Diagnosis & TreatmentMedical Oncology

Chemotherapy

The most commonly used drugs used for treating pancreatic cancer, are gemcitabine (Gemzar®), docetaxel (Taxotere®), cis-platinum (Platinol®), 5-fluorouracil (5-FU), and mitomycin C.

Side Effects of Chemotherapy

Gemcitabine, docetaxel, 5-fluorouracil and mitomycin C all can cause low white blood cell count which can lead to a life-threatening infection, a low red blood cell count causing weakness and shortness of breath, and a low platelet count which can increase the risk of bleeding. Cis-platinum most commonly causes nausea, anemia, and kidney problems, sometimes leading to kidney failure. Hair loss is common with docetaxel and mitomycin C. Nerve damage causing tingling, numbness, and difficulty walking can be seen with docetaxel and cis-platinum. Other side effects can also occur. The chances that a patient will have any or all of these side effects depends on individual sensitivity to the drugs, the dose and schedule of the drug used, the combination of drugs selected, and other medications prescribed to help prevent side effects.

Administering Chemotherapy

Although some chemotherapy agents can be ingested and absorbed through the digestive tract, the drugs used to treat pancreatic cancer are most frequently given intravenously, either through a vein in the arm or through a central catheter. If a vein in the arm is used, a small needle is placed into the vein. Most patients experience some discomfort while the medicine is flowing into the vein. This is caused by the substance necessary to keep the medicine in solution. If 5-flourouracil is used, the vein will often darken and become more noticeable.

Central Catheters

There are three major types of central catheters—a percutaneous central line (PIC line), an implanted port (Portacath), and a central line that is external (Groshong®, Broviac®, Hickman®).

A PIC line is placed for up to three days before it must be changed. It is used for short term infusion of chemotherapy and venous access, usually when the arms' veins are too small.

The thin tube of a Portacath is inserted by surgery into a large vein in the chest. A small metal disk with a silicone bubble sits just under the skin to allow the medications to flow into tube, and thus the vein, from a needle inserted into the bubble. Once the incision heals, the system needs to be accessed at least once a month to keep the tubing open.

An external central line is similar to a Portacath, but the end of the tubing is not implanted beneath the skin and protrudes slightly from the chest wall. Thus, for access to the vein, the capped end of the tube, not the patient, is stuck with the needle. These tubes are more easily removed than the Portacath and are often used when chemotherapy treatments will only last a few months.

All central catheters carry a risk of infection and must be meticulously cared for by someone familiar with the care of central lines. They should be flushed with saline or heparin solution to avoid blockages from forming. Care must be taken each time the catheter is accessed to avoid infection; if it should become infected removal is usually necessary.