Reviewed by: Assoc Prof James St John - MBBS, MD, FRCP, FRACP, AGAF; Dr Lara Lipton - MBBS, PhD and FRACP
Dr Suzanne Kosmider - MBBS, FRACP; Mr Benjamin Thomson, MBBS FRACS, Consultant Hepatobiliary Surgeon, Peter MacCallum Cancer Centre and Royal Melbourne Hospital
Taken from: 
Pancreatic cancer booklet (2.1MB)
On this page: Surgery | After the operation | Radiotherapy | Chemotherapy | Complementary and alternative medicines | Prognosis | When cancer can't be cured | Jaundice | Vomiting | Weight loss | Malabsorption | Pain
Many years of treating cancer patients and testing different treatments in clinical trials help doctors know what is likely to work for a particular type and stage of cancer. Your doctor will advise you about the best treatment for your cancer. This will depend on the type of cancer you have, where it is and how far it has spread, your general health, and what you want.
Treatment for pancreatic cancer may include surgery, endoscopic treatment, chemotherapy or radiotherapy. You may have just one of these treatments, or a combination.
Before any treatment begins, make sure that you have discussed it with your doctor so that you know what to expect. You may find it useful to have a family member or a friend with you when you talk with the doctor. You may also find it helpful to make a list of questions before your visit: a sample list is included at the end of this booklet.
Surgery is sometimes not possible for pancreatic cancer. If the cancer has spread to the liver or other abdominal organs (metastases), there is no benefit in removing the pancreatic cancer as all of the cancer cannot be removed.
The cancer can spread to large blood vessels next to the pancreas, making it impossible to remove the cancer (advanced local disease). In this case, your medical team will consider other treatment for your cancer.
Surgery may be considered if there is no evidence of spread of the cancer or for management of some symptoms of pancreatic cancer, particularly jaundice.
Operations to remove a tumour of the pancreas are major and complex operations and for this reason you need to be well enough for major surgery.
During the operation, the surgeon will closely inspect the liver and the area around the pancreas and make a final decision on the type of surgery that should be performed.
If there is no evidence of spread, the surgeon will remove the cancer and part of the pancreas. Most commonly, some of the duodenum, bile duct, gall bladder and stomach may also be removed. This procedure is called a Whipple's resection. This is a big operation and generally performed in centres with special expertise in this type of surgery. Talk with your doctors about the risks and complications that may be associated with major surgery like this.
Unfortunately, in many people, cancer of the pancreas is found to have spread at the time of the operation. This can happen even if your doctor has done a careful investigation before the operation. If the cancer has spread, then surgery mayl be done to bypass any blockage in the bile duct and any blockage of the outlet of the stomach (also known as a double bypass). Here, the aim is to relieve (‘palliate') the symptoms of blockage rather than to cure the cancer (see ‘When cancer can't be cured' at the end of this section).
As with all major operations, you will have some pain and discomfort for several weeks after the operation. You will be given effective pain-relieving drugs to deal with this. An intravenous infusion (drip) will be used to replace body fluids until you are able to drink and eat again after the operation. You will probably be ready to go home within 10 to 14 days of having the operation. If you have complications after surgery, you may need to stay in hospital longer.
People who have surgery to the pancreas can develop diabetes and need to take insulin after this operation. Some people may need to take tablets to help digest fat and proteins (see 'Malabsorption').
Radiotherapy treats cancer by using x-rays to destroy cancer cells. These x-rays can be targeted onto cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your normal body tissues.
Radiotherapy may be used after surgery for pancreatic cancer to try to destroy any cancer cells which remain in your body.
It may also be given as the main treatment when surgery is not possible, in combination with chemotherapy. Sometimes radiotherapy may be advised before surgery. It may also be used to relieve (palliate) symptoms, particularly pain, rather than to cure the cancer.
Treatment is usually for five days a week over several weeks. It is painless and only takes a few minutes for each treatment.
