Pancreatic Cancer Treatment by Extent of Disease

Precancerous pancreatic lesions are abnormal cells found in the lining of the pancreas. These abnormal cells may be precancerous, meaning they may become cancer and spread to nearby tissue.

Precancerous pancreatic lesions include pancreatic intraepithelial neoplasia (PanINs), intraductal papillary mucinous neoplasia (IPMNs), and mucinous cystic neoplasia (MCNs). People with PanINs, IPMNs, and MCNs have varying degrees of risk for developing pancreatic ductal adenocarcinoma, the most common and aggressive type of pancreatic cancer.

Treatment of precancerous pancreatic lesions may include:

• active surveillance to monitor lesions for changes and to intervene before they become dangerous 
• surgery to remove precancerous pancreatic lesions that either have a high risk of developing into pancreatic cancer or have become cancerous

Resectable pancreatic cancer can be completely removed by surgery because it has not grown into major blood vessels near the tumor.

Borderline resectable pancreatic cancer has grown into a major blood vessel or nearby tissues. It may be possible to remove the tumor after treatment with chemo or chemoradiation, but there is a high risk that cancer cells will remain after surgery.

Treatment of resectable or borderline resectable pancreatic cancer may include:

• Surgery. Whipple procedure or distal pancreatectomy may be used to remove as much of the cancer as possible. Prognosis is best when the cancer can be completely removed with surgery. Some types of surgeries—such as stent placement and gastric bypass—are palliative, meaning they are done to relieve symptoms of pancreatic cancer but are not meant to cure it.
• Chemotherapy. You may receive chemotherapy before surgery, after surgery, or both. Chemotherapy before surgery can sometimes shrink the tumor, making it possible to remove more of it during the procedure.
• Radiation therapy. You may receive radiation therapy alongside chemotherapy before surgery or after surgery to kill remaining cancer cells and reduce the risk of recurrence. However, more research is needed to understand whether radiation therapy improves survival for people with pancreatic cancer.

Learn more about these treatments at Pancreatic Cancer Treatment.

Locally advanced pancreatic cancer is usually considered unresectable, meaning it cannot be completely removed by surgery.

Treatment of locally advanced pancreatic cancer may include: 

• Chemotherapy. You may receive chemotherapy to try to shrink the tumor so it can be removed by surgery. If chemo successfully shrinks the tumor, you may also receive chemo after surgery to try to destroy any cancer cells that remain.
• Targeted therapy. In addition to chemotherapy, you may receive targeted therapy if molecular testing shows that the tumor has changes to certain genes, such as NTRK, RET, BRCA1/2, or KRAS.
• Immunotherapy. You may receive immunotherapy with an immune checkpoint inhibitor if the tumor has certain changes in its DNA, such as high microsatellite instability (MSI-H), deficient DNA mismatch repair (dMMR), or high tumor mutational burden (TMB-H).
• Radiation therapy. You may receive radiation therapy alongside chemotherapy. However, more research is needed to understand whether radiation therapy improves survival for people with pancreatic cancer.
• Surgery. Whipple procedure or distal pancreatectomy may be used to remove as much of the cancer as possible. However, most surgeries for locally advanced pancreatic cancer are palliative. Palliative surgeries include endoscopic stent placement and gastric bypass.

Learn more about these treatments at Pancreatic Cancer Treatment.

Pancreatic cancer that has spread beyond the pancreas is called stage 4 or metastatic pancreatic cancer. Treatment for metastatic pancreatic cancer focuses on slowing the spread of the cancer and controlling symptoms.

Chemotherapy is the main treatment for metastatic pancreatic cancer. You may receive a combination of two or three different drugs over a period of 6 months.

Learn more about treatments at Pancreatic Cancer Treatment.

If initial treatments removed all detectable disease but the cancer comes back, it is called recurrent pancreatic cancer. Treatment for recurrent pancreatic cancer focuses on slowing the spread of the cancer and controlling symptoms.

Some of the treatments used for earlier stages of pancreatic cancer may also be used for recurrent pancreatic cancer. Your choice of treatments will partly depend on how the cancer responded to initial treatments, what side effects you are experiencing, and your goals of treatment.

Most pancreatic cancers are advanced when diagnosed, and current treatments do not always help you live longer. Clinical trials offer additional treatment options, although the side effects of these treatments and impact on your survival are not known. Consider joining a clinical trial if you have advanced cancer or if your current treatments are not working. You can find clinical trials at Treatment Clinical Trials for Pancreatic Cancer. Learn more about clinical trials, including how to find and join one, at Cancer Clinical Trial Information for Patients and Caregivers.