Pancreatic Cancer

Understanding treatment for pancreatic cancer and how it is delivered

Last modified: February 15, 2022

What are the treatment options for pancreatic cancer? Treatment options

Treatment for pancreatic cancer depends on the stage and location of the cancer as well as your overall health and personal preferences. For localised pancreatic cancer the first goal of treatment may be to try and eliminate the cancer where possible. When that isn’t an option, the focus may be on improving quality of life and limiting the cancer from growing or causing more harm.

The primary treatment options for pancreatic cancer may include surgery, chemotherapy, radiation or a combination of these. When the cancer is advanced, the primary treatment option is chemotherapy. New treatments are regularly being developed in clinical trials and there may be an option to participate in a clinical trial for your cancer.

This page aims to give you a comprehensive overview of how pancreatic cancer treatment works in the private health system.

Types of pancreatic cancer treatmentTypes of treatment

Surgery for pancreatic cancerSurgery

There are two main types of surgery for pancreatic cancer: surgery for early pancreatic cancer which is performed with the goal of curing your cancer and surgery for advanced pancreatic cancer which can help to relieve symptoms and improve your quality of life.

Surgery for early pancreatic cancer

If your pancreatic cancer has not spread beyond the pancreas, surgery can offer a potential cure for your cancer. All of the cancer must be removed for surgery to be effective, and the type of surgery you receive will depend on factors such as the tumour’s size and your general health. Generally, only 15-20% of people can have this type of surgery, as pancreatic cancer is often discovered in its later stages. Types of surgeries include:

Whipple procedure

This is an extensive surgery that removes the head of the pancreas, as well as parts of the small intestine and bile duct, the gallbladder, lymph nodes and a section of the stomach.

Distal pancreatectomy

A distal pancreatectomy removes the pancreas’ tail and the spleen. Some of the pancreas’ body may also be removed.

Total pancreatectomy

In a total pancreatectomy, the entire pancreas is removed, alongside the gallbladder, common bile duct, part of the small intestine, a section of the stomach and small bowel, nearby lymph nodes and potentially the whole spleen. As the pancreas is responsible for the production of insulin and other hormones, a total pancreatectomy can lead to diabetes.

Surgery for advanced pancreatic cancer

Surgery can also relieve symptoms when your pancreatic cancer spreads to other organs in the body, which is known as palliative care. There are a number of reasons why advanced pancreatic cancer may require surgery. This includes:

  • Tumours blocking the common bile duct, stopping bile from moving into the bowel. This causes jaundice symptoms, including itchy and yellowing skin
  • Pancreatic cancer blocking the first part of the small intestine (duodenum), preventing food from moving into the bowel and stomach and causing side effects such as nausea

The surgical options for blockages include:

Stent placement

This involves placing a small tube (known as a stent) into the blocked area to keep it open and allow for bile or food to continue passing through the body. Stents can be cleaned or replaced after several months.

Bypass surgery

A bypass surgery connects the bile duct into the small intestine or duodenum into a lower part of small intestine. This bypasses the pancreas and smooths the flow of bile or food respectively.


This connects the stomach to the middle of the small bowel.

Venting gastrostomy

This connects the stomach to an artificial opening in the abdomen.

Celiac plexus block

This is a procedure that damages the celiac nerves so they cannot send pain messages to the brain. It is sometimes used to treat abdominal pain in advanced pancreatic cancer patients. This can be done via an endoscopy or by an interventional radiologist.

Radiation therapy for pancreatic cancerRadiation therapy

Although radiation therapy is not often used for pancreatic cancer, it can be a treatment option for advanced pancreatic cancer or to assist with surgery4. It may be delivered8:

  • Before surgery to shrink cancer cells
  • After surgery to destroy any remaining cancer cells
  • As the main treatment if surgery is not an option
  • To relieve symptoms and improve quality of life for advanced pancreatic cancer

Radiation therapy for pancreatic cancer is commonly delivered in combination with chemotherapy.

