Chemotherapy and surgery to remove pancreatic cancer

You should be offered chemotherapy after surgery to remove the cancer (such as the Whipple’s procedure), to try to reduce the chances of the cancer coming back. There are three types of chemotherapy that may be used:

• FOLFIRINOX
• gemcitabine with capecitabine (GemCap)
• gemcitabine.

The type of chemotherapy you are offered will depend on how you are feeling and what your doctor thinks will be best for you.

You should be given time to recover properly from your surgery before starting chemotherapy, as you need to be well enough for six months of chemotherapy. Chemotherapy may start up to 12 weeks after your surgery.

Pancreatic cancer and surgery to remove it can cause problems with digestion, including weight loss, losing your appetite, and changes to your poo. If you have any problems after surgery, speak to your doctor, nurse or dietitian to make sure these don’t delay the chemotherapy. A dietitian is an expert in diet and nutrition.

Chemotherapy for borderline resectable pancreatic cancer

Borderline resectable cancer is cancer that has grown very close to major blood vessels near the pancreas. Surgery to remove the cancer may be possible, but it depends which blood vessels are affected, and how far the cancer has grown.

You may be offered chemotherapy. Some people may then be offered chemotherapy together with radiotherapy (see below). The aim is to shrink the cancer away from major blood vessels so that there’s a better chance of removing it.

You will have scans before, during and at the end of your treatment to see how the chemotherapy is working.

Chemotherapy with radiotherapy (chemoradiotherapy)

Chemotherapy used together with radiotherapy is called chemoradiotherapy. Radiotherapy uses high energy x-rays (radiation) to damage cancer cells and stop the cancer growing. The chemotherapy may make the cancer cells more sensitive to radiotherapy, so that it works better.

Some people with borderline resectable cancer (see above) and locally advanced cancer may be offered chemoradiotherapy.

If you have chemoradiotherapy, you will normally have chemotherapy on its own for around three to six months to begin with. You will then have a CT scan. If this shows that the cancer hasn’t grown or spread, you will start chemoradiotherapy.

The chemotherapy drug most often used with radiotherapy is capecitabine, which is a tablet. You will have radiotherapy and capecitabine five days a week, for five to six weeks.

Updated April 2022

Review date April 2024