In short: pancreatic cancer is one of the most difficult tumours, but it can be treated and in some cases cured. The chance of cure comes from surgery: it is possible in about 15–20 % of patients, and after surgery and chemotherapy five-year survival reaches 20–40 %. With metastases, modern chemotherapy prolongs life and relieves symptoms.
Why pancreatic cancer is hard to treat
The pancreas lies deep in the abdomen, and the tumour causes no symptoms for a long time. In most patients it is therefore found when it has already grown into large blood vessels or spread. The tumour is also relatively resistant to chemotherapy and radiotherapy. Five-year survival across all stages in Germany is about 10 %, but the outlook is much better for patients who can have surgery.
Warning signs
- painless jaundice (yellow skin and eyes, dark urine, pale stools);
- unexplained weight loss and loss of appetite;
- upper abdominal pain radiating to the back;
- newly diagnosed diabetes after the age of 50;
- greasy stools that are hard to flush, bloating.
Treatment by stage
| Situation | Main treatment | Goal |
| Resectable tumour | surgery (e.g. Whipple procedure) + mFOLFIRINOX chemotherapy for about 6 months | cure |
| Borderline resectable | chemotherapy first (sometimes with radiotherapy), then surgery | cure |
| Locally advanced (vessels involved) | chemotherapy; with a good response, re-assessment for surgery | disease control, sometimes cure |
| Metastatic | chemotherapy (FOLFIRINOX, NALIRIFOX or gemcitabine with nab-paclitaxel); with a BRCA mutation, olaparib maintenance | longer life, symptom control |
Surgery — the main chance of cure
For tumours of the head of the pancreas a pancreaticoduodenectomy (Whipple procedure) is performed; for tumours of the body and tail, a distal resection with removal of the spleen. These are complex operations, and their results depend directly on the hospital’s experience. In Germany they are concentrated in certified pancreas centres that perform dozens to hundreds a year, which lowers the risk of complications and post-operative mortality.
Chemotherapy after surgery is essential: it destroys invisible tumour cells and markedly increases the chance of cure.
What else matters
- Molecular testing of the tumour — some patients have mutations (BRCA, MSI-high, NTRK and others) for which special drugs exist.
- Supportive care — pancreatic enzymes, blood sugar control, pain relief, a bile duct stent for jaundice, nutrition.
- Clinical trials — German university hospitals take part in trials of new drugs, which international patients can also access.
More about the methods: pancreatic cancer treatment in Germany. We arrange a consultation in a specialised centre and help you quickly obtain a second opinion on your scans and histology.
