Page last updated: April 2024
The information on this webpage was adapted from Understanding Pancreatic Cancer - A guide for people with cancer, their families and friends (2024 edition). This webpage was last updated in April 2024.
Expert content reviewers:
This information was developed based on clinical practice guidelines, and with the help of a range of health professionals and people affected by cervical cancer:
- Prof Lorraine Chantrill, Honorary Clinical Professor, University of Wollongong, and Head of Department, Medical Oncology, Illawarra Shoalhaven Local Health District, NSW
- Karen Baker, Consumer
- Michelle Denham, 13 11 20 Consultant, Cancer Council WA
- Prof Anthony J Gill, Surgical Pathologist, Royal North Shore Hospital and The University of Sydney, NSW
- A/Prof Koroush Haghighi, Liver, Pancreas and Upper Gastrointestinal Surgeon, Prince of Wales and St Vincent’s Hospitals, NSW
- Dr Meredith Johnston, Radiation Oncologist, Liverpool and Campbelltown Hospitals, NSW
- Dr Brett Knowles, Hepato-Pancreato-Biliary and General Surgeon, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, and St Vincent’s Hospital, VIC
- Rachael Mackie, Upper GI – Clinical Nurse Consultant, Peter MacCallum Cancer Centre, VIC
- Prof Jennifer Philip, Chair of Palliative Care, University of Melbourne, and Palliative Medicine Physician, St Vincent’s Hospital, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, VIC
- Lucy Pollerd, Social Worker, Peter MacCallum Cancer Centre, VIC
- Rose Rocca, Senior Clinical Dietitian – Upper GI, Peter MacCallum Cancer Centre, VIC
- Stefanie Simnadis, Clinical Dietitian, St John of God Subiaco Hospital, WA
Surgery to remove the cancer, in combination with chemotherapy and possibly radiation therapy, is generally the most effective treatment for early pancreatic cancer (stage 1–2 and some stage 3 pancreatic cancers).
This treatment will be suitable for only about 20% of people with pancreatic cancer, as most people are diagnosed at a later stage.
It is important that the surgery is done by a surgeon who is part of a multidisciplinary team in a specialist pancreatic cancer treatment centre.
Treatments before or after surgery
Your surgeon may recommend other treatments before surgery to shrink the tumour, or after surgery to destroy any remaining cancer cells.
Treatments given before surgery are known as neoadjuvant therapies, while treatments given after surgery are called adjuvant therapies. They both may include:
- chemotherapy – use of drugs to kill or slow the growth of cancer cells
- chemoradiation – chemotherapy combined with radiation therapy.
Your health care team may talk to you about doing some exercises to help improve your fitness before surgery. This may be called prehabilitation.
More about cancer treatment
Surgery to remove the cancer
Surgical removal (resection) of the tumour is the most common treatment for people with early-stage cancer who are in good health. It may also be considered for some stage 3 cancers, usually with chemotherapy (and sometimes radiation therapy).
These stage 3 cancers are known as borderline resectable cancers, which means that surgery alone may or may not be able to remove all of these tumours.
The aim of resection is to remove all the tumour from the pancreas, as well as a margin of healthy tissue. The type of surgery you have will depend on the size and location of the tumour, your general health and your preferences.
Your surgeon will talk to you about the most appropriate surgery for you, as well as the risks and any possible complications.
How the surgery is done
Surgery for pancreatic cancer is carried out in hospital under a general anaesthetic.
It is difficult surgery and should only be performed by surgeons with a lot of experience in doing this operation. There are three main approaches:
- open surgery – involves one larger cut in the abdomen so the surgeon can remove the cancer.
- keyhole surgery (laparoscopic or minimally invasive surgery) – involves a number of small cuts in the abdomen. The surgeon inserts a long, thin instrument with a light and camera (laparoscope) into one of the cuts and uses images from the camera for guidance. The surgeon inserts tools into the other cuts to remove the cancer.
- robotic-assisted surgery – is a type of keyhole surgery. The surgeon sits at a control panel to see a three-dimensional image and moves robotic arms that hold the instruments.
Open surgery is usually the best approach for pancreatic cancer, but keyhole or robotic-assisted surgery may be offered as an option in some circumstances.
Talk to your surgeon about what options are available to you, ask about the risks and benefits of each approach, and check if there are any extra costs.
Types of surgery
- Whipple procedure – treats tumours in the head of the pancreas. Also known as pancreaticoduodenectomy, it is the most common surgery for pancreatic tumours.
