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NCCN Guidelines for Patients



Pancreatic Cancer, Version 1.2017


Cancer treatments

Surgery | Radiation therapy

There is more than one treatment for

pancreatic cancer. The main types are

described in this chapter. This information

may help you with the treatment guides in

Part 5. It may also help you know what to

expect during treatment. Not every person

with pancreatic cancer will receive every

treatment listed.


Surgery is an operation to remove or repair a part

of the body. Sometimes surgery can be used as the

main treatment to remove pancreatic cancer. NCCN

experts recommend that surgery for pancreatic

cancer should only be done at a hospital that does

more than 15 pancreatic surgeries each year.

Hospitals that perform many pancreatic surgeries

often have better results.

There are three types of surgery used for pancreatic

cancer. The type of surgery you receive depends on

where the tumor is in the pancreas. Some surgeons

now consider minimally invasive surgery (smaller

incisions and less recovery time) for pancreatic

cancer. This depends on whether the cancer is able

to be removed with this type of surgery.

The goal of surgery is to remove all of the cancer. To

do so, the tumor is removed along with some normal-

looking tissue around its edge. The normal-looking

tissue is called the surgical margin. A clear margin is

when no cancer cells are found in the normal-looking

tissue around the edge of the tumor. This is also

referred to as a negative margin. A positive margin

is when cancer cells are found in the normal-looking


Whipple procedure

The surgery for a tumor in the widest part (head) of

the pancreas is called a pancreatoduodenectomy,

also known as a Whipple procedure. This surgery

removes the head of the pancreas, the gallbladder,

duodenum (first part of the small bowel), part of the

bile duct, and often part of the stomach. Some of the

lymph nodes near your pancreas will be removed

to test for cancer cells. Once the cancer has been

removed, your surgeons will connect your organs so

you can digest food.

Distal pancreatectomy

The surgery for a tumor in the middle part (body) or

narrow end (tail) of the pancreas is called a distal

pancreatectomy. This surgery removes the body and

tail of the pancreas, some nearby lymph nodes, and

sometimes the spleen and its blood vessels.

Total pancreatectomy

The surgery for cancer in a large portion of the

pancreas is called a total pancreatectomy. This

surgery removes the entire pancreas. It also removes

the gallbladder, duodenum, part of the bile duct and

stomach, nearby lymph nodes, and sometimes the

spleen. This surgery is not often done.

Radiation therapy

Radiation therapy uses high-energy rays to treat

cancer. The rays damage a cell’s instructions for

making and controlling cells. This either kills the

cancer cells or stops new cancer cells from being

made. More research is needed to know the best

practice for treating pancreatic cancer with radiation.

This section explains the methods of radiation

therapy that are currently used.

For pancreatic cancer, radiation is often given with

chemotherapy. Chemotherapy may improve how well

radiation works. This combined treatment is called