This section gives an overview of treatments used for early-stage pancreatic cancer, including treatment of early-stage pancreatic NETs. See information on the treatment of locally advanced and metastatic pancreatic cancer.
Surgery to remove the cancer, in combination with chemotherapy, and possibly radiotherapy, is generally the most effective treatment for early-stage pancreatic cancer.
Your medical team will discuss the best treatment for you based on the following factors:
Some people in rural and regional areas have to travel to attend appointments with specialists. If you need to travel a long way for treatment, ask your doctor what support is available to coordinate your journey. You may also be able to get financial assistance towards the cost of accommodation or travel. To check your eligibility or to apply, speak to your GP, the hospital social worker or travel department, call Cancer Council 13 11 20 or see patient transport factsheet.
Surgical removal (resection) of the tumour is usually the most suitable treatment for people with early-stage disease who are in good health. The surgeon will aim to remove all the tumour from the pancreas as well as the surrounding tissue. The type of surgery will depend on the size of the tumour and where it is located.
Surgery for early-stage pancreatic cancer, particularly pancreatic NETs, is potentially beneficial, especially if the tumour is small. However, there are risks and potential complications involved in pancreatic surgery. Your surgeon will weigh up the benefits and impacts of surgery, while taking into account your wants, and your general health.
Surgeries for early-stage pancreatic cancer include:
Where the cancer is large, or in multiple places in the pancreas, a total pancreatectomy, may be performed. This involves removal of the entire pancreas and spleen. If the cancer has spread (metastasised) or the surgeon is unable to safely remove the whole tumour, a double bypass may be perfomed.
The Whipple procedure (pancreaticoduodenectomy) is a major operation that is done by specialised pancreatic or HPB surgeons. During this procedure the surgeon will remove:
The surgeon reconnects the remaining part of the pancreas, bile duct and stomach (or duodenum) to different sections of the small bowel to keep the digestive tract working. This allows food, pancreatic juices and bile to continue to flow into the small bowel for the next stage of digestion. The surgery usually lasts 5–8 hours and most patients stay in hospital for 1–2 weeks afterwards. See tips on managing dietary problems after a Whipple procedure.
The surgeon removes only the tail of the pancreas or the tail and a portion of the body of the pancreas. The spleen is usually removed as well. The spleen helps the body fight infections, so if it is removed you are at higher risk of some bacterial infections. Your doctor may recommend vaccinations before this surgery.
When cancer is large, or multiple tumours are found, the entire pancreas and spleen may be removed, along with the gallbladder, bile duct, part of the stomach and small intestine, and nearby lymph nodes. This is called a total pancreatectomy.
It is possible to live without a pancreas. However, the body will no longer produce insulin, so you will need to have regular insulin injections. It will also be necessary to take pancreatic enzyme pills to help digest certain foods.
During the surgery to remove the cancer, the surgeon may find that the cancer has spread (metastasised) or grown into one or more of the major blood vessels in the area. This may occur even if you had several scans and tests beforehand.
If this happens, the surgeon will not be able to remove the tumour. However, the surgeon may be able to perform procedures that will relieve some of the symptoms caused by the cancer.
See information on managing dietary issues that may be caused by pancreatic cancer and its treatment.
Other treatments may be used before surgery to shrink the tumour, or after surgery to destroy any remaining cancer cells. These are known as neoadjuvant (before) and adjuvant (after) therapies.
Your doctor may suggest the following:
"My symptoms started with itchy skin. After a few days I was jaundiced and had dark coloured urine and back pain. I thought I had a problem with my gall bladder so I went to Emergency. The doctors did several tests and scans and couldn’t figure out what was wrong, so they put a stent into my gall bladder to prevent it from becoming blocked.
"The stent was changed four times over the course of a year. I had regular scans but no cancer was detected.
"I wasn’t feeling well and I had a bout of pancreatitis, so my surgeon removed my gall bladder and did a biliary bypass. They were then able to see that I had a carcinoid pancreatic neuroendocrine tumour on the head of my pancreas.
"One good thing for me was that I didn’t have to have chemotherapy or radiotherapy.
"I had a Whipple procedure. It was a serious operation and I was in hospital for five weeks.
"During recovery in hospital, I didn’t have a feeding tube – I drank water and built up to other fluids. Over the next six months, I lost a lot of weight because I didn’t eat a great deal.
"I now eat a mostly vegetarian diet with meat 1–2 times per week. I take a digestive enzyme supplement called Creon® with food and increase the dose with a larger meal. I try to eat well most of the time.
"I rarely eat sugary, fatty or dairy foods. I’m able to maintain a healthy weight.
"Since I’ve learned to manage my diet, I was able to go overseas this year on a European river cruise. I was careful with what I ate and I rested a few days when I needed to, but I didn’t have any serious problems."