Treatments for resectable pancreatic cancer

The following are treatment options for resectable pancreatic cancer. Resectable means the tumour can be completely removed with surgery. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Surgery is the standard treatment for resectable pancreatic cancer. The type of surgery and amount of tissue that needs to be removed depends on several factors about the cancer, including the size of the tumour and where in the pancreas the tumour is located.

A Whipple procedure( also called a pancreaticoduodenectomy) is done to remove the head of the pancreas and surrounding structures. A Whipple procedure is used for resectable pancreatic cancer in the head of the pancreas.

A modified Whipple procedure( also called a pylorus-preserving pancreaticoduodenectomy) removes all the same tissues as the Whipple procedure except for the pylorus (the part of the stomach that connects to the small intestine). You may have a modified Whipple procedure for resectable pancreatic cancer in the head of the pancreas.

A distal pancreatectomy is done to remove the tail and part of the body of the pancreas as well as lymph nodes around the pancreas. It is used for resectable pancreatic cancer that is in the tail or body of the pancreas. The spleen is typically removed as well (called a splenectomy).

A total pancreatectomy removes all the same structures as the Whipple procedure but removes the entire pancreas instead of just the head. It is uncommon to have a total pancreatectomy. You will likely only have a total pancreatectomy in the rare case that the location of the tumour makes it impossible for the surgeon to remove it and preserve other parts of the pancreas.

Find out more about surgery for pancreatic cancer.

Chemotherapy uses drugs to destroy cancer cells. It may be offered following surgery for resectable pancreatic cancer to lower the chance that cancer will come back (called adjuvant chemotherapy).

In some cases, people with resectable pancreatic cancer who have very high levels of CA19-9 will also have chemotherapy before surgery to remove the tumour (called neoadjuvant chemotherapy).

Chemotherapy drug combinations used for resectable pancreatic cancer include:

• FOLFIRINOX – irinotecan, oxaliplatin, fluorouracil (also called 5-fluorouracil or 5-FU) and leucovorin
• gemcitabine and fluorouracil

If you cannot have these drug combinations, you may have fluorouracil or gemcitabine on their own.

Chemoradiation is chemotherapy and radiation therapy given during the same time period. You may be offered chemoradiation following surgery for resectable pancreatic cancer (called adjuvant chemoradiation) when there are cancer cells in the margin that was removed along with the tumour (called positive surgical margins). You may also have adjuvant chemotherapy after chemoradiation.

Chemoradiation is usually given with fluorouracil or gemcitabine.

Find out more about chemotherapy for pancreatic cancer.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. You may have external radiation therapy as a part of chemoradiation after surgery for resectable pancreatic cancer.

Find out more about radiation therapy for pancreatic cancer.

Talk to your doctor about clinical trials open to people with pancreatic cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.