Types of radiation therapy commonly used for people with pancreatic cancer include:

For advanced neuroendocrine tumours (NETs) with many somatostatin receptors, somatostatin analogue and radiation can be used to destroy and damage the cancer cells in a treatment known as peptide receptor radionuclide therapy (PRRT). This technique typically requires the expertise of a medical oncologist and nuclear medicine specialist.

Hormone therapy for pancreatic cancerHormone therapy

Somatostatin is a hormone that allows the pancreas to release other hormones. Somatostatin analogues (SSAs) are drugs which have a similar molecular structure to the somatostatin hormone which are used to treat NETs. They help to slow down somatostatin hormone production for neuroendocrine tumours (NETs), slowing the tumours’ growth and relieving symptoms such as diarrhoea. They are delivered through monthly injections into the muscle (intramuscular injections) or deep into the skin (deep subcutaneous injections).

Somatostatin analogue drugs used to treat NETs include octreotide and lanreotide.

Chemotherapy for pancreatic cancerChemotherapy

Chemotherapy uses a range of drugs to destroy and slow the growth of pancreatic cancer cells. This may include:

  • Neoadjuvant chemotherapy Chemotherapy that is delivered before surgery to reduce the size of the cancer and make surgery less extensive
  • Adjuvant chemotherapy – Chemotherapy that is delivered following surgery to destroy any remaining cancer cells and prevent future reoccurrence and spread
  • Chemoradiation – Chemotherapy that is used in combination with radiation therapy
  • Palliative chemotherapy – Chemotherapy which focuses on relieving symptoms and improving quality of life for advanced pancreatic cancer

The chemotherapy drugs you receive will depend on your condition. This may include two or more chemotherapy drugs for people with early pancreatic cancer or one for people with advanced cancer.

Chemotherapy is delivered in cycles, which means you will have one to three weeks of rest between receiving an injection or infusion. Neoadjuvant chemotherapy and adjuvant chemotherapy are typically delivered over three to six months, depending on your pancreatic cancer and treatment plan.

Learn more about chemotherapy and how it is delivered.

Common chemotherapy medicines

There are a number of different chemotherapy drugs that are used to treat pancreatic cancer. These drugs are typically combined based on factors such as your cancer’s stage and spread.

Some of the drugs include:


Gemcitabine is classified as an antimetabolite chemotherapy drug. It works by interfering with the DNA of cancer cells to stop them from being able to divide and grow. It may be given as adjuvant chemotherapy in combination with capecitabine, cisplatin or carboplatin, or other drug combinations following surgery. It is given by intravenous infusion every one to four weeks and orally as a tablet (capecitabine) every four weeks. It may be given alone to treat locally advanced or metastatic pancreatic cancer.

Gemcitabine and nab-paclitaxel

This is a chemotherapy drug that is given in combination with gemcitabine to treat advanced (or metastatic) pancreatic cancer. It is given by intravenous infusion on days one, eight and 15 every 28 days.


Capecitabine is an antimetabolite chemotherapy drug which is given together with radiation therapy to help the radiation therapy treat your cancer more effectively. It is usually given orally as a tablet twice a day for five days and repeated with each course of radiation therapy.


Fluorouracil is a chemotherapy drug which is given together with radiation therapy. It is usually given as an intravenous infusion every seven days and repeated with each course of radiation therapy.

Fluorouracil, leucovorin, oxaliplatin (OFF)

This is a combination of three different chemotherapy drugs that are used together to treat advanced (metastatic) pancreatic cancer. This is typically given by intravenous infusion every 42 days.

Fluorouracil, leucovorin, irinotecan, oxaliplatin (FOLFIRINOX)

This is a combination of four different chemotherapy drugs that are used together as neoadjuvant chemotherapy to help reduce the size of the cancer before surgery. They are usually given by intravenous infusion every two weeks. It may also be used to treat advanced (or metastatic) pancreatic cancer.

Ablation for pancreatic cancerAblation

Ablation delivers extreme heat (through radiowaves and microwaves) and cold (via cold gases) into cancerous tissue to destroy pancreatic cancer. This is achieved through inserting a thin needle-like probe into the pancreatic cancer, guided by CT scans. Ablation is a short 15-minute procedure and is often delivered when pancreatic cancer has spread to other organs in the body.

