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Medical Author:

Timothy Kuo, MD

Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Surgery is the primary treatment for pancreatic cancer; based on the results of the surgery, chemotherapy with or without radiation therapy may be offered to reduce the likelihood that the cancer will return (called adjuvant therapy).

Factors that increase the risk that the cancer may return after surgical removal are as follows:

• Tumor present at the edge of the surgical specimen (referred to as a positive margin)
• Tumor present within blood vessels or lymph channels
• Tumor tracking along nerves
• Surrounding lymph nodes containing cancer

Options for adjuvant therapy include the following:

• Chemotherapy and radiation therapy given simultaneously
• Chemotherapy alone

No standard recommendation is available for adjuvant therapy, and it remains an area of intense clinical research. Enrolling in a clinical trial should be considered.

For locally advanced pancreatic cancer that cannot be surgically removed safely, a combination of chemotherapy and radiation therapy or chemotherapy alone may be offered. This treatment remains controversial, and various centers have different recommendations based on a number of factors such as size of the disease and symptoms.

Chemotherapy is the cornerstone of treatment of pancreatic cancer that is locally advanced or metastatic. The chemotherapy agent most commonly used in this setting is gemcitabine (see Medications). However, in a 2013 study, a new oral agent termed S-1 (fluoropyrimidine S-1), when compared to gemcitabine showed remarkably better survival rates and may become the new drug that will offer higher survival rates to patients.

At specific intervals while a person is receiving treatment, imaging studies are repeated to help evaluate whether the tumor is getting smaller or bigger. If a time comes when the tumor grows despite chemotherapy, it may indicate that the cancer has become resistant to this particular therapy and an alternative plan needs to be considered.

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