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Chemotherapy treatment

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

When you have chemotherapy

You might have chemotherapy after surgery for pancreatic cancer. The chemotherapy helps to lower the risk of the cancer coming back. This is known as adjuvant chemotherapy. 

You usually have chemotherapy for about 6 months. You generally start treatment about 2 or 3 months after surgery.

Some people may have chemotherapy before surgery. You may have this if you have a borderline resectable tumour. This means the cancer is right next to a main blood vessel and so it isn’t clear if surgery would be able to remove all of the cancer. 

Treatment before surgery to remove pancreatic cancer is called neo adjuvant treatment. You usually have it as part of a clinical trial.

The chemotherapy may shrink the cancer enough to make surgery possible. Sometimes you have radiotherapy with the chemotherapy (chemoradiotherapy). 

If your cancer has spread outside the pancreas (advanced cancer) and surgery is not possible, you might have chemotherapy on its own.

If your cancer comes back after treatment or carries on growing during treatment, you might have a different combination of chemotherapy drugs. This is called second line treatment.

Which chemotherapy drugs

For people who are fit, you are most likely to have a drug combination called FOLFIRINOX or gemcitabine with capecitabine (GemCap). FOLFIRINOX is made up of the chemotherapy drugs:

  • fluorouracil (5Fu)
  • irinotecan
  • oxaliplatin

If you are not so fit, you might have gemcitabine on its own.

For people with cancer that has spread to another part of the body (advanced pancreatic cancer) another combination you might have is gemcitabine and nab-paclitaxel.

How you have chemotherapy

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

You usually have the treatment in cycles. You have treatment for a few days or weeks and then a time with no treatment to allow your body to recover.

Chemotherapy into your bloodstream

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

  • central line
  • PICC line
  • portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Taking your chemotherapy 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 newspapers, books or electronic devices to 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

COVID swab test

Due to coronavirus, you need to have a test to check for coronavirus before you have treatment. The test is called a COVID swab test.

To have the test your nurse takes a sample from the inside of your nose and the back of your throat. They use a long cotton bud to take the sample. Or the sample might be saliva or other fluid. Depending on which test your hospital uses, it can take from 90 minutes to a few days to get a result.

At most hospitals, you have a COVID swab test 48 to 72 hours (up to 3 days) before going for your treatment in the chemotherapy unit.

This means you might have the swab test on the same day that you visit the hospital for blood tests and your doctor’s clinic appointment. If you have treatment weekly or more often, some hospitals will ask you to have the swab test on the day of treatment.

Check with your team about when you’ll have the test as there are some differences between hospitals.

Blood tests

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.

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, including 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.

Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.

Dietary or herbal supplements and chemotherapy

Let your doctors know if you take any supplements or if you have been prescribed anything by alternative or complementary therapy practitioners.

It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. They could be harmful.

When you go home

Chemotherapy for 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.

Research into chemotherapy for pancreatic cancer

Researchers are looking at ways to improve treatment for pancreatic cancer. So your doctor might ask you to take part in a clinical trial.