surgery and wondered if it was right for them. Some had felt anxious before the operation.
Several people we interviewed had had a Whipple’s operation. Their cancer had been in the head of the pancreas. During this operation surgeons usually remove part of the stomach, part of the duodenum, the head of the pancreas, the common bile duct and the gall bladder. Some had a pylorus-preserving pancreatoduodenectomy, in which all these organs were removed except for the stomach. Vicky had a rare pancreatic cancer, a neuroendocrine tumour. Before her Whipple’s operation the doctor did an embolisation procedure. Embolisation is the blocking of an artery - a blood vessel supplying an organ - to stop blood flow. Vicky’s doctors blocked an artery going to her tumour and thus reduced the blood supply to the tumour, in an effort to shrink it and to reduce the possibility of haemorrhage during the Whipple’s operation.
People said that their Whipple’s operation took up to nine hours. Most people had an epidural injection before the operation to help control pain as well as a general anaesthetic. They left the operating theatre with intravenous infusions, a catheter, and drains. Some also had a naso-gastric tube or a percutaneous endoscopic gastrostomy (PEG) feeding tube (a tube which goes directly into the stomach through the abdominal wall). Two people had a feeding tube that went directly into the jejunum (middle section of the small intestine); this is called a JPEG tube.
After the operation people went into the intensive care unit for a few days; they were very drowsy and largely oblivious to what was happening around them. People had felt relieved to have survived such major surgery. Some said they felt very ‘safe’ in the intensive care unit because the staff were so attentive. Lesley had had her own nurse and called the nursing care ‘fantastic’. Most people said that pain was well controlled by the epidural or by a morphine pump. However, some, such as Fred, experienced bad side effects from morphine or tramadol (such as nausea or dizzy spells), and described their time in intensive care as ‘very painful’. At first people could sip only a little water. After a while they started to eat small quantities of food.
After a few days in intensive care people moved back to the main ward. Some felt rather nervous about that because the nurses were very busy and they feared lack of attention. However, one man had a ‘sense of achievement’, knowing that he had put his trust in the staff and that everything was going well. Once back on the ward, if recovery went according to plan, a nurse or doctor removed the drains and catheter and gradually stopped intravenous fluids. As people became stronger they were encouraged to get out of bed and to shower. Physiotherapists helped with mobility and strengthening exercises. Eating was often difficult at first but people gradually learned what they could and couldn’t eat.
People had had various postoperative problems, including nausea, vomiting, infections and hernias. Vicky had a paralytic ileus (inactivity of the bowel), and so had to go home with her JPEG feeding tube in place (see Vicky’s interview below), and one woman had unexplained bleeding from the back passage. Most people we interviewed went home after two to four weeks ~(it can be as short a stay as a week), but some were in hospital for longer than four weeks. Before people went home the nurses usually took out the stitches or staples that held the incision together. Lesley had 67 staples.

Some regional centres also use enhanced recovery programmes (ERPs) that aim to speed up recovery, reduce the length of time patients spend in hospital and improve patients’ experience. Each centre has its own programme, which will include precise details of what should happen every day, both before surgery and while in hospital. These might include what to eat and drink, what exercise to do, and how the person will be monitored. Not all patients will be suitable for an ERP. None of those we interviewed had been through an ERP.
 
People had been relieved to be home but still felt very weak and tired, and needed analgesics. One man decided to sleep downstairs for the first two months because he found it hard to climb the stairs. Ann had lost two stone in weight and needed to rest several times a day. She also had headaches which worried her. Fred had a lot of pain along the line of his incision. Some people had wound infections which needed regular dressing by the district nurse. Some people’s GP also visited or phoned. May developed a wound infection and went back to hospital for a few days. Others recovered more quickly and became mobile, walking a little further each day. Tony, for example, recuperated at home for two or three weeks and then felt well enough to do a little gardening and painting.
Weeks after surgery many people still felt exhausted at times but gradually felt strong enough to resume normal activities, enjoy life and go on holiday. A few went back to work. Others had to retire, partly because they needed further treatment, such as chemotherapy. Recovery can take several months and for some people up to a year.
 
Some people we interviewed had had cancer in the tail or in the body of the pancreas rather than its head. They had an operation called a distal pancreatectomy. Two people had their spleen removed too and needed to take antibiotics long term due to the resulting loss of immunity. Peter (Interview 36), who had a neuroendocrine tumour, also had part of his tumour removed from the portal vein. After surgery these people also went to the intensive care unit before returning to the ward. Like those who had had a Whipple’s operation, they had intravenous fluids, drains and a catheter, and a large incision. After one or two weeks in hospital they went home. As after the Whipple’s operation, some people recovered fairly quickly but others took many weeks. Davinder, for example, was very weak and tired when she got home and needed help with personal care for three weeks. She also needed special equipment to help her get in and out of bed. She twice had to go back to hospital because of urinary and abdominal infections.

In some people potentially curative surgery was not possible. They had surgery to relieve symptoms such as jaundice or vomiting due to bowel obstruction (see ‘Treating the initial symptoms’). 

Last reviewed June 2015.
Last updated June 2015.

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