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Resectable pancreatic cancer is the minority of pancreatic cancer that the surgeon can remove with clear margins because it has not wrapped around the main arteries or spread. Treatment is an operation, usually a Whipple procedure, followed by six months of combination chemotherapy, which is what turns surgery alone into a real chance of cure.
Pancreatic ductal adenocarcinoma is called resectable when CT shows no contact with the superior mesenteric or coeliac arteries, no more than abutment of the portal or superior mesenteric vein, and no metastases. Most such tumours sit in the head of the gland and present with painless jaundice; body and tail tumours present later and are less often removable. Staging is a pancreas-protocol CT, a chest CT and CA 19-9, with endoscopic ultrasound and biopsy where the diagnosis is in doubt or neoadjuvant treatment is planned, and staging laparoscopy in some centres to find small peritoneal or liver deposits that CT misses.
The operation is a pancreatoduodenectomy (Whipple) for head tumours or a distal pancreatectomy with splenectomy for body and tail tumours, both with regional lymphadenectomy, increasingly by robotic or laparoscopic approach in high-volume centres. Surgery alone cures few patients: CONKO-001 (2007) showed that adjuvant gemcitabine roughly doubles the number alive without recurrence, ESPAC-4 (2017) that gemcitabine plus capecitabine does better, and PRODIGE 24 (2018) that six months of modified FOLFIRINOX after surgery gives the longest survival yet seen in the disease for patients fit enough to receive it. Roughly half of patients never complete adjuvant chemotherapy because of slow recovery, which is the main argument for giving some or all of it before surgery.
Whether upfront chemotherapy helps clearly resectable tumours is not settled: PREOPANC-1 showed a benefit for neoadjuvant chemoradiation over upfront surgery in a mixed resectable and borderline population, but NORPACT-1 (2024) found no survival gain from neoadjuvant FOLFIRINOX in resectable disease, and the ALLIANCE A021806 trial is testing the question with modern chemotherapy. Every patient should be offered germline testing, because a BRCA, PALB2 or ATM variant changes chemotherapy choice and matters to relatives. Recurrence is common even after a complete resection and adjuvant chemotherapy, most often in the liver, and adjuvant trials of personalised mRNA vaccines (autogene cevumeran) and of the pan-RAS inhibitor daraxonrasib are trying to lower it.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
About one in five pancreatic cancers is judged removable at diagnosis, usually because a tumour in the head of the pancreas blocked the bile duct and caused jaundice early. It is the only stage at which the disease is routinely cured.
Most pancreatic cancers arise in the head next to the bile duct, which is why jaundice is the presenting sign; bile duct cancers are named by where along the tree they sit.
Same organ: Glucagonoma, VIPoma, Somatostatinoma, Pancreatic ductal adenocarcinoma, Biliary tract cancer (cholangiocarcinoma), Intrahepatic cholangiocarcinoma, Extrahepatic cholangiocarcinoma (perihilar and distal), Biliary tract cancer (all types), Neuroendocrine tumours, Pancreatic neuroendocrine tumours, Grade 3 well-differentiated neuroendocrine tumour, Extrapulmonary neuroendocrine carcinoma, Gallbladder cancer, Gallbladder adenocarcinoma, Papillary carcinoma of the gallbladder, Mucinous carcinoma of the gallbladder, Adenosquamous and squamous carcinoma of the gallbladder, Neuroendocrine carcinoma of the gallbladder, Incidental gallbladder cancer (found after cholecystectomy), Carcinoma in situ and dysplasia of the gallbladder, Cystic duct carcinoma, Ampullary cancer (ampulla of Vater), Borderline resectable pancreatic ductal adenocarcinoma, Locally advanced unresectable pancreatic ductal adenocarcinoma, Metastatic pancreatic ductal adenocarcinoma, KRAS G12C-mutant pancreatic ductal adenocarcinoma, KRAS wild-type pancreatic ductal adenocarcinoma, BRCA or PALB2-mutant pancreatic ductal adenocarcinoma, Mismatch repair deficient (MSI-high) pancreatic ductal adenocarcinoma, Pancreatic acinar cell carcinoma, Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors, Pancreatoblastoma, Adenosquamous carcinoma of the pancreas, Colloid (mucinous non-cystic) carcinoma of the pancreas, Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells, Invasive carcinoma arising in an intraductal papillary mucinous neoplasm (IPMN-associated carcinoma), Mucinous cystic neoplasm of the pancreas with associated invasive carcinoma (MCN-associated carcinoma), Solid pseudopapillary neoplasm of the pancreas
Nothing recorded yet.
Background: CA 19-9. Also on OnCo: Symptoms and red flags · Early detection roadmap.
Pancreas-protocol CT, chest CT and CA 19-9; endoscopic ultrasound with biopsy when tissue is needed before treatment; biliary stenting only for cholangitis, deep jaundice or delayed surgery.
Pancreatoduodenectomy for head tumours, distal pancreatectomy with splenectomy for body and tail tumours, with regional lymphadenectomy; open, laparoscopic or robotic in high-volume centres.
Six months of modified FOLFIRINOX for fit patients (PRODIGE 24); gemcitabine plus capecitabine (ESPAC-4) or gemcitabine alone (CONKO-001) for those who cannot tolerate it, started within twelve weeks of surgery.
Considered for tumours with high-risk features (large size, very high CA 19-9, suspicious nodes) and increasingly offered in trials for all resectable disease; PREOPANC and NORPACT-1 are the evidence for and against.
Offered to every patient at diagnosis; carriers of BRCA, PALB2 or ATM variants receive platinum-based chemotherapy and their relatives are offered testing and surveillance.
CA 19-9 and CT every three to six months for two years then less often; recurrence is treated as metastatic or locally advanced disease.
Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Answer a few questions from a report and read the guideline statement that applies, quoted word for word with its source. Educational aids to prepare for an appointment, not advice.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
The three main regimens share low blood counts, tiredness, sickness and sore mouth; FOLFIRINOX and NALIRIFOX add irinotecan diarrhoea and oxaliplatin's cold-triggered tingling and rare throat spasm, gemcitabine with nab-paclitaxel adds hair loss and neuropathy, and every regimen comes with the same temperature rule for ringing the 24-hour line.
The bowel cancer regimens share low blood counts, tiredness, sickness and a sore mouth. Oxaliplatin adds cold-triggered tingling, irinotecan adds early and late diarrhoea, capecitabine adds hand-foot syndrome and needs a DPD test first, and cetuximab or panitumumab add an acne-like rash and low magnesium. The rule for all of them: ring the 24-hour number rather than wait.
See all on the product pages:CapecitabineFOLFIRINOX / mFOLFIRINOXGemcitabineGemcitabine + nab-paclitaxel·Printable cards in the navigator
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Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
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