Advanced pancreatic cancer

Advanced pancreatic cancer means the cancer has spread beyond the pancreas to other parts of the body. This is also called stage 4 or metastatic cancer.

Some people are told they have advanced pancreatic cancer when they are first diagnosed. Others might be diagnosed with advanced pancreatic cancer if the cancer comes back or spreads after initial treatment.

While it can be difficult to hear that you have advanced pancreatic cancer, there are still treatment options that can help control the cancer, relieve symptoms, and help you live as well as possible.

This section provides information about these treatment options, managing symptoms, and planning ahead. It also includes information for family members and carers.

Treating advanced pancreatic cancer

When pancreatic cancer has spread, it is no longer possible to cure it with surgery.

When a cure is no longer possible, the goals of treatment are to control the cancer and its symptoms, to help you feel as well as possible.

Treatment options

Treatment options for advanced pancreatic cancer include:

• Chemotherapy is often the main treatment for advanced pancreatic cancer. It can help slow the cancer's growth and reduce symptoms. Your oncologist will recommend a chemotherapy plan based on your overall health and previous treatments.
• Radiotherapy can be helpful when pancreatic cancer has spread to other parts of the body. It uses high-energy X-rays to destroy cancer cells and can help with symptom control.
• Endoscopic treatments: Although surgery is not usually possible, your doctor may recommend specific procedures to relieve symptoms caused by the pancreatic tumour, such as bypass surgery or a stent.

The role of other treatment options, including targeted therapy and immunotherapy, continues to evolve.

• Targeted therapies act on specific gene changes in cancer cells. If genetic or molecular testing shows your tumour has these changes, targeted therapy may be an option.
• Immunotherapy treatments help the body's immune system fight cancer. These are being studied for pancreatic cancer.

Choosing not to have treatment

Some people decide not to have treatment for advanced pancreatic cancer, or to have only certain treatments to help manage symptoms.

This is a personal choice, and your healthcare team will support you whatever you decide.

You may want to talk through your decision with your:

• specialist or GP
• family or close friends
• counsellor or cancer support service.

Questions for your treatment team

Here are some questions you might want to ask your healthcare team when you are deciding about treatment for advanced pancreatic cancer.

• What can you do to reduce my symptoms?
• What extra support can I get if my family and friends care for me at home?
• Can you help me to talk to my family about what is happening?
• What support is available for my family or carer?
• Can I be referred to a community support service?

Supportive (palliative) care

When a cure for pancreatic cancer is no longer possible, the focus of your treatment will shift to controlling your symptoms and keeping you living as well as possible. This is also known as supportive or palliative care.

When you hear the term ‘palliative’, you might think about ‘end of life’. But palliative care is focused on comfort, quality of life and your whole wellbeing.

It is important to understand that palliative care is appropriate at any time during the cancer journey. People who access palliative care early tend to have an improved quality of life and reduced distress due to symptoms.

Recent studies have shown that people who have early palliative care may live longer, with fewer symptoms and with a better quality of life than patients who did not have palliative care.

Who provides supportive (palliative) care?

You may receive palliative care from a wide range of people including your:

• GP
• nurses
• oncologists
• palliative care specialists
• other medical specialists
• hospice organisations.

It can be provided alongside other treatments, or it can become the focus of care.

Palliative care guides families and carers through decision-making to allow them to work toward their healthcare goals. These goals may include the hope to prolong life and to encourage peace and dignity throughout the illness and at the end of life.

What services are offered under palliative care?

Palliative care identifies and treats symptoms which may be physical, emotional, spiritual, or social and can be delivered anywhere, including at home, in a hospital or nursing home, through outpatient care or in any other setting. Because palliative care is based on individual needs, the services offered will differ, but may include:

• relief of pain and other symptoms, e.g. vomiting, shortness of breath
• resources such as equipment needed to aid care at home
• assistance for families to come together to talk about sensitive issues
• links to other services such as home help and financial support
• support for people to meet cultural obligations
• support for emotional, social and spiritual concerns
• counselling and grief support
• referrals to respite care services.

As much as palliative care is person-centred, it is also a family-centred model of care, meaning that family and carers can receive practical and emotional support.

Planning for the future

Your GP or healthcare team may talk with you, your family, and carers about your wishes for your future medical and healthcare treatment. These conversations are a chance for you to think about what’s important to you and to share your preferences, in case there’s ever a time when you can’t make or communicate decisions yourself.

Advance care planning is voluntary, and it's up to you whether you choose to do this or not.

Advance Care Directive

An Advance Care Directive is a legal document that records your wishes about the type of treatment and care you would or wouldn’t want if you became too unwell to make those decisions yourself. It helps your family and healthcare team understand and respect your choices.

You can also choose someone you trust to make medical decisions on your behalf if you’re unable to. This person is called a substitute decision maker.

With help from your family, carer, or healthcare team, you may wish to think about appointing this person and completing an Advance Care Directive to make sure your wishes are clearly known and followed.