Surgery is the best treatment for people with pancreatic cancer that has not spread outside the pancreas. It can help people live longer. Cancer that can be removed by surgery is called resectable or operable cancer.
Only a small number of people can have surgery. This is partly because pancreatic cancer is often diagnosed when it has spread and can no longer be removed. Surgery may only be an option if there is no sign the cancer has spread.
If you have been diagnosed with pancreatic cancer, you will have scans to check whether surgery is an option for you. Your medical team will look carefully at these scans to work out if surgery is possible.
You also need to be fit and well enough to have surgery and will have tests to check this. Some hospitals offer programmes to help people get fit enough. This is called prehabilitation. It focuses on diet and physical activity, and can help you recover more quickly after surgery. Read more about the tests and preparing for surgery.
When is surgery not an option?
Surgery is not suitable for everyone.
- It may not be possible if you have some other health problems, such as severe heart or lung disease.
- It is usually not possible if you have locally advanced cancer. This is cancer that has spread outside the pancreas to large blood vessels, or to lymph nodes further from the pancreas (see below). Lymph nodes are part of the immune system.
- It is not possible if you have advanced (metastatic) cancer. This is cancer that has spread to other parts of the body.
Your doctor will explain whether surgery is an option. If it isn’t, they may offer you chemotherapy. This uses drugs to kill cancer cells. It may slow the growth of the cancer and help with symptoms. There are also other treatments to help manage symptoms.
If the cancer is close to major blood vessels
Sometimes the cancer may grow very close to large blood vessels near the pancreas. It may be possible to have surgery to remove the cancer. This will depend on which blood vessels are affected and how far the cancer has grown.
This is called borderline resectable pancreatic cancer. Your doctor may not call it this, they may just focus on whether your cancer can be removed with surgery.
You may be offered chemotherapy, sometimes with radiotherapy (chemoradiotherapy). If the cancer is just touching an artery or vein, chemotherapy may shrink the cancer so that surgery is then possible. The operation will usually happen around 6–8 weeks after you finish chemotherapy, although this can vary. The surgeon might also need to remove part of the affected vein (called a vein resection).
But if the cancer has grown around the artery or vein, surgery is less likely to be possible, even after chemotherapy.