Treatment
This is called neo adjuvant chemotherapy. Your doctor usually recommends it if you have a borderline resectable pancreatic cancer. This means it is less clear if surgery to remove all the cancer is possible because:
the cancer has started to involve the large blood vessels in the pancreas
cancer cells too small to see may be left behind – so, there is a higher chance of the cancer coming back
Having chemotherapy first may shrink the cancer enough to make surgery possible.
Doctors call this adjuvant chemotherapy. You might have adjuvant chemotherapy after surgery. This is to lower the risk of the cancer coming back.
You have adjuvant chemotherapy for up to 6 months. It should start within 3 months of having surgery to remove pancreatic cancer.
Doctors call this chemoradiotherapy. Some people have it before surgery. This is usually as part of a .
People with locally advanced pancreatic cancer may have chemoradiotherapy after a course of chemotherapy.
You usually have chemotherapy if the cancer has spread to another part of your body, such as the liver. This is called metastatic pancreatic cancer. You may also hear it called advanced or stage 4 pancreatic cancer.
It isn’t possible to remove metastatic pancreatic cancer. Depending on how well you are, you might have either:
one chemotherapy drug
a combination of chemotherapy drugs
Unfortunately, chemotherapy doesn't help everyone with pancreatic cancer. Some people feel better with treatment and some may live longer. But other people do not get much benefit. Your doctor and specialist nurse talk with you about the benefits and disadvantages before you decide whether to have it.
If your first treatment isn’t working or the side effects are too bad, you might be able to have a different treatment. This is called second line treatment. Your doctor will talk with you about the options if this happens.
If you are generally fit and well, you are most likely to have a drug combination called FOLFIRINOX. FOLFIRINOX is made up of the chemotherapy drugs:
fluorouracil (5FU)
irinotecan
oxaliplatin
Because of the high chance of serious side effects, doctors usually use a combination called modified FOLFIRINOX. This has lower amounts (doses) of some of the drugs.
Other combinations of chemotherapy for pancreatic cancer include:
gemcitabine and nab-paclitaxel
gemcitabine and capecitabine (GemCap)
oxaliplatin and fluorouracil (FOLFOX)
oxaliplatin and capecitabine (CAPOX)
gemcitabine and cisplatin (GC)
5FU, folinic acid and irinotecan (FOLFIRI)
If you are not well enough to have a combination of chemotherapy drugs you might have one on its own, such as:
gemcitabine
capecitabine
If you are having chemoradiotherapy you usually have capecitabine.
Find out about these chemotherapy drugs and their side effects
You have most chemotherapy drugs for pancreatic cancer as a drip into your bloodstream (intravenously). If you are having capecitabine, you take it as a tablet.
You usually have the treatment in cycles. This means you have treatment for a few days or weeks and then a rest to allow your body to recover. You then start the next cycle of treatment.
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
You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.
Find out more about having chemotherapy into your bloodstream
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 healthcare team before you stop taking a cancer drug or if you miss a dose.
Find out more about taking chemotherapy tablets
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.
Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.
Watch the video below about what happens when you have chemotherapy. It is almost 3 minutes long.
You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Your blood cells need to recover from your last treatment before you have more chemotherapy. Sometimes your blood counts are not high enough to have chemotherapy. If this happens, your doctor usually delays your next treatment. They will tell you when to repeat the blood test.
Before starting treatment with capecitabine or fluorouracil (5FU) you have a blood test to check levels of an enzyme called dihydropyrimidine dehydrogenase (DPD). A low DPD level might mean you are more likely to have severe side effects from these drugs. So, you may start treatment with a lower amount (dose) of the drug, or have a different treatment. Your doctor or nurse will talk to you about this.
Find out more about having a DPD deficiency
Chemotherapy for pancreatic cancer can cause side effects. These can vary from person to person. They depend on:
the chemotherapy drugs you are having
the amount (dose) you have
if you have them with other cancer treatments
Some of the common chemotherapy side effects include:
feeling or being sick
loss of appetite
breathlessness an looking pale (anaemia)
an increased risk of infection
tiredness and weakness
bruising, bleeding gums or nose bleeds
loose poo (diarrhoea)
hair loss
liver changes
skin problems
Read more general information about chemotherapy and its side effects
Chemotherapy for pancreatic cancer can be difficult to cope with. Tell your healthcare team about any problems or side effects that you have. Your nurse will give you telephone numbers of who to call if you have any problems at home.
Researchers are looking at ways to improve treatment for pancreatic cancer. So your doctor might ask if you would like to take part in a clinical trial.
Last reviewed: 29 Jun 2026
Next review due: 29 Jun 2029
The treatments for pancreatic cancer include chemotherapy, surgery, radiotherapy and treatment to control symptoms. There are lots of factors your doctor takes into account when recommending the best treatment for you.
There are many cancer drugs and cancer drug combinations. Search for the one you are looking for to understand more about how it works, how you have it, the side effects and other important information.
Cancer drugs have side effects and these can vary from person to person. But there are things that you can do to help you cope.
Your treatment depends on the position of the cancer in the pancreas, how big it is, the type of pancreatic cancer, whether it has spread, if they can remove it with surgery and your general health.
There is practical and emotional support available to help you cope with a diagnosis of pancreatic cancer, and life during and after treatment.
Pancreatic cancer starts in the pancreas. This is the gland that produces digestive juices and hormones such as insulin. Find out more including treatments, survival and coping with pancreatic cancer.
About Cancer generously supported by Dangoor Education since 2010. Learn more about Dangoor Education
Search our clinical trials database for all cancer trials and studies recruiting in the UK.
Connect with other people affected by cancer and share your experiences.
Questions about cancer? Call freephone 0808 800 40 40 from 9 to 5 - Monday to Friday. Alternatively, you can email us.
