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Pancreatic Cancer

Pancreatic cancer can be difficult to diagnose because the pancreas lies deep in the body, behind the stomach, where the cancer can grow undetected. Pancreatic cancer also typically causes few symptoms, so many people with pancreatic cancer are diagnosed after it has spread to other organs.

If your doctors think you have pancreatic cancer, a large cancer center like Duke provides you with prompt access to the latest diagnostic and treatment advances. Offering you the best-possible care is our number one priority.

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Surgery for Pancreatic Cancer

The treatment your doctors recommend will depend on the stage of your cancer. Some people have surgery soon after diagnosis. Others may require treatment first (neoadjuvant treatment) to reduce the size of the tumor.

Whipple Surgery

Whipple surgery (pancreaticoduodenectomy) is the most common operation to remove pancreatic cancer. It removes the head of the pancreas, the first part of the small intestine (known as the duodenum), and part of your bile duct. Some people may be candidates to have the operation performed through small incisions rather than through a single, larger incision.

Distal Pancreatectomy

If the pancreatic tumor has not spread to distant sites, the tumor, the left side of the pancreas, and sometimes the spleen are removed. This surgery is typically performed using small incisions.

Biliary Bypass

If a tumor blocks the bile duct, it can cause pain and bile buildup in the liver (a condition called jaundice). During a biliary bypass, your surgeon attaches your gallbladder or bile duct to your small intestine to minimize these problems.

Biliary Drainage for Jaundice

There are several options to drain a blocked bile duct. New techniques allow doctors to drain the gallbladder using an endoscope, which doesn't require skin incisions.

Gastrojejunostomy

When cancer blocks the outlet of your stomach, your surgeon can attach your stomach to your small intestine. This allows you to eat with few limitations.

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Endoscopic Treatments

Biliary Stent Placement
A thin, flexible tube called an endoscope is inserted in the mouth and used to guide the insertion of plastic or metal mesh tubes to open a blocked bile duct.

Duodenal Stent Placement
When cancer blocks the outlet of the stomach, one option is to place a stent across the obstruction. This is done via an endoscope. Doctors place a soft tube made of a metal mesh to push the tumor out and to open up the blockage.

Endoscopic Ultrasound-Guided Gastrojejunostomy
This new procedure is performed when cancer blocks the outlet of the stomach. It creates a connection between the stomach and a healthy portion of the small intestine, bypassing the obstruction. This is done through an endoscope, without any skin incisions.

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Chemotherapy and Radiation Therapy

Chemotherapy
Medicine can be given by mouth or IV to kill or slow the growth of the tumor. Doctors often recommend chemotherapy before surgery to help reduce the size of the tumor.

Radiation Therapy
External beams deliver radiation directly to your pancreatic tumor to slow or stop cancer growth. Radiation therapy may be combined with chemotherapy before or after surgery.

Interventional Radiology Treatments
A blocked bile duct may be treated with a catheter that goes through the liver. This treatment is usually intended to be a short-term solution and is performed when a biliary obstruction cannot be treated with an endoscope.

Tests

Duke’s pancreatic cancer specialists are leaders in the use of imaging technologies, including endoscopic ultrasound (EUS), to find pancreatic cancer at the earliest, most treatable stage.

Endoscopic Ultrasound

A tube with an ultrasound device at its tip is inserted through the mouth to create high-quality images of the pancreas and surrounding tissue. Our gastroenterologists may also use this technology to remove and sometimes biopsy tissue and suspicious lesions, which are tested to determine if cancer is present.

CT and MRI Scans

CT and MRI images of your pancreas and the surrounding area identify how large the tumor is, if it involves additional organs or blood vessels, and whether or not it has spread to other organs.

Genetic Screening Tests

These tests may be recommended if you have a family history of pancreatic cancer.

Molecular Testing

A tissue sample obtained during diagnosis may be sent for analysis. In some cases, this test may identify a mutation in the tumor that may respond well to a particular treatment.

Best Cancer Hospital in North Carolina

Where you receive your cancer care is important. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our cancer program is nationally ranked, and the highest-ranked program in North Carolina, according to U.S. News & World Report for 2025–2026.

Why Choose Duke

The Duke Cancer Institute

The Duke Cancer Institute brings together the extensive resources of Duke University, Duke Health, and the Duke Comprehensive Cancer Center. We are committed to making innovative discoveries, developing new ways to prevent, diagnose, and treat cancer, and delivering those therapies in a patient- and family-centric way.

Your Pancreatic Cancer Team

Our medical oncologists, radiation oncologists, surgical oncologists, and support team work together as a team and meet at least weekly to discuss challenging cases. Your personalized care is our goal.

Nutrition as Part of Your Treatment

Our dedicated nutritionist evaluates all new patients and offers counseling on diet and supplements to enhance your recovery. If you require surgery, our nutritionist will help you progress to normal eating and digestion as quickly as possible, a major hurdle for many people with pancreatic cancer.

High-Volume Whipple Center

This complex procedure requires high-level surgical skill and a knowledgeable staff, both of which you’ll find at Duke. Studies show that people who undergo a Whipple procedure in a major cancer center like ours experience fewer surgical complications, shorter hospital stays, and faster recovery.

Laparoscopic Whipple Experience

More than 100 laparoscopic Whipple procedures have been performed at Duke since we started doing this advanced, minimally invasive surgical procedure in 2010. Our experience has resulted in shorter operating times, less blood loss, and shorter hospital stays.

Leaders in Robotic Surgery

Duke surgeons perform thousands of robotic surgeries each year, including surgeries for pancreatic cancer. Robotic surgery leads to fewer complications, shorter hospital stays, and faster recovery times—meaning that you move on to the next phase of treatment or return to your activities more quickly. Our surgeons also advise industry engineers as they develop robotic surgical platforms that translate to better outcomes.

Nationally Recognized Experts

Our specialists are funded by the National Institutes of Health to study new ways to care for people with pancreatic cancer and precancerous lesions of the pancreas. Collectively, our findings have been published in more than 200 respected medical journals, including the New England Journal of Medicine. The Duke Cancer Institute is part of the National Comprehensive Cancer Network (NCCN), an alliance of the nation’s leading cancer centers dedicated to improving patient care.

Access to Clinical Trials

As part of a National Cancer Institute-designated Comprehensive Cancer Center, our pancreatic cancer team is recognized for exploring new therapies through ongoing research and clinical trials. As a Duke patient, you may be eligible to participate in clinical trials that are testing new therapies before they become widely available.

Support for You and Your Family

Our comprehensive support services range from helping patients minimize the side effects of treatment to coping with the emotional and psychological effects of diagnosis and treatment. View all of our cancer support groups in our event calendar.

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Cancer Support Services

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This page was medically reviewed on 10/16/2025 by

Jorge V. Obando, MD | Gastroenterologist