If you can’t have surgery (inoperable cancer)

If you have been diagnosed with locally advanced or advanced (metastatic) pancreatic cancer, you may have been told that surgery to remove your cancer isn’t possible. Your doctor may call your cancer inoperable or unresectable – which means it can’t be removed with surgery.

What is locally advanced pancreatic cancer?

Locally advanced cancer is cancer that has spread to areas near your pancreas, such as the stomach, spleen, or large blood vessels. (Read more about these organs.) It is stage 3 cancer.

Occasionally, stage 3 cancer is borderline resectable cancer. This means that the cancer has grown very close to the major blood vessels near the pancreas. You may be able to have surgery to remove the cancer, but it depends which blood vessels are affected.

What is advanced pancreatic cancer?

Advanced cancer is cancer that has spread to other parts of your body. It is stage 4 cancer. Your doctor may call it metastatic cancer.

What are my treatment options?

You may be able to have treatments to try to control the cancer, such as chemotherapy. There are also treatments for any symptoms. The aim of treatment will be to control the growth of your cancer, manage any symptoms and generally improve how you feel.

Whatever your options, having treatment is your decision, and you don’t have to decide anything straight away. You may be offered another appointment if you need it to discuss any questions you have.

Treatments for locally advanced cancer

If you have locally advanced pancreatic cancer, you may be offered chemotherapy on its own or together with radiotherapy (chemoradiotherapy). This is to try to shrink the cancer, slow down its growth, and control your symptoms. For a small number of people, this treatment may shrink the cancer enough to make surgery to remove the cancer possible.

Treatments for advanced cancer

If you have advanced cancer and are well enough, you may be able to have chemotherapy. Chemotherapy won’t cure the cancer, but it may help you to live longer and relieve your symptoms.

If you have symptoms from the cancer there are also treatments for these. A specialist palliative care team or supportive care team can help manage symptoms. They also provide emotional and practical support. They can help you live as long and as comfortably as possible, and plan for the future. They can also support your family.

Some people find the thought of palliative care upsetting. But these services aren’t just for people at the end of their life. They are available at any point during treatment or care.

Some people with advanced pancreatic cancer may not be able to have treatment to control their cancer. This will depend on your situation. For example, you might not be physically well enough for treatments like chemotherapy. Some people may decide not to have treatment for different reasons. Whatever your situation there is medical, emotional and practical support available, and you should be able to have treatment for any symptoms you have. Read more about the care you will have if you can’t have treatment to control the cancer.

Clinical trials

Clinical trials are carefully controlled medical research studies that involve patients. Most trials in pancreatic cancer aim to find better treatments. Ask your medical team whether there are any clinical trials that you could take part in. A clinical trial may give you the chance to try a new treatment – although there’s no guarantee that it will be any better than current treatments.

Getting a second opinion

You can ask for a second opinion about your treatment options from a different medical team, if you want one. Most doctors will help you do this, if you ask them. But don’t delay your treatment while you get a second opinion, as it can take several weeks.

Dealing with symptoms and side effects

Pancreatic cancer can cause symptoms, and the treatments can cause side effects. Not everyone will have the same symptoms or side effects.

It’s important to talk to your medical team about any symptoms as they can help you with managing them. Getting treatment for symptoms can improve how you feel, both physically and emotionally.

What symptoms might I get?

We have more information about all these symptoms. Remember that not everyone will get all these symptoms.

• Problems digesting food
• Weight loss
• Diabetes
• Extreme tiredness (fatigue)
• Pain
• Bowel problems
• Feeling and being sick
• Jaundice
• A blockage in the duodenum (first part of the small intestine)
• A blood clot in a vein

Published September 2020

To be reviewed September 2022