A Guide to the Treatment of Pancreatic Cancer

A pancreatic cancer diagnosis can feel like the floor dropped out. You may be reading scan reports, weighing a chemotherapy plan, or trying to understand whether surgery is even an option. Most of those questions trace back to one decision our team or yours makes first.

Before any treatment is chosen, your oncologist sorts the cancer into a planning group: resectable, borderline resectable, locally advanced, or metastatic. That label, more than the stage number, drives what comes next. Ask your doctor: "Which group am I in, and why?"

Most of what follows applies to exocrine pancreatic cancer, the most common form. It behaves differently from rarer neuroendocrine tumors.

The First Decision: Can the Tumor Be Removed Safely?

Surgery is the only treatment that can sometimes cure pancreatic cancer, and only when the surgeon can remove all visible disease with clear margins. That is why your team starts with resectability.

• Resectable: The tumor is contained and surgery can likely remove it. Chemotherapy is usually given before, after, or both.

• Borderline resectable: The tumor is close to or touching key blood vessels. Chemotherapy first, sometimes with radiation, may shrink it enough to operate.

• Locally advanced: The tumor wraps important vessels too closely for safe removal. The plan focuses on systemic treatment and, when useful, radiation for local control or symptom relief.

• Metastatic: The cancer has spread to the liver, lungs, abdominal lining, or distant nodes. Surgery on the primary tumor will not extend life here. Chemotherapy and supportive care lead the plan.

Only a minority of patients are in the resectable group at diagnosis. If you are not, the plan still has real treatment behind it. Chemotherapy, biomarker testing, selective radiation, and clinical trials all stay on the table, even when surgery does not.

Surgery

If your team places you in the resectable or borderline resectable group, surgery becomes the central question. A Whipple operation removes tumors in the head of the pancreas, while a distal pancreatectomy removes tumors in the body or tail.

These are major operations that usually take place at a hospital experienced in pancreatic surgery, not in our clinic. Our role is to coordinate the medical oncology around that surgical plan.

Chemotherapy before surgery, called neoadjuvant therapy, is now common for borderline resectable disease and increasingly used for resectable disease too. After recovery, your team will likely recommend more chemotherapy to lower recurrence risk.

When the case sits at the edge of resectability, a second opinion at a high-volume center is reasonable. We can help organize records for that referral.

Chemotherapy

Chemotherapy is not a backup plan. It is central to most pancreatic cancer treatment, whether you are preparing for surgery, recovering after it, or managing disease that cannot be removed.

The regimen your team recommends depends on your overall fitness, organ function, and goals. Common named regimens include FOLFIRINOX (a four-drug combination), gemcitabine plus nab-paclitaxel, and NALIRIFOX (irinotecan liposome with oxaliplatin, fluorouracil, and leucovorin).

NALIRIFOX received FDA approval in 2024 for first-line metastatic disease. Gemcitabine alone may fit better when fatigue, age, or other illnesses make aggressive treatment unsafe.

The choice is not about finding the strongest option. It is matched to your fitness, your support at home, and what matters most to you. Side effects, dose adjustments, and time off between cycles are part of the plan, not signs it is failing.

Knowing what to watch for between cycles can help you catch problems early and keep your plan on track.

Radiation Therapy

Radiation in pancreatic cancer is rarely the lead treatment, and that confuses some patients. Ask your radiation oncologist a simple question: what is this radiation trying to do?

• Shrink toward surgery: In borderline resectable disease, radiation paired with chemotherapy may pull the tumor away from a vessel.

• Improve local control: In locally advanced disease, radiation can hold the primary tumor in check while systemic therapy works.

• Relieve symptoms: Radiation may ease back pain or other local symptoms even when cure is not the goal. A duodenal blockage usually needs prompt evaluation and may require a stent or bypass procedure rather than radiation.

• Reduce local recurrence: After surgery, radiation may lower the chance the cancer returns in the same area.

Our radiation oncology team works alongside medical oncology and coordinates timing with the rest of your plan. Radiation is often combined with chemotherapy, but it can also be used on its own for symptom relief in selected situations. Your care team explains the purpose, the schedule, and what side effects to expect.

Biomarker Testing and Targeted Options

Biomarker testing is a standard part of pancreatic cancer care, and many patients do not realize it applies to them. Two questions are worth asking at diagnosis.

Have I had germline genetic testing? A blood or saliva test looks for inherited mutations such as BRCA1, BRCA2, or PALB2. BRCA gene testing results also matter for your family members.

A germline BRCA1 or BRCA2 mutation may qualify some patients for maintenance olaparib. The FDA indication applies to metastatic pancreatic adenocarcinoma that has not progressed after at least 16 weeks of first-line platinum-based chemotherapy.

Has my tumor been tested for actionable changes? Testing on tumor tissue can find mismatch-repair deficiency, which may open the door to checkpoint immunotherapy in a small subset of patients.

It can also find NRG1 fusions. Zenocutuzumab received FDA accelerated approval in 2024 for adults with advanced unresectable or metastatic NRG1 fusion-positive pancreatic adenocarcinoma whose disease progressed on or after prior systemic therapy. Other targets include KRAS variants, BRAF, and HER2.

ACTC offers targeted therapy and immunotherapy when biomarker testing supports their use.

These findings are uncommon in pancreatic cancer overall, but when they appear they can meaningfully change the plan. Your team will arrange testing and explain what results mean.

You may also see headlines about KRAS-targeted drugs such as daraxonrasib. As of April 2026, that drug is investigational and not approved by any regulatory authority.

Phase 3 results in previously treated metastatic disease have been encouraging. Ask your oncologist whether a clinical trial fits your situation.

Palliative Care and Clinical Trials

Two words still get misread in pancreatic cancer: palliative and trial.

Palliative care is not hospice and it is not giving up. It is a specialist team that focuses on pain, appetite, digestion, fatigue, mood, and caregiver support while your cancer-directed treatment continues. National guidelines, including a 2024 ASCO recommendation, support integrating it early alongside active treatment, not only at the end of care.

If your pain or appetite is changing the way you live, ask for a palliative referral.

Clinical trials should also be a question at diagnosis, not a last resort. Trials are studying new chemotherapy combinations, KRAS-targeted drugs, and immunotherapy. Ask our care team whether a trial might be right for you, what eligibility requires, and what records would be needed for a referral.

Understanding pancreatic cancer stages and outcomes can help you follow the conversations about your care. Rarer subtypes, including islet cell cancer and other endocrine tumors, follow different treatment paths.

Questions Patients Often Ask

Talk With Us About Your Next Step

A pancreatic cancer diagnosis brings more decisions than any one visit can hold, and you do not have to sort them alone. If you are in Brooksville, Spring Hill, Weeki Wachee, or Hernando County, our medical and radiation oncology teams can review your records and walk you through where you fit. Call 352-345-4565 or request a visit at https://actchealth.com/appointment.