Sometimes surgery for cancer of the pancreas is not appropriate and, following the multidisciplinary team (MDT) meeting, it may be recommended that you be treated with chemotherapy and/or radiotherapy in the first instance.
Chemotherapy is the use of cytotoxic (anti-cancer) medicines to destroy cancer cells. It is an important treatment option for many types of cancer, and clinical trials for chemotherapy are common.
You may have chemotherapy on its own or alongside other treatments such as radiotherapy or surgery. Usually you will be given chemotherapy by injection into a vein (intravenously). You may also be able to have certain types of chemotherapy by mouth (tablets). The blood then carries the medicines around the body to reach the cancer cells.
You can have chemotherapy as a day patient or as an in-patient. It depends on what is best for you and what type of chemotherapy you are having. It is sometimes possible to have chemotherapy at home. Your oncologist will discuss with you how and where you will have your chemotherapy and any possible side-effects.
Why is chemotherapy given?
Chemotherapy can be given for several reasons:
- On its own to try and treat some cancers. The aim is to destroy the cancer cells completely.
- To try to prevent the cancer coming back after surgery or radiotherapy. The aim is to destroy any cancer cells that could possibly remain. This is called adjuvant treatment.
- To reduce the size of a cancer. Chemotherapy can be used to shrink the tumour before surgery or radiotherapy can be considered. This is called neo-adjuvant treatment.
- To shrink a cancer in order to control symptoms which may be distressing. In this case chemotherapy can be given to try to control a cancer and prolong a good quality of life.
- To increase the effectiveness of radiotherapy treatment. Chemotherapy can be used alongside radiotherapy to increase the chance of treatment being more effective. This combined approach is becoming more common.
Will chemotherapy affect my everyday life?
Chemotherapy affects different people in different ways. You may be able to carry on as normal. However, if you have to go into hospital for your treatment, you will need to make changes to your usual routines.
If there is a special occasion that you would like to attend, or you want to go on holiday, it may be possible to arrange the timing of your treatment to suit. Your oncologist can tell you whether this is possible.
Many people feel tired a lot of the time during and after chemotherapy. If you are recovering from surgery or having radiotherapy as well as chemotherapy you may feel especially tired. If this happens to you, it can help to cut down on the things you don’t really need to do.
There is some evidence that exercise, of low to moderate intensity, may substantially help this tiredness. It is best not to over do it, though. Do as much as you think you can manage, and make sure you get enough rest and sleep. It can help to cut down on the things you don’t really need to do.
You may find you are able to carry on doing everything as normal but, if you work, you may need some time off.
Planning your chemotherapy
You oncologist will consider several things when planning your treatment:
- the type of cancer you have;
- where in the body it is situated;
- whether it has spread; and
- your general health.
How often you have your treatment and how long it takes depends on the type of cancer you have, the drugs you are taking, how well the disease responds to treatment, and any side-effects you are having.
You may need several courses of chemotherapy. Your oncologist will discuss everything with you at the time.
You will need blood tests before every chemotherapy treatment. This is to check that you are fit to have treatment. It may be possible for you to have the blood taken at your GP’s surgery, two or three days beforehand. This will save you waiting around at the hospital before your chemotherapy can start.
If you are unusually afraid of needles and are having difficulty with chemotherapy because of this, please mention it to someone in your specialist team who will work out a way of overcoming this.
What are the side-effects of chemotherapy?
Although chemotherapy is very effective in treating cancer, all medicines can have side-effects. The most common side-effects are tiredness, lack of energy, nausea (feeling sick), diarrhoea and temporary lowering of the blood cells produced by the bone marrow. This increases the risk of infection.
Most of these side-effects do not last long, and can be controlled or reduced by medicines. Please make sure you discuss them with your GP or oncologist. Your specialist team will also discuss everything with you.
Not all chemotherapy medication causes hair loss, and sometimes it is so slight that the loss is hardly noticeable. Fortunately, the commonest treatment for pancreatic cancer (Gemcitabine) is not associated with major hair loss. (It affects less than 15% of patients.) The amount of hair lost depends on the medicine or combination of medicines used, the dosage given and the way a person reacts to it. Occasionally the eyebrows, eyelashes, body and pubic hair may be lost. If hair loss is going to occur, it usually starts within a few weeks of beginning chemotherapy. Very occasionally, it starts within a few days.
What can be done to reduce hair loss?
Sometimes it is possible to lessen the amount of hair loss by cooling the scalp during and after your chemotherapy treatment. You wear a sort of “cold cap”, and this reduces the amount of chemotherapy reaching the hair follicles. The type of cap used varies from one hospital to another.
Will my hair grow back after chemotherapy?
Hair loss after chemotherapy is usually temporary and begins to grow back once your treatment is over. It may even begin to grow before you finish your treatment. At first the hair is very fine, but you’ll probably have a full head of hair after three to six months.
Choosing a wig or hairpiece
One practical way of coping with hair loss is to wear a wig or hairpiece. In the past, some wigs appeared old-fashioned and unattractive. Nowadays, there are many different styles and colours to choose from, for both men and women. Wigs are much more natural-looking and comfortable to wear.
Your specialist team can advise you about getting a wig if you think one would help.
What about chemotherapy trials?
Trials are common, and are the means by which knowledge in medicine progresses. There are three clinical phases through which a drug passes before it becomes available as an accepted treatment. Before a drug can be assessed in a trial it will have been through many years of development in research laboratories, the initial results of which suggest that there is a potential theoretical benefit from using the drug in patients.
Phase I trials
This type of trial is the first time that a drug has been given in humans. It is largely a study of how well the drug is tolerated and what side effects occur. Most drugs have been shown to be safe and well tolerated in animal studies, and the study often starts at a very low dose, and when this is shown to be well tolerated, the dose is increased until the optimal balance between dose and side-effects is reached. At this stage there is no evidence that the new drug is better, the same, or not as effective as the standard treatments.
Phase II trials
This type of trial looks at how effective a drug is at shrinking a tumour, but does not assess whether it is more or less effective than standard treatments. These trials often provide additional information on tolerance (side-effects). The aim is to assess the “response rate” and to provide information to ensure that the subsequent phase III trial is designed appropriately, and includes sufficient numbers of patients to reach a conclusion as to whether the new drug is an improvement on the current standard of care.
Phase III trials
These are the most important trials but also the most difficult to run. They often require a very large number of patients (because differences between treatments can be significant but only very small) and involve many specialist units and even international co-operation. In these trials, treatment is allocated randomly to either what is the current best-proven treatment, or to the new drug or combination of drugs. At this stage there is still no evidence that the new drug is better, the same, or not as effective as the established treatment. Benefit may come through better disease control or fewer side-effects. At the end of the trial the results are analysed, and a conclusion reached that may show no benefit, or may result in a change in what is considered to be the best proven treatment.
If you have questions about trials, or inclusion in trials, please speak to your specialist nurse or oncologist, who will be able to let you know what trials are currently being undertaken in your specialist centre.
What happens when my treatment is finished?
Once your treatment is finished your specialist team will ask you to return for regular check-ups. This might be to your local hospital or to a regional cancer centre. If you have any problems or experience any new symptoms in between your appointment times you should let your GP, specialist/support nurse or consultant know as soon as possible.
What if I need further treatment?
If you need any further treatment or care at any time, the most appropriate member of your specialist team will discuss the situation with you. If necessary, they will refer you to the right person to help you. Remember – if you have any questions, please do not hesitate to ask!