Pancreatic Cancer: Chemotherapy

What is chemotherapy?

Chemotherapy (chemo) uses medicines that kill cancer cells. The medicines are made to kill cells that grow quickly, like cancer cells. But some normal cells also grow quickly. Because of this, chemo can also harm those cells. This can cause side effects.

When might chemo be used for pancreatic cancer? 

Chemo is part of the treatment for most people with pancreatic cancer. Your healthcare provider may advise chemo in any of these situations:

• If you have pancreatic cancer that hasn't spread to distant parts of your body, but it’s not clear that all of the cancer can be removed. You may get chemo (often along with radiation therapy) as the first treatment. This is to try to shrink the tumor and make surgery possible. Treatment before surgery is called neoadjuvant therapy. 

• If you have surgery to remove the cancer as your first treatment. You may get chemo (often along with radiation therapy) after the surgery. This is to try to make sure all the cancer cells are killed. This is called adjuvant chemotherapy.

• If you have cancer that can't be removed with surgery or that has spread to other parts of your body. Chemo is often part of treatment.

• If you're not healthy enough for surgery. Chemo may be a choice.

How is chemo given for pancreatic cancer?

Before treatment starts, you’ll meet with a medical oncologist. This is a healthcare provider who specializes in treating cancer with medicines like chemo. The provider will talk about your treatment choices with you and explain what you can expect. 

Depending on which chemo medicine you’re taking, you may get them in one of these ways: 

• ByIV (intravenous).  The chemo is given through a small tube (catheter) that has been put into a vein. The medicine may drip in slowly over several hours or even days, or it may be given more quickly over a few minutes. When chemo is given over days, people often go home with a small infusion pump (in a bag that looks like a waist pack) that’s disconnected later.

• By mouth (oral). You swallow these medicines as pills.

Chemo is often given in an outpatient setting. This means you get it at a hospital, chemotherapy clinic, infusion center, or healthcare provider's office, and you can go home after the treatment. Less often, you may need to stay in the hospital during treatment. You'll be watched for reactions during your treatments. Since each chemo treatment may last for a while, you may want to take along something that is comforting to you, such as music to listen to. You may also want to bring something to keep you busy, like a book or mobile device.

To reduce the damage to healthy cells and to give them a chance to recover, chemo is given in cycles. Each cycle consists of one or more days of treatment, followed by some time to rest. The length of the cycle depends on which chemo medicines are given. Cycles may last 2, 3, or 4 weeks. Most people get up to 6 months of chemo as part of their initial treatment. Your healthcare provider will talk about your schedule with you.

What chemo medicines are used to treat pancreatic cancer?

These are some common chemo medicines used to treat pancreatic cancer:

• Albumin-bound paclitaxel (nab-paclitaxel)

• Capecitabine

• Cisplatin

• Docetaxel

• 5-fluorouracil (5-FU)

• Gemcitabine

• Irinotecan

• Irinotecan liposome

• Leucovorin (folinic acid)

• Oxaliplatin

• Paclitaxel

Two or more of these medicines are often combined as the first treatment. One of the most commonly used combinations is called FOLFIRINOX. It's made up of:

• FOL = folinic acid (leucovorin calcium)

• F = fluorouracil

• IRIN = irinotecan hydrochloride

• OX = oxaliplatin

People who aren't healthy enough to get two or more medicines, or people who have already gotten chemo, may only get one chemo medicine.  

What are common side effects of chemo?

Side effects of chemo are different for everyone. They vary based on the medicines you get. Below is a list of some of the most common side effects from chemo. When you get more than one chemo medicine and when radiation is given along with chemo, side effects tend to be worse. Ask your healthcare provider what side effects to watch for. Be sure to tell your provider about any changes you notice or problems you have. There are often things that can be done to ease side effects or keep them from getting worse.

Hair loss

If you have hair loss, much of the hair will grow back over time after the treatment stops.

Nausea and vomiting

This side effect can often be controlled with medicines. Getting help early from your healthcare provider can prevent complications such as weight loss and dehydration.

Mouth sores

Chemo can sometimes cause mouth sores. This might make it hard for you to eat or swallow. It's important to keep your mouth very clean and not eat foods or have drinks that could irritate your mouth. Your healthcare provider may recommend special mouth rinses to help.

Diarrhea

If you have diarrhea, take antidiarrheal medicines as prescribed by your healthcare provider. You may also need to make changes in your diet.

Loss of appetite or changes in the way things taste

Talk to your healthcare provider if you find you’re having trouble eating or are losing weight. There are often ways to help.

Increased risk of infection

During chemo, your white blood cell count may drop. This means your immune system won’t be working as well as it normally does. Try to stay away from people who have illnesses that you could catch. It’s also a good idea to take extra safety measures against cuts and scrapes that could become infected. Your healthcare provider will check your blood counts regularly during your treatment. Let your healthcare provider know if you have any signs of an infection. Symptoms can include fever, sore throat, a new cough, or burning during urination.

Bleeding and bruising more easily

Chemo can also lower your blood platelet counts. Platelets are needed to help the blood clot well. 

Fatigue

You may feel tired while getting chemo. This normally goes away once treatment ends. 

Nerve damage

Some other side effects can also be seen with certain chemo medicines. For example, cisplatin, carboplatin, and some other medicines can cause nerve damage (neuropathy). This can lead to pain, tingling, and numbness in your hands and feet. These may go away slowly after treatment ends. But it may be permanent. Oxaliplatin can make you super sensitive to cold. You may have pain if you swallow cold food or liquids or touch cold things. This can last for a few days after each infusion.

Working with your healthcare provider

It's important to know which medicines you're taking. Write down the names of all your medicines. Ask your healthcare team how they work and what side effects they might cause.

Talk with your healthcare providers about what signs to look for and when to call them. For instance, chemo can make you more likely to get infections. Make sure you know what number to call with questions. Is there a different number for evenings and weekends or holidays?

It may be helpful to keep a diary of your side effects. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.