Pancreatic Cancer Treatment

Pancreatic cancer is one of the most challenging cancers to treat because it is often diagnosed after it has grown close to major blood vessels or spread beyond the pancreas. The pancreas sits deep in the abdomen, near the stomach, duodenum, small bowel, liver, kidneys, spinal cord, and major arteries and veins. This location makes both surgery and radiation planning complex.

At ROC, we individualize radiation treatment based on the patient’s imaging, chemotherapy response, symptoms, tumor location, and surgical plan. Radiation is often considered after a period of chemotherapy, especially when scans show that the disease is not rapidly spreading and local control of the pancreatic tumor is important.

When Radiation Therapy May Be Recommended

Radiation may be part of care for:

• Borderline resectable pancreatic cancer, where treatment may improve the chance of a successful operation
• Locally advanced pancreatic cancer that cannot be safely removed at diagnosis
• As adjuvant treatment after surgery and chemotherapy to help improve local control
• Persistent tumor near major blood vessels after chemotherapy
• Pain caused by tumor pressure on nerves or nearby organs
• Local recurrence after surgery
• Bleeding, obstruction, or other symptoms from the primary tumor
• Limited metastases when local treatment may help

For locally advanced tumors, radiation may be combined with chemotherapy. Chemotherapy can make cancer cells more sensitive to radiation and helps treat disease that may be outside the radiation field.

How the Technical Planning Works

Pancreatic radiation requires careful planning because the tumor is often only millimeters away from the stomach or small bowel. These organs are sensitive to radiation, so the plan must deliver enough dose to the tumor while staying within safe limits for nearby digestive structures.

The process begins with a simulation CT scan. The patient is positioned in a reproducible way, often with custom immobilization. We may use 4D-CT to understand how the pancreas and nearby organs move with breathing. If the tumor moves significantly, motion-management tools may be used. These can include breath-hold, abdominal compression, respiratory gating, or other techniques that help keep the target in the planned position.

There are various techniques that can be utilized in radiation treatment delivery such as IMRT, or intensity modulated radiation therapy. This technique shapes the radiation dose around the tumor and involved regions. SBRT, or stereotactic body radiation therapy, is used only when the tumor and nearby organs can be treated safely with a higher dose per session. Daily image guidance is essential. Before each treatment, imaging confirms that the stomach, bowel, and tumor area are aligned as closely as possible to the treatment plan.

In plain language, pancreatic radiation is not simply “aimed at the pancreas.” It is built around a detailed map of the tumor, vessels, stomach, bowel, kidneys, liver, and spinal cord. The treatment plan is designed to treat the cancer while reducing unnecessary doses to the organs that help patients eat, digest, and recover.

Side Effects and How We Manage Them

Side effects vary depending on dose, treatment length, chemotherapy use, and whether the tumor is near the stomach or bowel.

Possible side effects may include:

• Fatigue
• Nausea or vomiting
• Reduced appetite or weight loss
• Heartburn or stomach irritation
• Abdominal discomfort or cramping
• Loose stools or diarrhea
• Temporary worsening of pain before improvement
• Rare stomach, bowel, liver, kidney, or ulcer-related complications

How we manage these effects:

• We use advanced radiation techniques and daily image guidance to protect nearby organs.
• We may prescribe anti-nausea medication before and during treatment.
• We use acid-reducing medication when stomach irritation or reflux is a concern.
• We monitor weight and nutrition closely.
• We involve dietitians when appetite, digestion, or weight loss becomes an issue.
• We encourage hydration and small, frequent meals when appropriate.
• We coordinate with medical oncology if chemotherapy timing needs adjustment.
• We follow patients closely after treatment to monitor pain, digestion, and imaging response.

Call 847-698-0600 ext. 112 to schedule a consultation.