Pancreatic Cancer
Pancreatic cancer is one of the hardest diagnoses in oncology — and one where honesty matters most. We can't promise outcomes we don't have. What we can promise is the best modern treatment combined with strong symptom care from day one, so that every week of life counts.
What pancreatic cancer is — in plain words
The pancreas is a gland tucked behind the stomach, producing digestive enzymes and insulin. Pancreatic cancer almost always means pancreatic ductal adenocarcinoma — a tumour arising from the duct cells. It is uncommon overall but its impact is heavy because it is often diagnosed late, sits in a difficult anatomical location, and tends to spread early.
Less common pancreatic tumours — neuroendocrine tumours, cystic tumours, others — behave very differently and often have a much better outlook. Always confirm exactly which type of pancreatic tumour you have.
Signs and symptoms to take seriously
Painless jaundice
Yellowing of the eyes and skin with dark urine and pale stools, without fever. Cancer in the head of the pancreas blocks the bile duct.
Mid- or upper-back pain
A persistent, gnawing pain that radiates from the upper abdomen through to the back, often worse at night or after eating.
Unexplained weight loss
Significant weight loss combined with loss of appetite and a vague upper-abdominal discomfort.
New diabetes
Onset of diabetes in someone over 50 with no family history and no obesity — especially with weight loss — sometimes signals an underlying pancreatic tumour.
"Honesty is a form of care. I will not promise what I cannot deliver. But I will commit to giving you the best possible treatment, the best possible symptom control, and the best possible support — from the first visit, through every cycle, for as long as you need us."
How pancreatic cancer is diagnosed
- Multi-phase CT scan (pancreatic protocol) — the most important single test. Shows the tumour, its relationship to nearby blood vessels and any spread.
- MRI / MRCP — for further detail of the pancreatic and bile ducts.
- Endoscopic ultrasound (EUS) with biopsy — the most accurate way to take a tissue sample, often combined with ERCP if a stent is needed to relieve jaundice.
- CA 19-9 blood test — a tumour marker useful for monitoring response (not for diagnosis).
- Genetic testing (BRCA1/2, PALB2 and others) — affects treatment choices and family screening; should be considered in every patient.
- Staging laparoscopy — sometimes used to rule out tiny peritoneal disease before major surgery.
The crucial first question: is it resectable?
Resectable
Tumour confined to the pancreas with clear planes around the major vessels. Surgery offers the chance of long-term survival.
Borderline resectable
Tumour touches but doesn't fully encase nearby vessels. Treated with chemotherapy first, then re-assessed for surgery.
Locally advanced
Tumour wrapped around major vessels and not removable. Treated with chemotherapy, sometimes followed by radiation.
Metastatic
Spread to liver, lungs or peritoneum. Treated with chemotherapy aimed at extending life and controlling symptoms.
How we treat pancreatic cancer
Surgery
For tumours in the head of the pancreas, a Whipple procedure (pancreaticoduodenectomy) — one of the most complex operations in general surgery. For tumours in the body or tail, a distal pancreatectomy. Surgery is the only path to long-term survival, but only 15–20% of patients are candidates at diagnosis.
Adjuvant chemotherapy (after surgery)
Modified FOLFIRINOX for six months is the standard for fit patients, and substantially improves cure rates. Gemcitabine plus capecitabine, or gemcitabine alone, are alternatives for those who cannot tolerate FOLFIRINOX. Read more about chemotherapy →
Neoadjuvant chemotherapy (before surgery)
Increasingly used for borderline-resectable disease and being studied for resectable tumours. Allows tumour shrinkage and selects out patients whose disease behaves aggressively before committing them to a major operation.
Chemotherapy for advanced disease
FOLFIRINOX (a four-drug combination) and gemcitabine plus nab-paclitaxel are the two main regimens. The choice depends on fitness, organ function and side-effect tolerance. Both can produce meaningful tumour shrinkage and symptom improvement.
Targeted therapy
- BRCA1/2 mutations — olaparib (a PARP inhibitor) for maintenance after platinum-based chemotherapy.
- KRAS G12C and other rare mutations — targeted drugs are emerging.
- NTRK or NRG1 fusions — uncommon but treatable with specific targeted agents.
Radiation therapy
Used selectively — for borderline-resectable tumours after chemotherapy, for locally advanced disease, or for symptom relief (pain, bleeding).
Palliative and supportive care — alongside, not after
From the first visit, attention to pain, nutrition, biliary drainage, blood sugar and emotional support is part of the treatment plan — not a separate path. Studies have shown that early specialist palliative care alongside chemotherapy improves both quality and length of life in pancreatic cancer. This is not "giving up" — it is the gold standard.
What the outlook honestly looks like
For resectable pancreatic cancer treated with surgery plus modern adjuvant chemotherapy, five-year survival is now around 30–40% — a meaningful improvement on the past. For locally advanced disease, median survival is 12–18 months with current treatment. For metastatic disease, median survival is around a year, with a significant minority doing better — sometimes much better — on FOLFIRINOX or maintenance PARP inhibitors. These numbers are averages; individual outcomes vary, and we will be honest about what is realistic for you.
Screening and prevention
- No general population screening for pancreatic cancer is currently effective.
- Surveillance for high-risk individuals — those with strong family history, hereditary pancreatitis, BRCA2 or Peutz-Jeghers syndrome — using annual MRI or EUS.
- Stop smoking; manage diabetes and weight — modifiable risk factors that, while not protective in any one person, reduce population risk.
Life during treatment
Energy, appetite and weight are central. Pancreatic enzyme replacement (taken with every meal) often makes a striking difference in absorption and strength. Nutritional support, attention to bowel function, and managing diabetes (which often appears or worsens) all matter. Family support, frank conversations, and planning for what matters most — these are part of care, not separate from it.
A diagnosis of pancreatic cancer is heavy. You don't have to carry it alone.
Bring the scans, the biopsy report and your recent blood tests. We will go through what is and isn't possible, and put together a plan that balances active treatment with strong symptom care.
Medically reviewed by
Dr. Rehan Abdullah
Dr. Rehan Abdullah is a dual-trained clinical and radiation oncologist with over a decade of experience treating both solid tumours and hematologic malignancies. He serves as Consultant Oncologist at INMOL Hospital and sees patients at Farooq Hospital and Healthnox Medical Center, Lahore. Read full profile →
This page is patient education, not a substitute for an in-person consultation. Cancer care must be individualised. Read our medical disclaimer →