NCCN Guidelines for Patients
Pancreatic Cancer, Version 1.2017
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
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
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.
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.
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 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