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Treatment decisions for pancreatic cancer

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The treatment you have depends on:

  • where your cancer is
  • how far it has grown or spread (the stage)
  • the type of cancer
  • how abnormal the cells look under a microscope (the grade)
  • your general health and level of fitness

Your doctor will discuss your treatment, its benefits and the possible side effects with you.

How doctors decide about treatment

To decide about what treatment you need your doctor might use a simple system based on whether they can remove (resect) the cancer with surgery. 

Your cancer may be:

  • resectable: this means that they can remove it
  • borderline resectable: it is less clear whether it can be removed
  • unresectable: this might be locally advanced which means that it has spread to nearby organs or it might be have spread to more distant organs (metastatic )

Resectable cancer

This means that the tumour is involving the pancreas and surrounding structures, such as the small bowel, bile duct or stomach. But it isn't affecting any of the nearby major blood vessels. This is the same as stage 1 and 2 cancer.

Treatment is surgery to remove the cancer along with an area of tissue from around the cancer that doesn’t contain any cancer cells. 

Once you have recovered from the surgery you might have chemotherapy. Depending on how well you have recovered from the surgery. There are different types of chemotherapy, most people have one of the following:

  • gemcitabine with capecitabine
  • gemcitabine with nab paclitaxel
  • gemcitabine on its own
  • FOLIFIRINOX

Sometimes, the CT scan and other tests show that it is possible to remove the cancer but when you have the operation your surgeon might find that it is not more extensive than was suggested by the tests. 

They will stop the resection and consider a bypass operation to avoid bile duct or gut obstruction. You might then have chemotherapy.

It's unclear if surgery will completely remove your cancer

This means that the cancer is in the pancreas and involves the nearby blood vessels. This can make it more difficult for the surgeon to remove the cancer completely and cancer cells too small to see may be left behind. 

Research shows that if the surgeon isn’t able to remove an area around the cancer with no cancer cells (clear margin) the risk of the cancer coming back is high. And the benefits of having a very big operation are less clear. 

You might have chemotherapy to reduce the size of the tumour. Then, you have an operation only if your surgeon thinks it is possible to remove it completely and remove a clear margin of tissue from around the tumour. You usually have this as part of a clinical trial. 

You might continue with chemotherapy if surgery is not possible, usually for 6 months. 

Unresectable cancer

Unresectable cancers may be locally advanced or have spread elsewhere in the body. 

Locally advanced

A locally advanced cancer is when the cancer has not spread elsewhere in the body but it is blocking or completely surrounding the nearby major blood vessels. This is the same as stage 3 cancer. 

It is not possible to remove these cancers completely with surgery. An operation is unlikely to be helpful and it could have major side effects. 

Surgery can help control or prevent symptoms so depending on what your symptoms are you may have an operation.

Chemotherapy is the main treatment. You might have one of these:

  • FOLIFIRINOX
  • gemcitabine with capecitabine
  • gemcitabine with nab paclitaxel
  • gemcitabine on its own

Your cancer has spread

When a cancer has spread to another part of the body it is called advanced or metastatic.

Treatment depends on how well you are. For people who are generally fit and well your doctor might suggest chemotherapy. This is usually:

  • FOLFIRINOX or
  • gemcitabine with nab-paclitaxel

You might have gemcitabine on its own if you aren't very fit or have high levels of bilirubin. 

You will also have other treatments to help reduce symptoms. For example, if the tumour is blocking the bile ducts and you are jaundiced you might have a small tube put into the bile duct to unblock it. This is called a stent. 

Other health conditions

Health problems might mean you can’t have some treatments including surgery. Before you have surgery you have tests to check how fit you are including heart and lung tests. 

For people who can’t have surgery or other treatments you will have treatment to help control symptoms. 

Clinical trials to improve treatment

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

Doctors are looking at some targeted treatments (biological therapy drugs) for pancreatic cancer. They are also looking at using a combination of radiotherapy and chemotherapy to treat early or locally advanced cancers.

Treatment for endocrine pancreatic cancers

Cancers that start in the hormone producing cells of the pancreas are called endocrine cancers and are much rarer and need different treatment

Information and help

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