If it’s not possible to remove the cancer, your doctor will discuss other treatments with you. This might include chemotherapy.
Your medical team will look carefully at your test results to work out if surgery is possible. But it can be difficult to tell how close the cancer has grown to blood vessels and whether it is possible to remove it. This means that different medical teams may have different opinions about whether surgery is possible. If your doctors don’t think it’s possible to remove the cancer you can ask for a second opinion from a different medical team. Be aware though that the second team’s opinion may not be any different.
When it’s not possible to remove the cancer?
Sometimes the surgeon may start the operation, but find that it’s not possible to remove the cancer. This may happen because:
- the cancer has spread to your liver
- the cancer has spread to the lining of your abdomen (tummy area)
- the cancer has grown into or around the blood vessels near the pancreas in a way that means it can’t be removed.
If this happens, your operation won’t continue as originally planned. Instead the surgeon may do a different operation, called bypass surgery, to help control symptoms. You may also be offered chemotherapy to help control the cancer.
It can be upsetting to find out that it wasn’t possible to remove the cancer. Read more about support to help you cope with pancreatic cancer.
Chemotherapy before or after surgery
Chemotherapy may sometimes be given before surgery to try to shrink the cancer, so that the surgeon has a better chance of removing it.
Some people with borderline resectable pancreatic cancer may be offered chemotherapy, then sometimes radiotherapy together with chemotherapy – this is called chemoradiotherapy. The aim is to try to shrink the cancer and make surgery possible. The chemotherapy drug most often used for chemoradiotherapy is capecitabine.
Chemotherapy before surgery may be given as part of a clinical trial. These clinical trials are medical research studies looking at the best ways to use chemotherapy with surgery.
You should be offered chemotherapy after surgery to try to reduce the chances of the cancer coming back.
- The chemotherapy drugs most often used after surgery are gemcitabine with capecitabine (GemCap).
- Another chemotherapy treatment called FOLFIRINOX may be offered instead of GemCap to people who are well enough to deal with it.
- If you aren’t well enough to cope with GemCap, you may be offered gemcitabine alone, as it may have fewer side effects.
You should be given time to recover properly from the surgery before starting chemotherapy, as you need to be well enough to cope with six rounds (cycles) of treatment. This could be up to 12 weeks after your surgery.
If you are having any eating problems after your surgery, speak to your doctor, nurse or dietitian to make sure these don’t delay the chemotherapy.