Treatment to remove pancreatic cancer

This section gives an overview of treatments used for many stage 1–2 (early) pancreatic cancers and some stage 3 pancreatic cancers. 

These treatment options will be suitable for only about 1 in 5 people with pancreatic cancer, as most people are diagnosed at a later stage. Surgery to remove the cancer, in combination with chemotherapy and possibly radiation therapy, is generally the most effective treatment for early-stage pancreatic cancer. It is important that the surgery is done by a surgeon who is part of a multidisciplinary team in a specialist pancreatic cancer treatment centre.

Where should I have treatment?

Treatment for pancreatic cancer is highly specialised. This is particularly the case for the surgery for early pancreatic cancer, such as the Whipple procedure.

There is strong evidence that outcomes are better when people have their treatment in a specialist centre that sees a lot of people with pancreatic cancer. These high-volume centres have multidisciplinary teams of health professionals experienced in treating pancreatic cancer.

Specialist centres offer access to a wide range of treatment options – including treatments available only through clinical trials – but you may need to travel away from home for treatment.

Sometimes the multidisciplinary team from a specialist centre will be able to advise your local specialist. You may find that you can visit the specialist centre to confirm the diagnosis and work out a treatment plan to have much of your treatment closer to your home.

To find a treatment centre that specialises in pancreatic cancer, talk to your GP.

Treatments before or after surgery

Your surgeon may recommend other treatments before surgery to shrink the tumour (called neoadjuvant therapies), or after surgery to destroy any remaining cancer cells (called adjuvant therapies).

They may include:

• chemotherapy – the use of drugs to kill or slow the growth of cancer cells
• chemoradiation – chemotherapy combined with radiation therapy.

Surgery to remove the cancer

Surgery to remove the tumour (resection) is the most common treatment for people with early-stage cancer who are in good health. It may also be considered for some stage 3 cancers, usually with chemotherapy (and sometimes radiation therapy) to shrink the tumour first. These stage 3 cancers are known as borderline resectable cancers, which means that surgery alone may or may not be able to remove all of the tumour.

The aim of resection is to remove all the tumour from the pancreas, as well as a margin of healthy tissue. The type of surgery you have will depend on the size and location of the tumour, your general health and your preferences. Your surgeon will talk to you about the most appropriate surgery for you, as well as the risks and any possible complications.

Types of surgery include:

If the cancer has spread

During surgery to remove the cancer, the surgeon may find that the cancer has spread around one or more of the major blood vessels in the area or into the lining of the abdomen (peritoneum). This may occur even if you had several scans and tests beforehand.

If this happens, the surgeon will not be able to remove the cancer. However, they may be able to perform procedures (such as a bypass) to relieve some of the symptoms caused by the cancer. 

How the surgery is done

Surgery for pancreatic cancer is carried out in hospital under a general anaesthetic. It is difficult surgery and should only be performed by surgeons with a lot of experience in doing this operation.

There are 3 main approaches:

Open surgery – This involves one larger cut in the abdomen so the surgeon can remove the cancer.

Keyhole surgery – This involves several small cuts in the abdomen (belly). It is sometimes called laparoscopic or minimally invasive surgery. The surgeon inserts a long, thin instrument with a light and camera (laparoscope) into one of the cuts and uses images from the camera for guidance. The surgeon inserts tools into the other cuts to remove the cancer.

Robotic-assisted surgery – This is a type of keyhole surgery. The surgeon sits at a control panel to see a 3-dimensional image and moves robotic arms that hold the instruments.

Open surgery is usually the best approach for pancreatic cancer, but keyhole or robotic-assisted surgery may be an option in some circumstances. Talk to your surgeon about what options are available to you. Ask about the risks and benefits of each approach, and check if there are any extra costs.

Having a Whipple procedure

The Whipple procedure (pancreaticoduodenectomy) is a major, complex operation. It has to be done by a specialised pancreatic surgeon or a hepato-pancreato-biliary (HPB) surgeon.

The surgeon removes the part of the pancreas with the cancer (usually the head); the first part of the small bowel (duodenum); part of the stomach; the gallbladder; and part of the common bile duct.

Then the surgeon reconnects the remaining part of the pancreas, common bile duct and stomach (or duodenum) to different sections of the small bowel to keep the digestive tract working.

Once these organs are reconnected, food, pancreatic juices and bile can continue to flow into the small bowel for the next stage of digestion. Many people need to change their diet after a Whipple procedure.

• A Whipple procedure is a long operation. It usually lasts 5–8 hours.
• As your surgeon will explain, this surgery is complex and there is a chance of serious problems, such as major bleeding or leaking where the remaining organs have been reconnected.
• Most people stay in hospital for 1–2 weeks after surgery, and full recovery takes at least 12 weeks. Your team will encourage you to move around and start gentle exercise as soon as you are ready.
• For tips on adjusting to issues with food after a Whipple procedure, see Managing your diet and nutrition .

What to expect after surgery

While you are recovering after surgery, your health care team will check your progress and help you with the following:

What if the cancer returns?

If the surgery successfully removes all of the cancer, you will have regular appointments to monitor your health, manage any long-term side effects and check that the cancer hasn’t come back or spread.

Check-ups will become less frequent if you have no further problems. Between appointments, let your doctor know immediately of any symptoms or health problems.

Unfortunately, pancreatic cancer is difficult to treat and it may come back after treatment. This is known as a recurrence. Most of the time, surgery is not an option if you have a recurrence. Your doctors may recommend other types of treatment with the aim of reducing symptoms and improving quality of life.

You may also be able to get new treatments by joining a clinical trial.