Surgery and cancer of the pancreas This information is an extract from the booklet Understanding cancer of the pancreas. You may find the full booklet helpful. We can send you a free copy see page 8. Introduction Contents Introduction Removal of the cancer (resection) After your operation Pain control (analgesia) Insulin and enzyme replacement Surgery to relieve symptoms Some people who have early-stage pancreatic cancer are able to have an operation to remove it, which is called a resection. Early stage means the cancer is contained in the pancreas or has spread to tissues nearby but hasn t grown into large blood vessels or spread to organs far from the pancreas. Surgery can also be used to relieve symptoms if the cancer is blocking the bile duct or the bowel. Removal of the cancer (resection) Occasionally, it s possible to remove all of the cancer with surgery. This is a major operation. It is only suitable for people with early-stage pancreatic cancer but it may cure the cancer in some people. This type of surgery should be done by specialist surgeons who are trained and experienced in pancreatic surgery, so you may need to be referred to a specialist centre for the operation. It s important to discuss the benefits and risks with your surgeon before making the decision to go ahead with any surgery. Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk Page 1 of 8
Depending on where the cancer is, and how much of the pancreas is involved, all or part of the pancreas may be removed during surgery. Your specialist may suggest that you have a laparoscopy to see which type of surgery is possible in your case. A laparoscopy is an operation done under a general anaesthetic. The surgeon makes a small cut (about 2cm/1in) in the skin and muscle near the belly button. They then insert a thin tube with a tiny camera and light on the end, called a laparoscope, into your abdomen. The doctor uses the laparoscope to look at the pancreas and surrounding tissues. One of the following operations may be done to treat pancreatic cancer: A pylorus-preserving pancreatoduodenectomy (PPPD), also called a modified Whipple s operation. This involves removing the head of the pancreas, most of the duodenum, the common bile duct, gall bladder and the surrounding lymph nodes. It is most commonly used for people with cancer in the head of the pancreas. a pancreatoduodenectomy or Whipple s operation this is similar to the PPPD operation, but the lower part of the stomach is also removed. removal of the whole pancreas (a pancreatectomy) removal of the lower end (body and tail) of the pancreas (a distal pancreatectomy). Page 2 of 8 Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk
Before a Whipple s operation Liver Stomach Gall bladder Head of pancreas Duodenum Common bile duct Tail of pancreas The sections in white show the parts of the body that are removed during a Whipple s operation. Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk Page 3 of 8
After a Whipple s operation Liver Remaining stomach Small bowel Tail of pancreas The surgeon attaches the remaining part of the stomach, the remaining bile duct, and the tail of the pancreas to the small bowel. After your operation Most people will be nursed in the intensive care or high-dependency unit for a few days after their operation. This is routine and doesn t mean your operation has gone badly or that there are complications. A machine called a ventilator may be used to help you to breathe for a few hours again, this is routine in some hospitals. The nurses will encourage you to start moving about as soon as possible after your operation. This is an essential part of your recovery, as it helps to prevent problems such as chest infections or blood clots. If you have to stay in bed, the nurses will encourage you to do regular leg movements and deep breathing exercises. A nurse or a physiotherapist can help you do the exercises. Page 4 of 8 Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk
The physiotherapist got me up and standing up. Then after a couple of days they brought one of the little frames, to support me. After a day, I went for a walk along the ward. I did that for a couple of days and then I got better and better. Fred Drips and drains After the operation, you may have some of the following in place for a short time: A fluid drip going into a vein in your arm or neck (intravenous infusion). This will give you fluids until you are able to eat and drink again. It may also be used to give you painkillers. A fine tube going into your back (epidural). This may be used to give you drugs that numb the nerves and stop you feeling sore. A feeding tube that goes into the small bowel through a small cut in the abdomen. It is used to give you food and nutrients until you re able to begin eating again. A fine tube that passes down your nose and into your stomach or small intestine. This is called a nasogastric tube and it allows any fluids in the stomach to be removed so that you don t feel sick. You may need this for up to five days. A small flexible tube (catheter) to drain urine from your bladder into a collecting bag. This will save you having to get up to pass urine and is usually taken out after a couple of days. One or more drainage tubes coming from your wound to collect any extra fluid or blood, or to drain bile or pancreatic fluid. These will be removed when the amount of fluid draining has reduced. Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk Page 5 of 8
