NCCN Guidelines for Patients
Pancreatic Cancer, Version 1.2017
Resectable pancreatic cancer
Primary treatment and follow-up
The type of surgery you will have depends on the
size and location of the tumor. At the start of the
surgery, your doctors may find that the cancer
has spread too much and can’t be removed by
surgery. In that case, the surgeon may still want
to do an operation to connect the stomach to the
jejunum (part of small intestine). This creates a path
between the stomach and of the middle section of
the small intestine. This is called a duodenal bypass
(gastrojejunostomy) and it may be done if cancer is
blocking the stomach. He or she may also want to
re-route the flow of bile around the blocked part of
the bile duct if you have or are at risk of developing
jaundice. This is called a biliary bypass. If you have
severe pain, the surgeon may also inject alcohol
(ethanol) into the nerves in the abdomen (called
celiac plexus) to destroy them to relieve the pain.
This is a nerve block referred to as celiac plexus
neurolysis. Finally, the surgeon should perform a
biopsy to confirm pancreatic cancer if not done
For cancer that cannot be removed by surgery, the
next treatments depend on how far the cancer has
spread. Cancer that has spread outside the pancreas
to involve nearby blood vessels or other structures
is called locally advanced unresectable. Cancer that
has spread outside the pancreas to far sites in the
body is called metastatic.
On the other hand, if surgery is successful and all
of the cancer can be removed, you will have more
treatment to try to kill any remaining cancer cells.
This treatment is given after surgery is complete. It is
called adjuvant treatment.
If surgery was completed, see Guide 7 for adjuvant
treatment recommendations. If surgery wasn’t
completed, see treatment for locally advanced or
metastatic pancreatic cancer.