Side effects of radiotherapy may include general tiredness, reddening of the skin, nausea, vomiting and diarrhoea. Talk with your doctor or the radiotherapy staff about any possible side effects and how to manage them. You will be prescribed anti-vomiting medicine with your treatment.
This is the treatment of cancer by anti-cancer drugs. The aim is to destroy cancer cells while doing the least possible damage to normal cells. The drugs work by stopping the cancer cells from growing and reproducing.
Chemotherapy is used as an added treatment after surgery for pancreatic cancer, sometimes in combination with radiotherapy. This is called adjuvant chemotherapy. It is also used with radiotherapy to treat cancer that has spread to the blood vessels.
Chemotherapy may also be used to treat advanced cancer where surgery or radiotherapy is not possible. This is called 'palliative' chemotherapy. This treatment aims to relieve the symptoms, particularly pain, rather than to cure the cancer.
Chemotherapy is usually given over one hour once a week or may be given as a continuous infusion during radiotherapy. You will probably have several courses of treatment. Because chemotherapy treatments change as new advances occur, discuss with your doctor which drugs you are having and how long your treatment will last.
Chemotherapy is usually given by injecting the drugs into a vein. This is called intravenous treatment. You may have other drugs as tablets.
Some chemotherapy can cause side effects. Side effects can include nausea and vomiting; anaemia, causing tiredness and breathlessness; low white blood cell count, causing poor resistance to infection; mouth sores; diarrhoea; flu-like symptoms such as fever, headache and muscle soreness; poor appetite; fluid retention; rash; and weakness.
You may have none or only some of these side effects if you have chemotherapy. Side effects are temporary, and steps can be taken to prevent or reduce them.
It's common for people with cancer to seek out complementary and alternative treatments. Many people feel that it gives them a greater sense of control over their illness, that it's ‘natural' and low-risk, or that they just want to try everything that seems promising.
Complementary therapies include massage, meditation and other relaxation methods that are used along with medical treatments. Alternative therapies are unproven remedies including some herbal and dietary remedies that are used instead of medical treatment. Some of these have been tested scientifically and found to be not effective or even harmful.
Some complementary therapies are useful in helping people to cope with the challenges of having cancer and cancer treatment. However, some alternative therapies are harmful, especially if:
you spend a lot of time and money on alternative remedies that simply don't work.
Be aware that a lot of unproven remedies are advertised on the Internet and elsewhere without any control or regulation. Before choosing an alternative remedy, discuss it with your doctor or a cancer nurse at the Cancer Council Helpline. The US National Center for Complementary and Alternative Medicines has more information at http://nccam.nih.gov/.
Treatment for pancreatic cancer is most effective if the cancer is found in its early stages. However, because its symptoms also occur with many other disorders, pancreatic cancer is usually not found until it is quite advanced.
If your cancer has spread and can't be removed, chemotherapy, radiotherapy or other types of treatment can provide relief from symptoms and help you to live a normal life for as long as possible.
The question, ‘How long am I likely to live?' is often raised by people who have pancreatic cancer. It is not possible for your doctor to give a precise length of time for you as an individual. However, they may be able to give an estimate based on the average length of time lived by people with a similar cancer to yours. It is important to remember that this is an average, and will not necessarily apply to you: some people will survive for less than the average time and some will survive much longer.
If you would like information about your own prognosis, you need to speak to your doctor who knows your full medical history.
If your cancer has spread and it is not possible to cure it by surgery, your doctor may still recommend treatment. In this case, treatment may help relieve any symptoms, can make you feel better and may allow you to live longer.
Whether or not you choose to have anti-cancer treatment, symptoms can still be controlled. For example, if you have pain, there are effective treatments for this.
General practitioners, specialists and palliative care teams in hospitals all play important roles in helping people with cancer. For further information, contact the Cancer Council Helpline on 13 11 20 or Palliative Care Victoria on 9662 9644.