Pain control (analgesia) After your operation you ll need painkilling drugs for a few days. To begin with, you may be given painkillers into the space around the spinal cord. This is called epidural anaesthesia. It numbs the nerves in the part of your body where you ve had your operation. If you have an epidural, before the operation, a fine tube is placed into your back, close to the spinal cord nerves. The tube is attached to a syringe in an electronic pump. The pump gives you a continuous infusion of medicines to numb your nerves and control pain. You may also have a hand control with a button you can press to give you a boost of painkilling medicine if you feel sore. This is called patient controlled epidural analgesia (PCEA). It is designed so that you can t have too much painkiller (an overdose), so it s okay to press it whenever you are uncomfortable. Because the tube is very fine, you can still lie on your back when you have an epidural in place. You are also able to sit up and walk around while having this type of pain control. Some people are given painkilling drugs into a vein (intravenously). These can be given continuously through an electronic pump. Pain can usually be controlled effectively with painkillers. It s important to let your doctor or the nurses on the ward know if you are in pain so that the dose can be increased or the painkillers changed as soon as possible. When you are ready to go home, your pain will be controlled with tablets, and you ll be given a prescription of painkillers to take as needed at home. Page 6 of 8 Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk
Insulin and enzyme replacement If you ve had a part of your pancreas removed, immediately after the operation the remaining pancreas may not be able to make enough insulin to control your blood sugar. You may need to have insulin given by injection into a vein. This is usually only until the remaining pancreas recovers and starts to make insulin again. If you have an operation to remove your entire pancreas, you ll need to continue with daily insulin injections. These are given under the skin (subcutaneously). You may also need to take capsules containing the digestive enzymes (pancreatin) normally made by the pancreas. Digestive enzymes help your body to break down and absorb fats and protein. If you don t have enough of them, you may have diarrhoea or your stools may float, look pale and smell offensive. You ll also find it difficult to put on weight because you can t absorb nutrients from your food. I was getting bouts of diarrhoea. I started taking pancreatin with everything that I eat. And it does help a great deal. Helen Surgery to relieve symptoms Bypass surgery for a blocked bowel If the first part of your small bowel (the duodenum) becomes blocked by the cancer, food or drink can t pass from your stomach through to your bowel. The food builds up in your stomach, makes you feel sick and causes vomiting. An operation to bypass the blockage can help. The surgeon connects the part of your small bowel just below the duodenum directly to your stomach. This allows food to pass from the stomach into your bowel. This operation is often done at the same time as an operation to relieve a blocked bile duct. An alternative way of treating a blockage in the duodenum is to place a tube called a stent in the duodenum. Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk Page 7 of 8
Bypass surgery for a blocked bile duct If cancer blocks the bile duct, causing jaundice, your doctors may suggest you have a tube called a stent placed in the bile duct during an endoscopy. If this is unsuccessful or not possible, you may be offered surgery to relieve the blockage. The bile duct (or occasionally the gall bladder) is cut above the blockage and reconnected to the small bowel. This bypasses the blocked part of the bile duct and allows the bile to flow from the liver into the bowel. The jaundice will then clear up. In some hospitals, it s possible to do this procedure during laparoscopy. Another way of treating a blockage in the bile duct is to place a stent in the duct. We can send you more information on stents and on laparoscopies. More information and support More than one in three of us will get cancer. For most of us it will be the toughest fight we ever face. And the feelings of isolation and loneliness that so many people experience make it even harder. But you don t have to go through it alone. The Macmillan team is with you every step of the way. To order a copy of Understanding cancer of the pancreas, visit be.macmillan.org.uk or call 0808 808 00 00. We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or thirdparty information or websites included or referred to in it. Macmillan Cancer Support 2013. Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ REVISED IN MAY 2013 Planned review in 2015 Page 8 of 8 Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk