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NCCN Guidelines for Patients



Pancreatic Cancer, Version 1.2017


Treatment guide

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.

Next steps

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.