The cancer may cause jaundice by pressing on the bile duct as it passes through the pancreas. The narrowing of the bile duct prevents bile from passing from the liver into the duodenum and this causes a build-up in the bloodstream. Your eyes and skin may look yellow and you may have uncomfortable, itchy skin. The bile duct blockage may affect your digestion of food and reduce your appetite, leading to weight loss.
Jaundice can be relieved by unblocking the bile duct. This may be done using an endoscopic treatment known as ERCP, or by surgery. This allows the bile to flow into the duodenum.
In ERCP, a tube is passed through your mouth and down to the entry of the bile duct into the duodenum. X-ray control will be used to position a plastic or metal tube across the blockage to hold it open. You will be sedated - most people do not remember the procedure. ERCP can be done as a day procedure or it may require one or two days in hospital.
Jaundice will usually disappear over two to three weeks but the itchy skin goes away in three to four days. Your appetite will improve and you may gain some weight.
The bile duct blockage can also be bypassed surgically. During the operation, a section of your bowel will be joined to the bile duct to take the bile around the blockage. This is a medium-sized operation and you will be in hospital for seven to 10 days.
Sometimes the blockage is relieved by draining the bile through a tube that comes out to the skin of the abdomen. This procedure is done in the radiology department. It is generally recommended if the blockage can't be reduced by an internal tube or operation.
Vomiting is a common symptom for patients with advanced pancreatic cancer. Most commonly it occurs because the nerves controlling the stomach are affected by the cancer and food drains only very slowly. This can be controlled with medications and changes in your diet.
Some cancers press on the duodenum and prevent food from leaving the stomach. This causes persistent vomiting and rapid weight loss.
If this happens to you, you may have surgery to join a piece of bowel onto the stomach and bypass the blockage. The operation can be done with laparotomy (open surgery) or keyhole surgery. Keyhole surgery is performed with laparoscopes: ‘telescopes' which are inserted through small holes in the abdomen wall. Recovery is quicker with this technique.
The blockage may also be relieved by placing an expanding metal tube in the narrowing caused by the cancer. This is called a stent and is performed with an endoscope that is put into your mouth then passed down your throat, into your stomach and through to your duodenum. You will be mildly sedated for the procedure and require one or two days in hospital.
Weight loss is a very common symptom. Causes include jaundice and delayed draining of the stomach. Pancreatic cancer can also produce hormones that cause your body to break down your muscle and fat, causing weight loss. Treatment includes treatment of the causes as well as supplementing your diet with high calorie drinks. Your doctor can suggest supplement drinks that are available from most chemists. It is important to limit weight loss as much as possible
The cancer may block the pancreatic duct and prevent pancreatic enzymes passing into the duodenum. Pancreatic enzymes are important for the breakdown and digestion of various types of food, particularly fat. This occurs in the small bowel. A lack of pancreatic enzymes causes fat to pass through the bowel unchanged, resulting in diarrhoea. This symptom is easily controlled by taking tablets containing pancreatic enzymes with every meal and by reducing the amount of fat in your diet.
The cancer sometimes causes pain in the centre of the abdomen and in the lower part of the back (the pancreas is closer to the back than the front of the abdomen). Most pain is well controlled with oral medication.
Opiates such as morphine are very effective if taken at the correct dose. Side effects can include nausea and constipation, which can be relieved with anti-nausea medications and laxatives. There is no need to be concerned about becoming dependent on opiates for the relief of cancer pain. Addiction is unlikely to happen when these drugs are taken for pain relief. Let your nurse or doctor know if you are in pain so that it can be treated. The pain does not become resistant to opiates and taking morphine or another opiate does not lead to more rapid growth of cancer.
If the pain is severe or difficult to control, then pain-relieving medication may be injected into the nerves that lie behind the pancreas. This is called a celiac axis block.
For further information, contact the Cancer Council Helpline on 13 11 20 or Palliative Care Victoria on 9662 9644.
