Pancreatic cancer

• Pain in the upper abdomen that pushes through to the back.
• Yellowing of the skin or eyes (jaundice) through blockage of the bile duct.
• Unexplained weight loss or loss of appetite.
• Fatigue.
• Digestive problems or new-onset diabetes.

• CT, MRI and PET scans to assess the pancreas and surrounding organs.
• Endoscopic ultrasound biopsy to confirm the diagnosis.
• Blood tests, including CA19-9, a tumour marker.
• Molecular profiling to identify targeted treatment options.

We arrange investigations rapidly and review results without delay.

Initial decision-making usually focuses on whether surgery is possible now, or might be possible at some point in the future.

• Operable (resectable): the tumour is confined to the pancreas and can be removed safely with surgery. Someone with other significant health issues such as cardiovascular disease might be described as ‘medically inoperable’, meaning the tumour is technically resectable but the operation would be too much for their body to take.
• Borderline resectable: the tumour is close to important blood vessels. Chemotherapy, with or without radiotherapy, are often given first to shrink it, increasing the chance of a successful operation.
• Locally advanced: the tumour involves major vessels or surrounding structures, making surgery difficult or impossible, but hasn’t spread to other organs. Treatment focuses on chemotherapy and advanced radiotherapy (such as MRI-guided sterotactic radiotherapy) to control growth and manage symptoms. Sometimes, locally advanced cancer becomes operable after chemotherapy and radiotherapy.
• Metastatic: the cancer has spread to other organs, most commonly the liver, lungs and peritoneum. Chemotherapy is the main treatment, with radiotherapy used for symptom control. High-dose targeted radiation can also be used in patients with more limited spread.

The exact treatment plan depends on a variety of factors, including the type and stage of cancer, your medical history and fitness for treatment, and your treatment goals.

This remains the only treatment that gives a chance of long-term cure. The type of operation depends on where the tumour is located. If it’s in the head of the pancreas, the most common procedure is a Whipple operation (also called pancreaticoduodenectomy), which removes part of the pancreas along with part of the small intestine, bile duct, and sometimes part of the stomach. Tumours in the body or tail of the pancreas are usually treated with a distal pancreatectomy, often combined with removal of the spleen. These are major operations that require a high level of surgical skill, expert post-operative care, and clear communication about the long-term impact on quality-of-life. Outcomes are significantly better when surgery is performed in a specialist centre as part of a multidisciplinary team, where surgeons and oncologists work closely together. This is exactly what we offer.

Chemotherapy can be given before surgery (neoadjuvant), after surgery (adjuvant), or as the main treatment for advanced disease. Common regimens include mFOLFIRINOX and gemcitabine / nab-paclitaxel. Chemotherapy helps shrink tumours, eliminate microscopic cancer cells, and improve life expectancy.

Radiotherapy plays an increasingly important role in pancreatic cancer:

• Borderline resectable disease: Chemoradiation can shrink the tumour, improving the chance of successful surgery.
• Locally advanced disease: Stereotactic ablative radiotherapy (SABR) delivers high-dose, highly targeted treatment. This can stabilise tumour growth, relieve symptoms, and in some cases make surgery possible.
• Oligometastatic disease: SABR can target a small number of metastases in the liver or lungs, used alongside chemotherapy.
• Palliative radiotherapy: Precisely delivered doses can relieve pain, bleeding, or obstruction, improving quality of life.

The most effective radiotherapy for pancreatic cancer

I am an internationally leading expert in using MRI-guided SABR for pancreatic cancer. This innovative treatment combines highly focused beams of radiation with real-time MRI imaging, so we can see the tumour and surrounding organs as we treat. I have pioneered this technique in the UK at GenesisCare’s centres in Oxford, London and Guildford, and continue to lead research and development. It can be used to treat both the pancreatic tumour and some secondary tumours, so a key question for everyone who has pancreatic cancer is: can this approach help me?

Researchers are actively exploring the use of vaccines as a treatment for pancreatic cancer. They are designed to stimulate the body’s immune response against the tumour by ‘teaching’ the immune system to be recognise and attack an abnormal cancer cell. The focus is mainly on mutations in the RAS gene, which are present in most pancreatic cancers. The vaccine aims to trigger T-cells and other immune cells to hunt down and destroy RAS-mutated cancer cells. For example, the ELI-002 vaccine has been able to generate strong immune responses. It may reduce the risk of pancreatic cancer recurrence after surgery and chemotherapy. Although it is not yet standard treatment, it is one of the most exciting areas of research in pancreatic cancer today — offering hope that vaccines could one day become part of routine care.

Immunotherapy also uses the body’s own immune system to fight cancer. It is not yet effective for most people because the tumour’s environment creates strong barriers that stop immune cells from attacking the cancer cells. However, there are important exceptions. In a small group of patients whose tumours have changes in DNA repair — called microsatellite instability (MSI-high) or mismatch repair (MMR) deficiency — immunotherapy drugs known as checkpoint inhibitors can unleash T-cells to attack the cancer, sometimes with long-lasting responses. Clinical trials are also testing combinations of immunotherapy with chemotherapy, radiotherapy, and vaccines to make the immune response more effective in pancreatic cancer. While not yet routine for all patients, immunotherapy represents a growing and hopeful area of research.

For people living with pancreatic cancer, how the body is supported during treatment can make a real difference to outcomes and quality of life. Integrating diet, exercise, and metabolic health into care isn’t an optional extra — it helps the treatment work better and reduces complications. A balanced diet provides the protein, vitamins, and calories needed to tolerate chemotherapy and repair tissues, while also helping to prevent weight loss and frailty. Regular physical activity, even something as simple as walking, improves strength, mood, and immunity, and reduces the risk of blood clots and infections. Paying attention to metabolic health — keeping blood sugar, weight, and cardiovascular fitness in check — lowers inflammation and improves how the body handles both cancer and its treatment. Put together, these lifestyle measures give you the best possible chance to live longer and feel stronger.

The team I work with will help you with:

• Nutrition: comprehensive dietary advice, iron and vitamin support, and enzyme replacement if needed.
• Symptom control: management of anaemia, bowel function, nausea, pain relief.
• Psychological support: this is available from a specialist nurse or psychologist for patients and families coping with anger, fear and uncertainty.
• Lifestyle: evidence-based guidance on exercise, sleep, and supplements to support wellbeing.