Embolisation for pancreatic cancerEmbolisation

If your pancreatic cancer has spread to the liver or another part of the body, embolisation can destroy the tumour by directing anti-cancer substances into the artery. This can include:

Trans-arterial embolization (TAE)

Substances are delivered through a thin tube, inserted through the inner thigh into the hepatic artery

Trans-arterial chemoembolization (TACE)

Chemotherapy drugs are sent through the hepatic artery, toward the liver

Targeted therapies for pancreatic cancerTargeted therapies

Pancreatic cancer cells are made up of multiple building blocks, such as genes or proteins. Targeted therapy focuses on targeting specific parts of these building blocks, known as modular targets, to stop pancreatic cancer cells from growing and spreading.

Targeted therapy drugs called tyrosine kinase inhibitors may be used to shrink, slow and prevent the growth of pancreatic cancer. Sunitinib or everolimus may also be effective for people with neuroendocrine tumours (NETs) to stop the cancer from growing and spreading. Targeted therapies are only effective for certain pancreatic cancers which have these modular targets. Your care team will examine the make-up of your cancer cells to determine if targeted therapies are suitable for you.

Immunotherapy for pancreatic cancerImmunotherapy

Immunotherapy trains the immune system to recognise and fight pancreatic cancer cells, which may hide behind proteins known as ‘checkpoints’. Checkpoint inhibitors such as PD-1 block these checkpoints, allowing the immune system to target the pancreatic cancer. While there are no immunotherapy drugs currently approved for use for pancreatic cancer in Australia, there may be immunotherapy treatments being investigated through clinical trials.

Clinical trials for pancreatic cancer

You may have the option of participating in a clinical trial for your pancreatic cancer treatment. Clinical trials offer hope and opportunity and contribute to breakthroughs in treatment for future cancer patients. A small number of patients have specific mutations in genes that mean their cancer might respond to targeted drugs which are being assessed through clinical trials. For example, patients with mutations in BRCA1 or BRCA2 genes (which can also be associated with a hereditary risk for other cancers) may benefit from PARP inhibitors (targeted therapy drugs), those with changes in one of the NTRK genes may benefit from NTRK inhibiting drugs (targeted therapy drugs), and patients with a deficiency of mismatch repair proteins in their tumour (proteins responsible for repairing DNA errors that occur during cell division) may benefit from immunotherapy treatment.

Icon offers a wide range of clinical trials providing patients with access to new and evolving treatments.

See current pancreatic cancer clinical trials delivered by Icon Cancer Centre.

Treatment by stage of pancreatic cancerTreatment by stage

When you are diagnosed with pancreatic cancer, your oncologist will develop your treatment plan as part of a multidisciplinary team based on the stage of your cancer. Common treatment options for each stage of pancreatic cancer include:

  • Resectable pancreatic cancer (Stage I)

    If your cancer is contained to the pancreas and you are healthy enough to undergo surgery, this may be recommended as your first treatment option and is often combined with chemotherapy and/or radiation.

  • Locally advanced pancreatic cancer (Stage II and Stage III)

    When your cancer has moved beyond the pancreas into nearby blood vessels or tissue, treatment for pancreatic cancer commonly takes a palliative approach. Surgery might be used to relieve symptoms, such as unblocking the ducts or small intestine. Treatment will commonly include chemotherapy, radiation therapy, and in some cases targeted therapy.

  • Metastatic pancreatic cancer (Stage IV)

    Metastatic pancreatic cancer which has spread to distant areas of the body is typically treated with chemotherapy and may be combined with targeted therapies depending on the type and location of your pancreatic cancer. Other treatments for metastatic pancreatic cancer include radiation therapy and palliative surgery. Different combinations of chemotherapy and participation in clinical trials may also be offered if the cancer has spread to distant areas. For the small percentage of pancreatic cancer patients whose cancer harbours an actionable mutation, targeted therapy or immunotherapy may be suitable.


For a full list of references, click here.
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