How Do Pancreatic Cancer Surgeons Assess Treatment Options?

After reviewing the available test results, the surgeon may classify the cancer as:

This classification helps the care team determine whether surgery may be considered first, whether treatment should be given beforehand or whether a non-surgical approach is more appropriate.

Since early symptoms of pancreatic cancer may be subtle or difficult to recognise, the extent of the cancer may not be clear from symptoms alone. Imaging helps the surgeon assess where the tumour is located, how far it extends and whether there are signs that it has spread. This information helps determine whether surgery may be appropriate and which operation may be considered.

Scans may be reviewed for:

CT scans are commonly used, although MRI, endoscopic ultrasound or other tests may also be required. If the cancer has spread to distant organs, surgery to remove the pancreatic tumour is generally not recommended as a curative treatment.

The pancreas lies beside major arteries and veins that supply the liver and intestines. Imaging is used to assess whether the tumour touches, surrounds or has grown into these vessels.

Limited involvement of certain veins may still permit surgery. In some cases, the affected portion of a vein can be removed and reconstructed to restore blood flow. More extensive involvement of major arteries can affect whether surgical removal is considered feasible.

The assessment therefore considers the vessel involved, the extent of tumour contact and whether vascular reconstruction may be feasible.

Even if the tumour appears resectable, the surgeon must decide whether the patient can safely undergo and recover from a major operation.

A tumour that appears resectable does not always mean surgery will be the first treatment. The care team considers the stage of the cancer, tumour characteristics and the patient's overall condition when deciding whether surgery or another treatment should come first.

Surgery may be considered as the first treatment when:

Chemotherapy may be recommended after recovery to address cancer cells that may remain elsewhere in the body but are too small to appear on scans.

Treatment given before an operation is called neoadjuvant treatment. It may include chemotherapy, with radiation therapy in selected cases.

This approach may be recommended for borderline-resectable tumours or cancers with other concerning features. Depending on the individual case, treatment before surgery may help to:

After treatment, the surgeon reviews updated scans and test results to reassess whether surgery may be appropriate.

The tumour marker CA 19-9 may also contribute to this assessment, but it is interpreted alongside imaging and other clinical findings. Its level can also be affected by factors such as bile duct obstruction.

The type of operation considered generally depends on the location of the tumour:

Depending on the operation, tumour characteristics and surgical expertise available, selected procedures may be performed using an open, laparoscopic or robotic approach.

Determining the appropriate treatment for pancreatic cancer requires careful review of the tumour, imaging findings and the patient's suitability for surgery. For patients considering surgery, an assessment can help clarify whether an operation is feasible and when it should form part of the treatment plan.

Tay Khoon Hean Surgery provides assessment and surgical care for pancreatic and hepatobiliary conditions, including pancreatic cancer. Dr Tay Khoon Hean has a particular focus on hepatopancreatobiliary surgery and undertook further training in hepatobiliary surgery at Pontchaillou Hospital, Université de Rennes in France.

If you have been diagnosed with pancreatic cancer or are seeking a further assessment of your treatment options, schedule an appointment with Dr Tay to discuss the options that may be appropriate for your condition.