Medical Oncology
What is a Medical Oncologist?
A medical oncologist is a doctor who specialises in treating pancreatic cancer with medication. This ‘systemic therapy’ travels via the bloodstream to destroy pancreatic cancer cells throughout the body.
The main systemic therapy used in pancreatic cancer is cytotoxic chemotherapy. Research into possible new therapies, such as targeted therapy and immunotherapy, is ongoing.
What is Chemotherapy?
Chemotherapy is the use of drugs, either single or in combination, that are toxic to pancreatic cancer cells.
Each chemotherapy ‘regimen’, has a treatment cycle during which chemotherapy is intermittently given followed by a period of recovery.
The number of cycles given depends on the regimen being used, if it is before or after surgery, or if it is needed longer term to control the cancer growth.
There are several chemotherapy drugs effective in the treatment of pancreatic cancer; the specific regimen your oncologist recommends for you will depend on several factors such as the stage of your cancer and your overall health.
When is chemotherapy given for pancreatic cancer?
Chemotherapy has several different roles in the treatment of pancreatic cancer. It may be given on its own, as the primary treatment for pancreatic cancer, or as part of a treatment plan that includes surgery and/or radiation therapy.
Neo-adjuvant chemotherapy:
This is given to shrink the tumour before surgery and increase the chance of the surgeon being able to remove it completely.
Adjuvant chemotherapy
This is given after surgery to kill any possible remaining cancer cells and reduce the risk of the cancer recurring.
It usually starts 8-12 weeks after your operation, depending on your recovery, and continues for 6 months.
Palliative chemotherapy
When it is not possible to remove the cancer with surgery (locally advanced), or it has spread to other parts of your body (metastatic), chemotherapy may be given to delay or slow pancreatic cancer growth and improve symptoms, such as increased appetite, reduced weight loss, and higher energy.
How is chemotherapy given?
Intravenous (IV): Most often, chemotherapy is given directly into a vein. It may take from a few minutes to several hours. It may be necessary for the chemotherapy to slowly infuse over several days via a small pump that you go home with. Insertion of a port under the skin may be necessary for this.
Oral: Some chemotherapy is now given in tablet form. There is still a very strict dose regimen, usually involving specific numbers of days on and off the tablets.
Where is chemotherapy given?
You will receive chemotherapy in an ‘Oncology Day Centre’, run by specialist chemotherapy nurses. It will usually take several hours to receive your chemotherapy, after which you can go home.
What are the side effects of chemotherapy?
Side effects vary widely between drugs and people.
Common side effects include fatigue, poor appetite, nausea, diarrhoea, and mouth sores. A weakened immune system may give a higher risk of infection. Additional toxicities from drugs often used in pancreatic cancer include damage to the nerve endings causing numbness and tingling in the fingers and toes (peripheral neuropathy), and redness, drying and possible blistering of the palms and soles (Hand-foot syndrome).
Your medical oncologist will discuss these in more detail. They are specialised in preventing and controlling these side effects and supporting you through the chemotherapy.
What is Targeted therapy?
Targeted therapies work by interfering with genes or proteins found in the cancer cells that are needed to grow and divide. Because these treatments work more specifically on the cancer cells, they cause different side effects and usually damage healthy cells less.
What is Immunotherapy?
Immunotherapy drugs work by modulating your own immune system to recognise and destroy cancer cells. In pancreatic cancer, immune checkpoint inhibitors may potentially benefit pancreatic cancer that is MSI-high, but less than 1% of patients with pancreatic cancer have this.