This section gives an overview of treatments used for the most common type of pancreatic cancer: exocrine tumours. This includes adenocarcinoma. Our next section looks at the treatment of pancreatic neuroendocrine tumours (PNETs).
Although continuing research has improved outcomes for many people, pancreatic cancer can be difficult to treat. Surgery in combination with chemotherapy, and possibly radiotherapy, is the most effective treatment.
Your medical team will consider your situation and recommend the best treatment for you. This will depend on:
It can be difficult to make decisions about treatment. For more information read deciding on treatments.
Surgical removal of the tumour (resection) is the most effective treatment for people who have early-stage disease.
Surgery is an option if:
Surgery may also be used as palliative treatment to treat symptoms of pancreatic cancer, such as intestinal obstruction or jaundice. Jaundice is a condition in which the skin turns a yellow colour due to a build-up of bile in the blood.
If you have diabetes, it may go away after an operation. Talk to your doctor for more information.
The most common operation for pancreatic cancer in the head of the pancreas is known as pancreaticoduodenectomy or the Whipple's surgery. It's a major operation that's done by specialised surgeons. Whipple's procedure removes:
The surgeon reconnects the remainder of the pancreas, bile duct and stomach to different sections of the small bowel so the digestive tract keeps working. This allows food, pancreatic juices and bile to continue to flow into the small bowel for the next stage of digestion.
The surgeon may find that the cancer has spread (metastasised) at the time of the operation. This is possible even if you had several scans and tests beforehand. If this happens, the surgeon won't be be able to remove the tumour, but the operation can be done to relieve symptoms, such as jaundice.
Double bypass surgery allows a blockage in the common bile duct and/or the outlet of the stomach to be bypassed. The surgeon connects a piece of your bowel to the bile duct or gall bladder to take the bile around the blockage. This is a medium-sized operation and you will be in hospital for 7 to 10 days.
If you don't have surgery to relieve the jaundice, the most common treatment is stenting.
As with all major operations, you'll be given pain relief. When you're in hospital, you'll also have a drip (intravenous infusion) to replace your body's fluids. If you can't eat or drink within a few days, the doctor may insert a temporary feeding tube.
Most people go home within a fortnight of surgery, but if you have complications after surgery, you may need to stay in hospital longer. If you're in pain when you return home, talk to your medical team. They may prescribe pain-killers to make you more comfortable.
Some people who have surgery will need to take tablets known as pancreatic enzymes, which will help to digest fat and proteins.
A small number of people also develop diabetes and may need insulin therapy. See our Nutrition and dietary problems page for more on the dietary issues that may be caused by pancreatic cancer and its treatment.
"I was diagnosed with pancreatic cancer at the age of 49. I was already an insulin-dependent diabetic of some 10 years. In my case, weight loss was the first indication that something was wrong, but the most prominent symptom was persistent itching. It was to the point where I was scratching continuously on my legs, stomach and backside. It was particularly difficult to get to sleep at night.
When the cancer was finally diagnosed, I didn't get any real time at all to process anything. I think I was diagnosed on Thursday and was in hospital having a Whipple's procedure on the following Wednesday.
I had some complications after surgery and spent two months in hospital. Pain management was essential in the early stages. I remember that I had a sense of not being in control of anything. I didn't really know enough about what was happening to me.
When I returned home, I had difficulty eating and getting my appetite back. One thing that I had particular difficulty with in the early stages was generating saliva. It seemed to be worse at night. I sought out some products from a chemist, which had limited success, but eventually the problem disappeared as my appetite returned to normal. I now take a digestive enzyme supplement."
Chemotherapy is the use of anti-cancer drugs, which kill or slow the growth of cancer cells.
If you have stage 1, 2 or 3 pancreatic cancer, your doctor may suggest that you have chemotherapy combined with radiotherapy. This may be to destroy any cancer cells remaining after surgery. Chemotherapy can also be given to reduce the risk of the cancer coming back after an operation (adjuvant chemotherapy).
If you have advanced pancreatic cancer – for example, stage 4 disease – chemotherapy may be given as palliative treatment to help slow the spread of cancer and relieve any symptoms you may have.
Chemotherapy is usually given by injecting drugs into a vein (intravenously). You'll usually go to an outpatient oncology day unit, where you'll sit in a chair and be attached to a drip. The drugs are given over 1 to 3 hours. Most people have up to six courses of treatment. After each treatment session, you'll have a break or rest period of 1 to 3 weeks at home. Your medical team will talk to you about how they'll assess if the treatment has worked.
Chemotherapy affects fast-growing cells in the body, such as the cells involved in hair growth or mouth cells.
Some chemotherapy can cause temporary side effects, which may include:
The most common side effects are fatigue and nausea, however you may have none or some of the above side effects. Discuss how you're feeling with your medical oncologist, as steps can be taken to reduce or manage your side effects.
"I found chemo a bit daunting – walking into the room with the chairs lined up. But the nurses were great and talked through it with me so I knew what to expect." – Cheryl
Radiotherapy treats cancer by using x-rays to kill cancer cells or injure them so they can't multiply. These x-rays can be targeted at cancer sites in your body.
Radiotherapy may be used:
Treatment is usually given Monday to Friday, for up to five weeks. It's painless and each session takes a few minutes. Treatment is planned to do as little harm as possible to your normal body tissues.
Radiotherapy can cause temporary side effects, which may include:
Palliative treatment helps to improve people's quality of life by alleviating symptoms of cancer when a cure may not be possible. It's particularly important for people with advanced cancer, but it can be used during different cancer stages.
Often treatment is concerned with pain relief and stopping the spread of cancer, but it can also involve the management of other physical and emotional symptoms, such as depression. Treatment may include radiotherapy, chemotherapy or other medication.
If pancreatic cancer has spread and it's not possible to treat it with surgery, your doctor may recommend treatment to relieve problems such as: