Treatment options for pancreatic cancer

Your doctor will talk to you about the treatment they suggest. They will explain its benefits and the possible side effects.

This will depend on:

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

Deciding which treatment you need

To decide about what treatment you need, your team looks at your test and scan results to see if they can remove (resect) the cancer. Your cancer may be:

Resectable, which means they can remove it with surgery.

Borderline resectable, which means the cancer is right next to a main blood vessel and so it is less clear if surgery is possible. You may have chemotherapy first to shrink the cancer.

Unresectable, which means that surgery to remove the cancer is not possible. The cancer may have grown into nearby organs (locally advanced cancer) or to more distant areas of the body (metastatic cancer).

Resectable cancer

This means that the cancer is only in the pancreas, or has grown just outside it into structures such as the small bowel, bile duct or stomach. But it isn't affecting any of the nearby major blood vessels. Generally, stage 1 and 2 pancreatic cancers are resectable.

The surgeon needs to be able to remove the cancer along with an area of tissue around it that doesn’t contain any cancer cells.

Once you have recovered from the surgery you might have chemotherapy. This depends on how well you have recovered from the operation. There are different types of chemotherapy. You may have one of the following:

Sometimes, although the cancer looks resectable on scans, when the surgeon starts the operation they find that the cancer is bigger than they thought. And so surgery to remove the cancer is not possible. 

In this case, they may consider doing a different type of operation to help relieve or prevent symptoms. For example, a bypass operation to avoid a blockage of the bile duct or stomach. You might then have chemotherapy.

Borderline resectable cancer

This means that the cancer is in the pancreas and has started to involve 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 without any cancer cells (a 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 first to reduce the size of the cancer. This is called neo adjuvant chemotherapy. You might have this as part of a clinical trial. After the chemotherapy, you have the operation to remove the cancer - only if your surgeon thinks it is possible to remove it completely and remove a clear margin of tissue from around the tumour.

You might continue with chemotherapy after surgery, or if surgery is not possible, usually for up to 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 to other parts of 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. 

You may have other types of surgery to help control or prevent symptoms caused by the cancer.

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

  • gemcitabine with capecitabine
  • gemcitabine on its own

Your cancer has spread to another part of the body (metastatic cancer)

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

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

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 cancer is blocking the bile ducts and you are jaundiced Open a glossary item 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

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.

Treatment for endocrine pancreatic cancers

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

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