- Distal pancreatectomy – the surgeon removes only the tail of the pancreas, or the tail and a portion of the body of the pancreas. The spleen is usually removed as well. The spleen helps the body fight infections, so if it is removed you are at higher risk of some types of bacterial infection. Your doctor may recommend vaccinations before and after a distal pancreatectomy.
- Total pancreatectomy – when cancer is large or there are many tumours, the entire pancreas and spleen may be removed, along with the gall bladder, common bile duct, part of the stomach and small bowel, and nearby lymph nodes.
If the cancer has spread
During surgery to remove the cancer, the surgeon may find that the cancer has spread around one or more of the major blood vessels in the area or into the lining of the abdomen (peritoneum).
This may occur even if you had several scans and tests beforehand.
If this happens, the surgeon will not be able to remove the cancer. However, they may be able to perform procedures (such as a bypass) that will relieve some of the symptoms caused by the cancer.
Having a Whipple procedure
The Whipple procedure (pancreaticoduodenectomy) is a major, complex operation. It has to be done by a specialised pancreatic or hepato-pancreato-biliary (HPB) surgeon. The surgeon removes:
- the part of the pancreas with the cancer (usually the head)
- the first part of the small bowel (duodenum)
- part of the stomach
- the gall bladder
- part of the common bile duct.
Then the surgeon reconnects the remaining part of the pancreas, common bile duct and stomach (or duodenum) to different sections of the small bowel to keep the digestive tract working.
Once these organs are reconnected, food, pancreatic juices and bile to continue to flow into the small bowel for the next stage of digestion. Many people need to change their diet after a Whipple procedure.
A Whipple procedure is a long operation. It usually lasts 5–8 hours. As your surgeon will explain, this surgery is complex and there is a chance of serious problems, such as major bleeding or leaking.
Most people stay in hospital for 1–2 weeks after surgery, and full recovery takes at least 8–12 weeks. Your team will encourage you to move around and start gentle exercise as soon as you are ready.
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What to expect after surgery
While you are recovering after surgery, your health care team will check your progress and help you with the following:
Pain control
You will have some pain and discomfort for several days after surgery. You will be given pain medicines to manage this. If you are in pain when you return home, talk to your doctors about a prescription for pain medicine.
Surgical drain
You may have a thin tube placed in the abdomen to drain fluid into a small bag or bottle. The fluid can then be checked for potential problems.
The tube is usually removed after a few days but may be left in for longer. Surgical drains are never permanent.
Drips and tubes
While in hospital, you will have a drip to replace your body’s fluids. At first, you may not be able to eat or drink. You’ll then be on a liquid diet before slowly returning to normal food.
A temporary feeding tube may be put into the small bowel during the operation. This tube provides extra nutrition until you can eat and drink normally again.
The hospital dietitian can help you manage changes to eating.
Enzyme supplements
Many people will need to take tablets known as pancreatic enzymes after surgery. These are taken with each meal to help digest fat and protein. See page 51 for more information
Insulin therapy
Because the pancreas produces insulin, people who have had all or some of their pancreas removed may develop diabetes after surgery and need regular insulin injections (up to four times per day).
A specialist doctor called an endocrinologist will help you develop a plan for managing diabetes.
Moving around
Your health care team will probably encourage you to walk the day after surgery. They will also provide advice about when you can get back to your usual activity levels.
Length of hospital stay
Most people go home within two weeks, but if there are problems, you may need to stay in hospital longer. You may need rehabilitation to help you recover and regain physical strength, and adapt to changes after surgery.
This may be as an inpatient in a rehabilitation centre or through a home-based rehabilitation program.
"Before the pancreatic cancer diagnosis, I was a busy teacher and my children were all still at home. I now have the time to walk regularly and cancer was a great motivator for doing strength exercises. I’ve taken up my art again and attend an art group, which I find very therapeutic." Karen
What if the cancer returns?
If the surgery successfully removes all of the cancer, you will have regular appointments to monitor your health, manage any long-term side effects and check that the cancer hasn’t come back or spread.
Check-ups will become less frequent if you have no further problems. Between appointments, let your doctor know immediately of any symptoms or health problems.
Unfortunately, pancreatic cancer is difficult to treat and it often does come back after treatment. This is known as a recurrence. Most of the time, surgery is not an option if you have a recurrence.
Your doctors may recommend other types of treatment with the aim of reducing symptoms and improving quality of life. You may also be able to get new treatments by joining a clinical trial.
More about clinical trials
