Chemotherapy for advanced cancer

Advanced pancreatic cancer means that the cancer has spread outside the pancreas to another part of the body. The main treatment for advanced pancreatic cancer is chemotherapy.

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.

Why you might have chemotherapy

Although chemotherapy can't cure advanced pancreatic cancer, it can help to control or shrink the cancer for a time. This can reduce or control symptoms and improve your quality of life. 

Unfortunately chemotherapy doesn't help everyone with pancreatic cancer. Some people will feel better with treatment and some may live longer. But some people having chemotherapy won't get much benefit at all. You might want to consider the benefits and disadvantages of treatment before deciding whether to have it. Your doctor and specialist nurse will talk to you about this.

What chemotherapy drugs you might have

If you are well enough, you might have a combination of chemotherapy drugs called FOLFIRINOX. This is made up of the following drugs:

  • FOL - Folinic acid (also called leucovorin, calcium folinate or FA)
  • F - Fluorouracil (also called 5FU)
  • Irin - Irinotecan
  • Ox - Oxaliplatin

If you can't have FOLFIRINOX, you may have another combination of drugs:

  • nab paclitaxel (Abraxane)
  • gemcitabine 
  • FOLFOX (fluorouracil, folinic acid, oxaliplatin)

Another combination of drugs is called GemCap. This is:

  • gemcitabine
  • capecitabine

If you are not well enough to be able to have a combination of chemotherapy drugs, you might have gemcitabine on its own.

How you have chemotherapy

You have most chemotherapy drugs for pancreatic cancer into your bloodstream. Capecitabine is a tablet that you swallow.

Chemotherapy into your bloodstream

You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Chemotherapy as tablets

You must take tablets according to the instructions your doctor or pharmacist gives you.

Speak to your pharmacist if you have problems swallowing the tablets.

Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, no more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

Where you have chemotherapy

You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.

You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.

For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Your doctors and pharmacists work out your chemotherapy dose based on your blood test results, your weight, height and general health.

Side effects

Common chemotherapy side effects include:

  • feeling sick
  • loss of appetite
  • losing weight
  • feeling very tired
  • a lower resistance to infections
  • bleeding and bruising easily
  • diarrhoea or constipation
  • hair loss
Contact your doctor or nurse immediately if you have signs of infection. These include a temperature above 37.5C or below 36C, or generally feeling unwell. Infections can make you very unwell very quickly.

Side effects depend on:

  • which drugs you have
  • how much of each drug you have
  • how you react

Tell your treatment team about any side effects that you have.

When you are at home

Chemotherapy for advanced pancreatic cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. Your nurse will give you telephone numbers to call if you have any problems at home.

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