Metastatic Pancreatic Cancer Treatment

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Symptoms of Stage IV Pancreatic Cancer

Metastatic or stage IV cancer occurs when cancer spreads to distant or adjacent organs of the body such as the liver, lungs and stomach, spleen, and the bowel. Surgery may be required to confirm the cancer is in stage IV.

There are two types of metastatic pancreatic cancer:

  1. Stage IVA which is also known as localized or locally advanced pancreatic cancer. With this type, the cancer tumor is confined to the pancreas but infects the surrounding organs or blood vessels, making it hard to remove.
  2. Stage IVB, also called metastatic cancer, spreads to distant organs such as the liver.

For both types of pancreatic cancer, may symptoms include the following:

  • Weight loss
  • Depression
  • Fatigue
  • Jaundice
  • Diabetes
  • Pain in the upper abdomen that extends to the back
  • A loss of appetite

Treatment Options

Treatment of IVA involves inducing a remission period that may persist for months or years. IVB treatment entails managing symptoms and the pain caused by cancer. For IVA, since cancer has infected surrounding organs, surgical removal may not be an available option.

Systemic Therapy

Systemic therapy is a treatment that is aimed at destroying cancer cells throughout the body. The treatment is used for both IVA and IVB patients to decrease cancer recurrence and enhance chances of survival.

Systemic therapies include precision cancer immunotherapy, medicines, and chemotherapy.


Cancer cells develop when the immune system is not strong enough to fight off cancer, or when cancer manipulates the immune system to not fight it. Immunotherapy works by supporting the immune system, the body’s natural defense mechanism, to recognize and fight off cancer cells.

There are several types of immunotherapy. Those relevant to the treatment of metastatic cancer are:

  • Monoclonal Antibodies (MABs): Antibodies attach themselves to organisms invading the body and prevent them from penetrating the cells. MABs are synthetic antibodies designed to behave like natural ones. They recognize and attach to proteins on the surface of cancer cells. When the MABs attach themselves to the antibodies, it makes it easier for the natural antibodies to recognize cancer cells and launch an attack. Checkpoint inhibitors are a subset of MABs which prevent cancer cells from disarming natural antibodies from attacking.
  • Cancer vaccines: Doctors and scientists are researching to find vaccines that support the natural immune system to find and attack cancer cells. Vaccines are a weak form of the disease itself and provide a training ground for teaching the immune system to attack cancer cells. Once the antibodies learn, they’re able to launch an attack when the real disease shows up.


Chemotherapy is the use of drugs to destroy cancer cells. Chemotherapy may be administered intravenously or as a pill and may contain single or combinations of drugs. The chemo drugs travel all through the body, killing cancer cells that may have travel from the pancreas to other parts.

Drugs commonly used in chemotherapy are Gemcitabine (Gemzar) used either alone or in combination with others such as Abraxane, Tarceva, or Xeloda.


Chemotherapy, used together with radiation, is known as chemoradiation. Chemoradiation is the use of electromagnetic rays to destroy cancer cells. Side effects of chemoradiation are loss of hair, increased risk of infection, and fatigue.

Palliative Care

As the cancer tumor grows, you may face a lot of discomfort from the pressure the tumor puts on nerves and possibly the organs surrounding it. Doctors can give you medication that cuts the nerves that causes pain.

Besides treating with medication, doctors can also carry out palliative surgery to remove cancer and increase your comfort and reduce pain. Such surgeries include:

  • Gastric bypass surgery: Connects the stomach and the small intestine. The bypass is used to go over a tumor that is blocking food from reaching your intestines.
  • Stent: A stent is a small metal tube used to drain out bile from a blocked bile duct. The stent may direct the bile to the small intestine or outside of the body. A stent may also be used to open up a small intestine blocked by a cancer tumor.
  • A bile duct bypass surgery is also known as choledochojejunostomy, and is undertaken in situations where the tumor blocks the bile duct. Jaundice is evidence that there is a build-up of the bile in the body. The bypass surgery joins the bile duct directly to the small intestine to get around the blockage.

Clinical Trials

When your doctor exhausts all available cancer treatments, you may enroll for clinical trials. Clinical trials enable you to test medication or treatment options not yet available to the public.

Ask your doctor for available trials or search through trusted online sources such as the US National Library of Medicine of the National Cancer Institute.


Due to the pain cancer causes, a doctor may also prescribe pain relief medication such as opioid analgesics or other drugs that block nerves. To help you cope with managing the disease’s emotional impact, a doctor may prescribe sleeping pills, antidepressants, and/or anti-anxiety medications.