Chemotherapy and surgery to remove pancreatic cancer

If you are able to have surgery to remove the cancer (such as a Whipple's procedure) you may have chemotherapy after surgery. If the cancer is close to major blood vessels (borderline resectable cancer), you may also have chemotherapy.

Chemotherapy for pancreatic cancer can be used in different ways. If you are able to have surgery to remove the cancer (such as the Whipple’s procedure), chemotherapy can be used:

  • after surgery, to try to stop the cancer coming back
  • before surgery, to try to shrink the cancer so that the surgeon has a better chance of removing it (borderline resectable cancer)
  • with radiotherapy – which is called chemoradiotherapy.

Chemotherapy can also be used when surgery to remove the cancer is not possible. It can be used to slow down the growth of the cancer if it has spread to areas near the pancreas (locally advanced pancreatic cancer) or away from the pancreas to other parts of the body (advanced pancreatic cancer). Read more about chemotherapy to treat inoperable pancreatic cancer.

Chemotherapy after surgery to remove the cancer

You should be offered chemotherapy after surgery (such as the Whipple’s procedure) to try to reduce the chances of the cancer coming back.

  • Gemcitabine with capecitabine (GemCap) is used most often after surgery.
  • You may be offered FOLFIRINOX chemotherapy instead of GemCap if you are well enough to deal with the possible side effects.
  • If you aren’t well enough for GemCap, you may be offered gemcitabine alone, as it may have fewer side effects.

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.

If you are having any problems eating after your surgery, speak to your doctor, nurse or dietitian to make sure these problems don’t delay the chemotherapy. A dietitian is an expert in diet and nutrition.

Chemotherapy for borderline operable pancreatic cancer

Occasionally, the cancer may grow very close to major blood vessels near the pancreas. You may be able to have surgery, but this depends on which blood vessels are affected by the cancer, and how far the cancer has grown. This is called borderline resectable pancreatic cancer.

You may be offered chemotherapy. Some people may then be offered chemotherapy together with radiotherapy – which is called chemoradiotherapy. The aim is to shrink the cancer, so that there is a better chance of removing it. But we need more research into how well these treatments work before surgery.

You may be offered chemotherapy before surgery as part of a clinical trial. Speak to your oncologist about any clinical trials that may be suitable for you.

If the cancer has grown around a blood vessel, it’s not usually possible to remove the cancer with surgery. You will be offered chemotherapy to help control the cancer.

Chemotherapy with radiotherapy (chemoradiotherapy)

Chemoradiotherapy is when chemotherapy is used together with radiotherapy. The chemotherapy may make the cancer cells more sensitive to radiotherapy, so that it works better.

Some people with borderline resectable cancer and locally advanced cancer may be offered chemoradiotherapy. But we need more research into how well this treatment works, and you may be offered chemoradiotherapy as part of a clinical trial.

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 taken as a tablet. You will have radiotherapy and capecitabine every day from Monday to Friday, for five to six weeks.

Updated August 2019

Review date August 2021